Home mechanical ventilation: a narrative review and a proposal of practical approach
Ventilação mecânica domiciliar: uma revisão narrativa e uma proposta de abordagem prática
Simone Chaves Fagondes, Carmem Lúcia Oliveira da Silva, Anneliese Hoffmann, Rita de Cássia Guedes de Azevedo Barbosa, Daiane Falkembach, Ângela Beatriz John
Abstract
Growing evidence of the benefits of home ventilatory support in patients with chronic respiratory failure along with technological advances in ventilators have enabled their use in overly complex situations, shaping a new scenario for physicians. This has further given rise to new challenges related to their incorporation into current medical practice. However, this evolution needs to be coupled with knowledge and skills of physicians who are willing to prescribe Home Mechanical Ventilation (HMV), in order to prevent them from making inappropriate choices or adjustments that may ultimately have ethical and legal implications. This article aims to provide guidance and information to support the indication for HMV and the ventilation modalities to be implemented, review basic ventilation concepts, including the ventilator modes most commonly used in patients outside the hospital setting, list the brands and models available in the Brazilian market, provide the means for obtaining equipment for HMV, and finally, describe the requirements for selection of equipment, taking into account the individual characteristics of the patient to ensure safe perioperative care and earlier dehospitalization.
Keywords
Resumo
Evidências crescentes sobre os benefícios do suporte ventilatório domiciliar em pacientes com insuficiência respiratória crônica, juntamente com os avanços tecnológicos dos ventiladores, possibilitaram seu uso em situações altamente complexas, moldando um novo cenário para os médicos. Isso também gerou novos desafios relacionados à incorporação desse recurso à prática médica atual. No entanto, essa evolução precisa ser acompanhada do conhecimento e das habilidades dos profissionais que se propõem a prescrever a Ventilação Mecânica Domiciliar (HMV), a fim de evitar escolhas ou ajustes inadequados que possam, em última instância, ter implicações éticas e legais. Este artigo tem como objetivo fornecer orientações e informações para apoiar a indicação de HMV e as modalidades ventilatórias a serem implementadas, revisar conceitos básicos de ventilação, incluindo os modos de ventilação mais utilizados em pacientes fora do ambiente hospitalar, listar as marcas e modelos disponíveis no mercado brasileiro, indicar os meios de obtenção de equipamentos para HMV e, por fim, descrever os critérios para seleção dos aparelhos, considerando as características individuais do paciente para garantir um cuidado perioperatório seguro e uma desospitalização mais precoce.
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Submitted date:
04/05/2024
Accepted date:
12/23/2024
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