Home mechanical ventilation in Chile: Ten years of experience

Reinero, Rebeca Paiva; Vera-Uribe, Roberto; Torres‐Castro, Rodrigo; Valenzuela, Raúl; Pontoni, Paola

doi:10.1183/1393003.congress-2017.pa2009

Cited by 4 publications

(5 citation statements)

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“…Since the establishment of a home ventilation program in adults by the Chilean Health Authorities in 2008 and until 2017, 1105 patients were included in the register, with a mean of 110 patients per year. In 2017, there were 17.6 million inhabitants in Chile [22], 78% of whom depended on state health insurance coverage (FONASA for its acronym in Spanish) [12]. That same year, 722 adults and 701 children were enrolled in our national HMV programs [23].…”

Section: Discussionmentioning

confidence: 99%

Results of the home mechanical ventilation national program among adults in Chile between 2008 and 2017

et al. 2021

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Background Home mechanical ventilation (HMV) is a viable and effective strategy for patients with chronic respiratory failure (CRF). The Chilean Ministry of Health started a program for adults in 2008. Methods This study examined the following data from a prospective cohort of patients with CRF admitted to the national HMV program: characteristics, mode of admission, quality of life, time in the program and survival. Results A total of 1105 patients were included. The median age was 59 years (44–58). Women accounted for 58.1% of the sample. The average body mass index (BMI) was 34.9 (26–46) kg/m2. A total of 76.2% of patients started HMV in the stable chronic mode, while 23.8% initiated HMV in the acute mode. A total of 99 patients were transferred from the children's program. There were 1047 patients on non-invasive ventilation and 58 patients on invasive ventilation. The median baseline PaCO2 level was 58.2 (52–65) mmHg. The device usage time was 7.3 h/d (5.8–8.8), and the time in HMV was 21.6 (12.2–49.5) months. The diagnoses were COPD (35%), obesity hypoventilation syndrome (OHS; 23.9%), neuromuscular disease (NMD; 16.3%), non-cystic fibrosis bronchiectasis or tuberculosis (non-CF BC or TBC; 8.3%), scoliosis (5.9%) and amyotrophic lateral sclerosis (ALS; 5.24%). The baseline score on the Severe Respiratory Insufficiency questionnaire (SRI) was 47 (± 17.9) points and significantly improved over time. The lowest 1- and 3-year survival rates were observed in the ALS group, and the lowest 9-year survival rate was observed in the non-CF BC or TB and COPD groups. The best survival rates at 9 years were OHS, scoliosis and NMD. In 2017, there were 701 patients in the children's program and 722 in the adult´s program, with a prevalence of 10.4 per 100,000 inhabitants. Conclusion The most common diagnoses were COPD and OHS. The best survival was observed in patients with OHS, scoliosis and NMD. The SRI score improved significantly in the follow-up of patients with HMV. The prevalence of HMV was 10.4 per 100,000 inhabitants. Trial registration This study was approved by and registered at the ethics committee of North Metropolitan Health Service of Santiago, Chile (N° 018/2021).

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Section: Discussionmentioning

confidence: 99%

Results of the home mechanical ventilation national program among adults in Chile between 2008 and 2017

et al. 2021

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“…In fact, in our cohort, one‐third of the pts lived more than 500 km away from the hospital; hence, it is a representative sample of children with complex diseases from all regions of our country attended in the public sector. Only, Chilean 5–7 and Brazilian authors 8,9 have published reports on other pediatric Latin American experiences on HV. Few pediatric reports have been published from other emerging countries 10–14 …”

Section: Discussionmentioning

confidence: 99%

Feasibility of a pediatric long‐term Home Ventilation Program in Argentina: 11 years' experience

Leske

Guerdile

González

et al. 2020

Pediatric Pulmonology

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Background Pediatric home ventilation (HV) has increased worldwide. A Home Ventilation Program (HVP) was started in the Pulmonary Department of the “Hospital de Pediatría Prof. Dr. J. P. Garrahan,” Argentina, in 2007. This is the largest Argentine national pediatric tertiary care referral center. Limited studies on pediatric HV from Latin American countries have been published. Objective This study describes and analyzes the cohort of children admitted to the HVP during an 11 years period. Methods Longitudinal study. Population: all patients (pts) admitted to the HVP between 2007 and 2018. We analyzed demographic and clinical variables, sleep study results, ventilation setting, and start manner collected in a prospective data base. Results A total of 244 pts were admitted. Median age at ventilation start was 9.41 (3.47‐14.08) years, 84% of pts had health insurance. The most frequent underlying diseases were neuromuscular disease (43%) and genetic syndromes (23%). Home‐hospital distance was 100‐500 km in 16% of cases and greater than 500 km in 34%. Seventy percent of pts had sleep studies before ventilation initiation. Ventilation was started in our general pediatric ward in 83.6%. Noninvasive ventilation was used in 86.1%. The actual number of pts still on follow up is 133 of 244 (54.5%), 16.8% dropped out, 16.4% were transitioned to adult care, 5.32% resolved their sleep‐disordered breathing, and 5.32% died. Conclusions The HVP admitted pts from all the country. Ventilation was started on the basis of clinical and objective sleep measures. This long‐term experience underlines the feasibility of a HVP in an emergent country.

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“…Figure 4 illustrates the evolution over time of HMV in 15 areas, where estimates of prevalence of HMV were available at different periods 5 6 13 16 17 19–22 42–49. The number of HMV users were constantly rising, with rapid progression in some countries, and slow progression in others.…”

Section: Prevalencementioning

confidence: 99%

“…Evolution of the prevalence of HMV in 15 areas. Data by decreasing prevalence of HMV (reference): Norway,5 20 42 Finland,5 20 43 Vaud (Switzerland),44 44 Sweden,13 20 22 France,5 6 Netherlands,5 21 Catalonia (Spain),6 6 45 UK,5 6 Germany,5 6 Belgium,5 19 USA,45 46 Chile,16 47 Ontario (Canada),48 Poland23 23 and Greece 5 17. HMV, home mechanical ventilation.…”

Section: Prevalencementioning

confidence: 99%

Building a home ventilation programme: population, equipment, delivery and cost

Toussaint

Wijkstra

McKim

et al. 2022

Thorax

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Home mechanical ventilation (HMV) improves quality of life and survival in patients with neuromuscular disorders (NMD). Developing countries may benefit from published evidence regarding the prevalence, cost of equipment, technical issues and organisation of HMV in NMD, facilitating the development of local turn-key HMV programmes. Unfortunately, such evidence is scattered in the existing literature. We searched Medline for publications in English and French from 2005 to 2020. This narrative review analyses 24 international programmes of HMV. The estimated prevalence (min–max) of HMV is ±7.3/100 000 population (1.2–47), all disorders combined. The prevalence of HMV is associated with the gross domestic product per capita in these 24 countries. The prevalence of NMD is about 30/100 000 population, of which ±10% would use HMV. Nocturnal (8/24 hour), discontinuous (8–16/24 hours) and continuous (>16/24 hours) ventilation is likely to concern about 60%, 20% and 20% of NMD patients using HMV. A minimal budget of about 168€/patient/year (504€/100 000 population), including the cost of equipment solely, should address the cost of HMV equipment in low-income countries. When services and maintenance are included, the budget can drastically increase up to between 3232 and 5760€/patient/year. Emerging programmes of HMV in developing countries reveal the positive impact of international cooperation. Today, at least 12 new middle, and low-income countries are developing HMV programmes. This review with updated data on prevalence, technical issues, cost of equipment and services for HMV should trigger objective dialogues between the stakeholders (patient associations, healthcare professionals and politicians); potentially leading to the production of workable strategies for the development of HMV in patients with NMD living in developing countries.

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Home mechanical ventilation in Chile: Ten years of experience

Cited by 4 publications

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Results of the home mechanical ventilation national program among adults in Chile between 2008 and 2017

Results of the home mechanical ventilation national program among adults in Chile between 2008 and 2017

Feasibility of a pediatric long‐term Home Ventilation Program in Argentina: 11 years' experience

Building a home ventilation programme: population, equipment, delivery and cost

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