Estado actual de la ventilación mecánica domiciliaria en España: resultados de una encuesta de ámbito nacional / Home mechanical ventilation in Spain today: results of a national survey

La ventilación mecánica domiciliaria constituye una modalidad de tratamiento de la insuficiencia respiratoria crónica para aquellos pacientes en situación clínica estable que precisan un soporte ventilatorio parcial o total. Con el objetivo de conocer el estado de la ventilación mecánica domiciliaria en España, se envió una encuesta a los servicios de neumología de todos los hospitales de la red sanitaria pública, cerrándose la recogida de datos en abril de 1999. Se han obtenido respuestas de 43 hospitales que pertenecen a 14 comunidades autónomas. La ventilación mecánica domiciliaria se inició en 1987 y el número total de pacientes actualmente en ventilación se eleva a 1.821. Los diagnósticos corresponden a enfermedad restrictiva toracógena en el 44 por ciento, enfermedades neuromusculares en el 25 por ciento, síndrome de hipoventilación-obesidad en el 15 por ciento, EPOC en el 9 por ciento y otras enfermedades en el 7 por ciento. De los 1.821 pacientes, 856 utilizan respiradores volumétricos y 965 diferentes modelos de soporte de presión. En cuanto a la forma de conexión al respirador, un 90 por ciento lo hacen mediante máscara nasal, un 6 por ciento a través de traqueotomía, un 2 por ciento utilizan máscaras faciales y menos de un 1 por ciento a través de piezas bucales. En conclusión, la ventilación mecánica domiciliaria se encuentra ampliamente introducida en nuestro país, siendo la forma más habitual la ventilación no invasiva mediante máscara nasal. Además de las indicaciones clásicas, enfermedades de la caja torácica y neuromusculares, otros procesos como el síndrome de hipoventilación-obesidad y la EPOC son causa de indicación de ventilación mecánica domiciliaria. (AU)

[Current status of home mechanical ventilation in Spain: results of a national survey]. / Estado actual de la ventilación mecánica domiciliaria en España: resultados de una encuesta de ámbito nacional.

Home mechanical ventilation (HMV) is used to treat chronic respiratory insufficiency in patients who are clinically stable and require partial or total support ventilation. To determine how HMV is being used in Spain, we mailed a questionnaire to the respiratory medicine departments of all hospitals in the public health system. The closing date for receipt of responses was April 1999. Forty-three hospitals in 14 autonomous communities of Spain responded. At the time of the survey, 1,821 patients were using HMV, which had been introduced in 1987. Volumetric respirations were being used by 856 patients and various models for delivering support pressure were being used by 965. Nasal masks connected to respirators were being used by 90%, while 6% were ventilated through a tracheotomy, 2% through face masks and fewer than 1% trough mouth devices. In conclusion, HMV has been widely applied in Spain and non invasive ventilation is usually provided through a face mask. HMV is prescribed for the usual reasons (chest and neuromuscular diseases) and for such conditions as hypoventilation due to obesity and chronic obstructive pulmonary disease.

[Prediction of exercise capacity after lung resection in patients with chronic airflow limitation]. / Predicción de capacidad de esfuerzo tras resección pulmonar en pacientes con limitación crónica al flujo aéreo.

To assess the usefulness of a method for predicting postoperative peak oxygen uptake based on lost lung function after lung resection (VO2peak-PPO) and to establish the underlying physiological foundation for the relation between VO2peak-PPO and the measured postoperative value VO2peak-PO), we studied 29 patients (26 men) [age 60 (SD9)] with chronic airflow limitation [FEV1 = 66 (SD13)%] undergoing lobectomy or major pulmonary resection to treat lung cancer. The patients were assigned to groups according to whether postoperative exercise tolerance was considered to be limited by exhaustion of ventilatory reserve (LV) or not (NLV). Data to estimate postoperative pulmonary function was obtained one week before surgery: patients performed pulmonary function tests and exercise tests on a treadmill; dyspnea was also evaluated and perfusion scintigraphs were obtained. Pulmonary function, exercise tolerance and dyspnea were evaluated again approximately five months after surgery. The mean difference between VO2peak-PPO and VO2peak-PO was -0.034 (CI 0.293 to -0.348) l.min-1 and the between-group correlation coefficient was 0.76. The correlation between VO2peak-PPO and VO2peak-PO was 0.86 (SE 0.1) [0.89 (SE 0.13) for LV (n = 14) patients and 0.85 (SE 0.16) for NLV (n = 15) patients]. The correlations after adjusting for preoperative VO2peak-PPO were 0.73 (SE 0.2) and 0.35 (SE 0.27) for LV and NLV patients, respectively. We conclude that VO2peak-PPO provides a valid but only moderately precise estimate of VO2peak-PO. Only in LV patients is there a true relation between a decrease in VO2peak and loss of lung function.