RESUMEN
Based on a 15-year study, the indication of assisted ventilation at home is discussed. It depends on the seriousness of the C.R.I. (dyspnea, repeated acute failures, PaCO2 greater than or equal to 55 Torr). The only possible course is ventilation by tracheostomy. The best indication is represented by pure restrictive syndromes. On the contrary, the indication should be considered with extreme caution in obstructive syndromes.
Asunto(s)
Respiración con Presión Positiva Intermitente , Respiración con Presión Positiva , Insuficiencia Respiratoria/terapia , Traqueotomía , Resistencia de las Vías Respiratorias , Humanos , Cooperación del PacienteRESUMEN
The following results have been obtained from a study of 118 tracheostomized patients ventilated at home: --Survival on the whole is generally prolonged. --The prognosis of tracheostomized subjects with restrictive syndrome is totally modified in length and quality when the patients are ventilated. --In the case of obstructive syndrome, the length and quality of survival are probably increased. However, it seems that assisted ventilation at home leads only to the disappearance of asphyxiating paroxysms and right cardiac failure. It does not seem to prevent the unrelenting evolution of the disease.
Asunto(s)
Respiración con Presión Positiva Intermitente/normas , Respiración con Presión Positiva/normas , Insuficiencia Respiratoria/terapia , Adulto , Anciano , Asfixia/prevención & control , Insuficiencia Cardíaca/prevención & control , Atención Domiciliaria de Salud , Humanos , Persona de Mediana Edad , PronósticoRESUMEN
With 200 patients during the last 15 years the daily use of apparatus and supervision modalities, as described in the present work, has shown that H.A.V. is entirely possible in tracheostomized C.R.I. patients. Rather strict conditions must be respected (as with hemodialysis at home) if H.A.V. is to be medically and materially successful. The expenses involved can vary greatly according to the medical and material management (choice of study material, economic maintenance, minimal oxygen consumption through proper adjustment...). Finally, the use of assisted ventilation requires a choice amont several adjustment possibilities which are still subject to evolution.
Asunto(s)
Respiración con Presión Positiva Intermitente/métodos , Respiración con Presión Positiva/métodos , Insuficiencia Respiratoria/terapia , Atención Domiciliaria de Salud , Humanos , Respiración con Presión Positiva Intermitente/normas , TraqueotomíaRESUMEN
Prerequisites for success in domiciliary assisted respiration for chronic respiratory insufficiency are the understanding of the patient and his active participation in the treatment as well as adjustment and attitude of his environment. The authors report their experience in 89 patients. Spirographic data were obtained in 72 patients which permitted subdivision into a group with restrictive disturbances and one with obstructive changes. The differences in prognosis in these two groups of patients were surprising. The survival rates in the obstructive diseases after 3, 5 and 10 years were 54%, 38% and 33% respectively; the corresponding values for the restrictive diseases were 84%, 84% and 69%. These differences are statistically significant. The restrictive changes are therefore considerably more favorable to assess, also with respect to a better quality of life.