Assuntos
Doenças Neuromusculares/complicações , Transtornos Respiratórios/terapia , Diretivas Antecipadas , Assistência Ambulatorial , Doenças Cardiovasculares/complicações , Terapia Combinada , Técnicas de Diagnóstico do Sistema Respiratório , Gerenciamento Clínico , Progressão da Doença , Serviços de Assistência Domiciliar , Humanos , Doenças Neuromusculares/fisiopatologia , Cuidados Paliativos , Equipe de Assistência ao Paciente , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/prevenção & controle , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/prevenção & controle , Transtornos Respiratórios/etiologia , Transtornos Respiratórios/fisiopatologia , Respiração Artificial/ética , Respiração Artificial/instrumentação , Respiração Artificial/normas , Testes de Função Respiratória , Músculos Respiratórios/fisiopatologia , Paralisia Respiratória/etiologia , Paralisia Respiratória/fisiopatologia , Paralisia Respiratória/terapia , Terapia Respiratória/normas , Assistência Terminal/ética , Assistência Terminal/legislação & jurisprudência , Assistência Terminal/métodos , TraqueostomiaRESUMO
Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection.
Assuntos
Pneumopatias/reabilitação , Garantia da Qualidade dos Cuidados de Saúde/normas , Transtornos Respiratórios/reabilitação , Terapia Respiratória/normas , Acreditação , Doença Crônica , Dispneia/etiologia , Dispneia/reabilitação , Medicina Baseada em Evidências , Acessibilidade aos Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido , Pneumopatias/cirurgia , Doenças Neuromusculares/complicações , Doenças Neuromusculares/reabilitação , Pneumonectomia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Controle de Qualidade , Qualidade de Vida , Registros , Transtornos Respiratórios/etiologia , Terapia Respiratória/métodos , Serviço Hospitalar de Terapia Respiratória/organização & administração , Serviço Hospitalar de Terapia Respiratória/normas , EspanhaRESUMO
OBJECTIVE: During home mechanical ventilation the prescribed settings are applied without permanent supervision of health professionals. After a long-time period of unattended operation at home the ventilator may not apply the ventilation parameters prescribed. This quality control study of home mechanical ventilation assessed whether tidal volume (V(T)), frequency (f), and minute ventilation (V'(E)) actually applied by the ventilator coincide with the values set on the ventilator control panel and with those prescribed. MEASUREMENTS: Actual V(T), f, and V'(E) applied by the ventilator in 30 patients on nocturnal HMV were measured at the patients' homes. The patients were subjected to volume targeted assist ventilation through nasal mask (n=28) or tracheostomy (n=2). The values of V(T), f, and V'(E) set at the ventilator were recorded. The actual and set V(T), f, and V'(E) values were compared with those prescribed. RESULTS: Considerable differences were found between actual, set and prescribed V(T), f, and V'(E). Actual V'(E) was significantly lower than V'(E) set: mean difference was 0.82 l/min, with considerable individual differences. Differences between actual and prescribed V'(E) were caused both by a poor performance of the ventilator and by a discrepancy between the values prescribed and those set at the ventilator control panel. CONCLUSIONS: Regularly assessing the actual performance of ventilators at the patient's home is a quality control procedure useful for detecting malfunctions which could improve compliance and outcome of home mechanical ventilation.