Abstract
BackgroundHome mechanical ventilation is an established treatment for chronic respiratory failure resulting in improved survival and quality of life. Technological advancement, evolving health care reimbursement systems and newly implemented national guidelines result in increased utilization worldwide. Prevalence shows great geographical variations and data on East-Central European practice has been scarce to date. The aim of the current study was to evaluate prevalence and characteristics of home mechanical ventilation in Hungary.MethodsWe conducted a nationwide study using an online survey focusing on patients receiving ventilatory support at home. The survey focused on characterization of the site (affiliation, type), experience with home mechanical ventilation, number of patients treated, indication for home mechanical ventilation (disease type), description of home mechanical ventilation (invasive/noninvasive, ventilation hours, duration of ventilation) and description of the care provided (type of follow up visits, hospitalization need, reimbursement).ResultsOur survey uncovered a total of 384 patients amounting to a prevalence of 3.9/100,000 in Hungary. 10.4% of patients received invasive, while 89.6% received noninvasive ventilation. The most frequent diagnosis was central hypopnea syndromes (60%), while pulmonary (20%), neuromuscular (11%) and chest wall disorders (7%) were less frequent indications. Daily ventilation need was less than 8 h in 74.2%, between 8 and 16 h in 15.4% and more than 16 h in 10.4% of patients reported. When comparing sites with a limited (< 50 patients) versus substantial (> 50 patients) case number, we found the former had significantly higher ratio of neuromuscular conditions, were more likely to ventilate invasively, with more than 16 h/day ventilation need and were more likely to provide home visits and readmit patients (p < 0,001).ConclusionsOur results show a reasonable current estimate and characterization of home mechanical ventilation practice in Hungary. Although a growing practice can be assumed, current prevalence is still markedly reduced compared to international data reported, the duality of current data hinting to a possible gap in diagnosis and care for more dependent patients. This points to the importance of establishing home mechanical ventilation centers, where increased experience will enable state of the art care to more dependent patients as well, increasing overall prevalence.
Highlights
Home mechanical ventilation is an established treatment for chronic respiratory failure resulting in improved survival and quality of life
The most comprehensive survey of Home mechanical ventilation (HMV) practice to date has been the Eurovent survey, the survey mainly focused on westernand central European centers and showed a markedly reduced rate of use in the one East-Central European country reviewed (0.1 versus 6.6 overall prevalence) [9]
Telephone recontact of the sites after the initial study period showed that 91% (71) of the initially non-responder sites had no relevant information to share, while 9% (7 sites) missed the initial deadline or did not wish to participate in the survey. 47.2% (17) of sites that responded reported to actively oversee home mechanical patients, while 25% (9) provide care if needed, 13.9% (5) direct patients to other sites with more established practice. 11.1% (4) sites reported no need for HMV in any of their practice, while 11.1% (4) reported a need with inability to provide HMV
Summary
Home mechanical ventilation is an established treatment for chronic respiratory failure resulting in improved survival and quality of life. Technological advancement, evolving health care reimbursement systems and newly implemented national guidelines result in increased utilization worldwide. Home mechanical ventilation (HMV) is an established mode of treatment in patients with chronic respiratory failure, resulting in increased survival in several different patient groups [1,2,3] as well as improved quality of life and reduced hospitalization rates [4]. The most comprehensive survey of HMV practice to date has been the Eurovent survey, the survey mainly focused on westernand central European centers and showed a markedly reduced rate of use in the one East-Central European country reviewed (0.1 versus 6.6 overall prevalence) [9]. New indications have been gaining ground, with obesity hypoventilation syndrome and chronic obstructive pulmonary disease supplying an increased demand for long term mechanical ventilation [5, 7, 11]
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