The evolution of home mechanical ventilation in poland between 2000 and 2010.

BACKGROUND: Home mechanical ventilation (HMV) is a routine method of treatment for patients with chronic ventilatory failure. Over the last 20 y, a marked development in HMV has been noted in terms of its prevalence and the changing proportion of patients with various indications. However, data on HMV come exclusively from the developed countries of Europe and North America. Nowadays, we can see the emergence of HMV in less developed countries. This study aimed to describe the development of HMV in Poland. METHODS: Data from the largest HMV centers were retrospectively evaluated with regard to cause of respiratory failure, ventilation technique, and characteristics of the HMV-implementing institution. RESULTS: The number of subjects treated with HMV increased from 8 in 2000 to 928 in 2010. Neuromuscular diseases remained the main indication. However, their relative contribution decreased from 100 to 51% in favor of pulmonary diseases (an increase from 0 to 21%) and hypoventilation syndromes (0% in 2000 and 11% in 2010). The majority of the HMV population treated between 2000 between 2008 was ventilated by tracheostomy; however, since 2007, the percentage of subjects on noninvasive ventilation significantly increased and was equal to the number of tracheostomized subjects. HMV was initiated mainly in ICUs. However, their role systematically diminished, and an increasing number of subjects were recruited in respiratory departments. CONCLUSIONS: The prescription pattern of HMV in Poland has evolved, and there is a clear shift from neuromuscular to respiratory diseases. The prevalence of ventilation via tracheostomy still remains very high in comparison with other European countries. The Polish experience could be useful for countries with emerging HMV care systems.

[Prevalence of home mechanical ventilation in Poland]. / Rozpowszechnienie wentylacji mechanicznej w warunkach domowych w Polsce.

INTRODUCTION: Home mechanical ventilation (HMV) is increasingly used in the treatment of chronic respiratory failure thanks to rapid technological development, increasing number of elderly people and extension of indications. The aim of the study was to assess: prevalence of HMV in Poland, the proportions of lung disease and neuromuscular patients using HMV and the type of interface (invasive v. non-invasive). MATERIAL AND METHODS: The questionnaire was send to all institutions providing HMV in Poland and to regional departments of National Health System (NHS). RESULTS: All NHS departments responded. They reported 846 HMV users, 31% of children. The prevalence of HMV in Poland was assessed as 2,2 patient per 100.000 population without striking differences between provinces. Among 39 HMV centers in Poland 12 (31%) answered. They reported 206 patients (24% of all HMV users). Proportion of ventilation mode consisted of 59% (122 pts) treated via a tracheostomy and 41% (84 pts) with non invasive ventilation (NIV). 168 patients (82%) had neuromuscular diseases (ND), majority of them muscular dystrophy - 57 patients ( 34% of ND) and amyotrophic lateral sclerosis - 39 patients (23% of ND). There were only 38 patients (18%) with lung and thoracic cage diseases: 17 with COPD and 10 with kyphoscoliosis. CONCLUSIONS: The prevalence of HMV treatment in Poland has developed dramatically in the last decade, but is still very low comparing to other European countries, especially due to very low number of patients with lung and chest wall diseases. The prevalence of invasive mode of ventilation is extremely high. The most important factors which inhibit development of HMV in Poland are: omission of respiratory physicians in the process of qualification, lack of national guidelines, sophisticated demands for HMV providers. The awareness of the need of HMV especially in patients with respiratory failure due to obesity hypoventilation syndrome and restrictive lung diseases should be increased among chest physicians.