[Invasive home mechanical ventilation, mainly focused on neuromuscular disorders]
Geiseler J, Karg O, Boerger S, Becker K, Zimolong A
Record ID 32009100069
German
Authors' objectives:
To assess medical, social, economic, and ethical aspects of invasive home mechanical ventilation for patients with chronic respiratory insufficiency due to neuromuscular diseases.
Authors' recommendations:
Analysis of the literature shows that invasive mechanical ventilation may improve symptoms of hypoventilation. An increase in life expectancy is likely, but for ethical reasons it is not confirmed by premium-quality studies. Complications (eg, pneumonia) are rare. A study regarding the pneumonia ratio reports 1.89 pneumoniae/1000 ventilator days in the first 500 days of invasive ventilation. This is a frequent reason for rehospitalization of patients, but the prognosis is favorable. Mobile home ventilators differ regrettably in their technical performance. Some studies compare the economic aspects of in-hospital ventilation to outpatient ventilation. The included studies report a 62% to 74% reduction for in-home care via an ambulatory nursing service, in comparison to the costs that accumulate in the intensive care unit of a hospital. Higher expenses arise due to the necessary equipment and the high cost of time for highly qualified staff in the partial 24-hour care of affected patients. However, none of the studies applies to the German provisionary conditions. The results of quality-of-life studies are mostly qualitative. Caregivers of ventilated patients report positive as well as negative ratings. From a legal standpoint the code of social law (Sozialgesetzbuch V) regulates the financing of home ventilation, especially invasive mechanical ventilation, requiring specialized technical nursing. The absorption of costs is distributed among different insurance carriers. Hence, the necessity to enforce a claim of cost absorption often arises in exercising the basic right of free choice of location.
Details
Project Status:
Completed
URL for project:
http://portal.dimdi.de/de/hta/hta_berichte/hta268_summary_en.pdf
Year Published:
2010
URL for published report:
http://portal.dimdi.de/de/hta/hta_berichte/hta268_bericht_de.pdf
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Germany
MeSH Terms
- Neuromuscular Diseases
- Respiration, Artificial
- Ventilators, Mechanical
Contact
Organisation Name:
German Agency for HTA at the German Institute for Medical Documentation and Information
Contact Address:
German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information, Waisenhausgasse 36-38a, D-50676 Cologne Germany
Contact Name:
dahta@dimdi.de
Contact Email:
dahta@dimdi.de
Copyright:
German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information (DAHTA@ DIMDI)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.