Chiner Eusebi, Llombart Mónica, Martínez-García Miguel Angel, Fernández-Fabrellas Estrella, Navarro Rafael, Cervera Angela
Hospital Universitario San Juan de Alicante, Alicante, España.
Arch Bronconeumol. 2009 Mar;45(3):118-22. doi: 10.1016/j.arbres.2008.04.006. Epub 2009 Feb 25.
To obtain representative data on the frequency of use and availability of resources for noninvasive mechanical ventilation (NIV) in hospitals (acute respiratory failure) and at home (chronic respiratory failure).
We sent a purpose-designed questionnaire to all the hospitals in the Autonomous Community of Valencia, Spain and followed up with a telephone interview.
Seventy percent of the hospitals responded to the survey. NIV was used to treat patients with acute respiratory episodes in 100% of the intensive care units and in 88% of the respiratory medicine departments. The most common diseases were chronic obstructive pulmonary disease (COPD) (mean [SD] 60% [20%]), obesity hypoventilation syndrome (22% [12%]), neuromuscular diseases (6.5% [8%]), and kyphoscoliosis (6.5% [7%]). Other diseases accounted for 4% [11%] of cases. Emergency departments used NIV in 69% of patients, internal medicine departments in 37%, hospital-based home care units in 19%, and other departments in 12%. None of the hospitals that responded to the survey had an intermediate care unit and considerable differences were found in terms of NIV systems used. Home NIV was provided by 88% of hospitals. Patients using home NIV had COPD (31% [18%]), obesity hypoventilation syndrome (30% [18%]), neuromuscular diseases (16% [23%]), kyphoscoliosis (12% [10%]), and other diseases (11% [17%]). Patient numbers varied greatly from one hospital to the next. Home NIV was delivered using a nasal interface in 65% (32%) of cases, an oral-nasal interface in 33% (33%), a tracheostomy tube in 2% (3%), and a mouthpiece in 1% (32%). Only 31.3% of hospitals has a specialized home NIV unit. Home monitoring was performed mainly by service providers. We calculated that home NIV was used in 29 individuals per 100 000 population. Only 50% of the respiratory medicine departments surveyed had written hospitalization protocols; the corresponding percentages for other departments were 44% for home care units, 19% for emergency departments, and 12% for internal medicine departments.
We observed differences in the type of requirement used, and considerable deficiencies in the availability of human and material resources and support systems. Although NIV is mostly used in hospitals to treat patients with acute respiratory failure, home NIV is also very common and is characterized by greater variability in terms of the number and type of patients. We also observed deficiencies in terms of written protocols for patients with acute and chronic disease.
获取关于医院（急性呼吸衰竭）和家庭（慢性呼吸衰竭）中无创机械通气（NIV）使用频率及资源可获得性的代表性数据。
我们向西班牙巴伦西亚自治区的所有医院发送了一份专门设计的问卷，并随后进行电话访谈。
70%的医院回复了调查。100%的重症监护病房和88%的呼吸内科使用NIV治疗急性呼吸发作患者。最常见的疾病是慢性阻塞性肺疾病（COPD）（均值[标准差]60%[20%]）、肥胖低通气综合征（22%[12%]）、神经肌肉疾病（6.5%[8%]）和脊柱侧弯（6.5%[7%]）。其他疾病占病例的4%[11%]。急诊科在69%的患者中使用NIV，内科在37%的患者中使用，医院家庭护理单元在19%的患者中使用，其他科室在12%的患者中使用。回复调查的医院中没有一家设有中级护理单元，且在使用的NIV系统方面存在显著差异。88%的医院提供家庭NIV。使用家庭NIV的患者患有COPD（31%[18%]）、肥胖低通气综合征（30%[18%]）、神经肌肉疾病（16%[23%]）、脊柱侧弯（12%[10%]）和其他疾病（11%[17%]）。不同医院的患者数量差异很大。65%（32%）的病例使用鼻面罩进行家庭NIV，33%（33%）使用口鼻面罩，2%（3%）使用气管造口管，1%（32%）使用口含器。只有31.3%的医院设有专门的家庭NIV单元。家庭监测主要由服务提供者进行。我们计算得出每10万人口中有29人使用家庭NIV。接受调查的呼吸内科中只有50%有书面的住院治疗方案；家庭护理单元、急诊科和内科的相应比例分别为44%、19%和12%。
我们观察到在使用需求类型方面存在差异，在人力和物力资源以及支持系统的可获得性方面存在相当大的不足。虽然NIV主要在医院用于治疗急性呼吸衰竭患者，但家庭NIV也很常见，其特点是患者数量和类型的变异性更大。我们还观察到急性和慢性疾病患者的书面方案存在不足。
