Vmd catalunya 25 05 2010
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Vmd catalunya 25 05 2010

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Sessió Clínica a l'Hospital del Mar (Barcelona)

Sessió Clínica a l'Hospital del Mar (Barcelona)

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Vmd catalunya 25 05 2010 Vmd catalunya 25 05 2010 Presentation Transcript

  • Ventilació mecànica a domicili Barcelona, 25 de maig de 2010 Origens i perspectiva actual Dr. Joan Escarrabill Pla Director de les Malalties Respiratòries (PDMAR) Institut d’Estudis de la Salut Barcelona [email_address]
  • L’epidèmia de poliomielitis Lassen. Lancet 1953;i:37-41.
  • ...dels pacients amb IRA no podien abandonar el ventilador 10% Kinnear Br J Dis Chest 1985;79:313-51 Bertoye. Lyon Médical 1965;38:389-410.
  • VMD traqueo CPAP Sullivan Lancet 1981 Robert. Rev fr Mal Resp 1983;11:923-936. Brocard L. N Engl J Med. 1990;323:1523-30 . Ventilació: de la polio a casa i a la UCI
  • VMD: els primers passos Nogueras. Med Clin (Barc) 1985;84:333-4 . Pacient Respirador Mark 7 Oxígen Aigua (humidificació) Montserrat. Respiration 1988;53:128-131
  • Estopà. Arch Bronconeumol 1988;24(supl 1);64 1987 Juny 1988 “ Poncho” Traqueotomía Escarrabill. Arch Bronconeumol 1990;26:375-6 Ventilació amb pressió negativa i ventilació invasiva
  • Ventilació no invasiva NIV Escarrabill. Med Clin (Barc) 1991;97:421-423 Nov 1988 Masa. Arch Bronconeumol 1991;27:290-4
  • Arch Bronconeumol 2000;36:545-50 Font: F. Crespo, Vitalaire (2006) ¿ 5000 ? 34 8 228 39 632 13 146 134 1160 546 230 1034 487 63 139 Any d’inici de la VMD
  • Year of starting HMV >50% after 90’s Eur Respir J. 2005;25:1025-31. HMV before 80’s
  • Eur Respir J. 2005;25:1025-31. Centres patients on HMV Service funding by the government or the NHS 329 21.526 Mean prevalence: 6.6 pts/10 6 inhab
  • HMV: Financial issues Tax-funded Social-insurance-funded
  • Diagnostics Eur Respir J. 2005;25:1025-31. Neuromuscular Chest wall Airway
  • Diagnostics: airway vs prevalence Eur Respir J. 2005;25:1025-31.
  • Patient & Caregiver Training Source: Eurovent Survey Patients Caregivers Is training crucial before discharge? 97% 84% Is there a continued training after discharge? 36% 34%
  • Characteristics of care Source: Eurovent Survey 49% without home care
  • HMV in neuromuscular disases (NMD) in Catalonia Prevalence / 100.000 hab Departament de Sanitat i Seguretat Social. Consell Assessor de Malalties Neuromusculars. 2001 Patients with NMD and HMV Health Regions
  • Oupatient vs hospital initiation of NIV Chatwin et al. Respir Med 2008;102:1528-35. Luján et al. Respir Med 2007; 101:1177-82. Domenech-Clar et al. Respir Med 2008;102:1521-7 7 days 6 days 3.8 days Training: 1,2 + 0,4 sessions Admission days in the control group Feasible in selected patients Little impact on the availability of beds n=28 n=16 n=42
  • Follow-up Escarrabill J. Breathe 2009;6:37-42. Population: 291.500.000
  • Escarrabill J. www.ers-education.org/ JIVD 2009 Eurovent 2002
  • Respir Med 2007;101:1068-1073 A = Acute E = Elective n = 43 Age = 77 + 1.9 yrs Compliance : 8.3 + 3.1 hrs/day 9% 4,8% 11% Patients < 75 yrs: 2% 6 years
  • Escarrabill J. Breathe 2009;6:37-42.
  • VMD i el PDMAR