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93 paediatric patients were followed at IDVC and ventilation initiated in 80 patients &#40;9&#8211;15 new patients&#47;year&#41; &#8211; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; The majority were male &#40;58&#37;&#41; with neuromuscular disease &#40;35&#46;5&#37;&#41;&#44; malformative syndrome &#40;24&#46;7&#37;&#41; or cerebral palsy &#40;20&#46;4&#37;&#41;&#46; Noninvasive ventilation &#40;NIV&#41; was used in 95&#37; of patients&#46; Ventilation had palliative goal in 90&#46;3&#37;&#44; was initiated at 8&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6 years of age&#44; with elective indication in 61&#37;&#46; Elective ventilation was started at hospital setting in 42 patients and outpatient setting in 15 patients since 2012&#46; Patients under domiciliary ventilation also were provided with respiratory therapeutic equipment at home&#58; in-exsufflater&#44; oximeter&#44; respiratory secretions suction device&#44; oxygen therapy&#44; nebulizer and glossopharyngeal breathing&#46; During follow-up &#40;3&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8 years&#44; maximum 12&#46;5 years&#41;&#44; 55&#46;9&#37; had no hospitalizations and 41&#46;9&#37; had less than two hospital stays&#47;year&#46; No major complications related with ventilation requiring its withdraw were described&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The exponential ventilation use in paediatric chronic patients in our IDVC follows the international trend during the last decade in developed countries&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;2</span></a> mainly by an increase of NIV&#46; We report a higher percentage of patients under domiciliary NIV than most centers&#46; Noninvasive ventilation advantages include lower infection risk&#44; more independence and less vocal commitment&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There was a reduced need of hospital admission for ventilation adaptation&#44; which can be related to a better use of resources available in the hospital and community and the efficient home monitoring provided by the IDVC program&#46; Ambulatory ventilation adaptation benefits have not been studied in children&#44; but studies in adults have proven similar clinical efficacy while reducing the economic costs by 50&#8211;70&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In most of our cases there was a low number of hospital admissions &#40;0&#46;5 hospital admission&#47;patient&#47;year&#41; in spite of patients&#8217; disease complexity&#44; as has been reported in other centres with paediatric multidisciplinary ventilation clinics &#40;0&#46;17&#8211;1&#46;6 hospital admissions&#47;patient&#47;year in different demographic and clinic groups of paediatric patients&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Close cooperation between patient&#44; his family and a specialized group of health care professionals can improve clinical outcomes&#46; Domiciliary care and monitoring in continuum with hospital multidisciplinar assessments might improve respiratory care for chronic paediatric patients needing domiciliary ventilation&#46; Outpatient clinic models&#44; like the IDVC described&#44; can be integration tools between home and hospital care&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Research Letter
Integrated domiciliary ventilation outpatient clinic – Description and experience of an integrated and multidisciplinary model
A.C. Freitasa,
Corresponding author
anacrisfrei@gmail.com

Corresponding author.
, V. Lavradora, I. Coelhob, R. Sousaa, V. Senraa, L. Moraisa
a Pediatric Pulmonology, Pediatric Department, Centro Hospitalar do Porto, Portugal
b Pediatric Care Point REMEO, Linde Healthcare, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Long-term domiciliary ventilation has been a growing therapeutic option in children&#44; namely in children with special and complex health care needs&#46; For this reason&#44; multidisciplinar outpatient clinics became necessary&#46; Authors&#8217; goal was to describe the organizational model of an integrated domiciliary ventilation paediatric outpatient clinic &#40;IDVC&#41;&#44; describing its first 6 years of experience with a retrospective methodology&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Integrated Domiciliary Ventilation Outpatient Clinic was created in 2009 at <span class="elsevierStyleItalic">Centro Hospitalar do Porto&#39;s</span> Paediatric Department in Portugal&#46; A paediatric pulmonologist &#40;IDVC coordinator&#41;&#44; a nurse and a physiotherapist with specialize education in paediatric pulmonology have been the core IDVC working group&#46; Starting in the hospital evaluation&#44; general patient assessment is done &#40;in coordination with various medical specialities&#44; optimizing hospital visits&#41;&#44; respiratory monitoring support equipment is adjusted and caregivers are trained in the needed domiciliary care&#46; Since 2012 it is also possible to start long-term ventilation in the outpatient setting&#44; followed by a close monitoring at home&#46; Individual follow-up care plan is performed in coordination with institutions available near home in permanent cooperation with the domiciliary team&#46; This team is formed by health professionals trained in respiratory problems and is coordinated by IDVC physiotherapist&#46; They perform periodic and urgent assessments at home&#44; providing expert technical support and monitoring respiratory therapies&#44; which strengthens therapeutic adhesion and enables a rapid and efficient approach to exacerbations and ventilation problems&#46; The physiotherapist presence at the hospital evaluation allows integration of technical and monitoring data with the clinical assessment leading to a rapid and dynamic flow of information&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Between 2009 and 2014&#44; 93 paediatric patients were followed at IDVC and ventilation initiated in 80 patients &#40;9&#8211;15 new patients&#47;year&#41; &#8211; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; The majority were male &#40;58&#37;&#41; with neuromuscular disease &#40;35&#46;5&#37;&#41;&#44; malformative syndrome &#40;24&#46;7&#37;&#41; or cerebral palsy &#40;20&#46;4&#37;&#41;&#46; Noninvasive ventilation &#40;NIV&#41; was used in 95&#37; of patients&#46; Ventilation had palliative goal in 90&#46;3&#37;&#44; was initiated at 8&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6 years of age&#44; with elective indication in 61&#37;&#46; Elective ventilation was started at hospital setting in 42 patients and outpatient setting in 15 patients since 2012&#46; Patients under domiciliary ventilation also were provided with respiratory therapeutic equipment at home&#58; in-exsufflater&#44; oximeter&#44; respiratory secretions suction device&#44; oxygen therapy&#44; nebulizer and glossopharyngeal breathing&#46; During follow-up &#40;3&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8 years&#44; maximum 12&#46;5 years&#41;&#44; 55&#46;9&#37; had no hospitalizations and 41&#46;9&#37; had less than two hospital stays&#47;year&#46; No major complications related with ventilation requiring its withdraw were described&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The exponential ventilation use in paediatric chronic patients in our IDVC follows the international trend during the last decade in developed countries&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;2</span></a> mainly by an increase of NIV&#46; We report a higher percentage of patients under domiciliary NIV than most centers&#46; Noninvasive ventilation advantages include lower infection risk&#44; more independence and less vocal commitment&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There was a reduced need of hospital admission for ventilation adaptation&#44; which can be related to a better use of resources available in the hospital and community and the efficient home monitoring provided by the IDVC program&#46; Ambulatory ventilation adaptation benefits have not been studied in children&#44; but studies in adults have proven similar clinical efficacy while reducing the economic costs by 50&#8211;70&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In most of our cases there was a low number of hospital admissions &#40;0&#46;5 hospital admission&#47;patient&#47;year&#41; in spite of patients&#8217; disease complexity&#44; as has been reported in other centres with paediatric multidisciplinary ventilation clinics &#40;0&#46;17&#8211;1&#46;6 hospital admissions&#47;patient&#47;year in different demographic and clinic groups of paediatric patients&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Close cooperation between patient&#44; his family and a specialized group of health care professionals can improve clinical outcomes&#46; Domiciliary care and monitoring in continuum with hospital multidisciplinar assessments might improve respiratory care for chronic paediatric patients needing domiciliary ventilation&#46; Outpatient clinic models&#44; like the IDVC described&#44; can be integration tools between home and hospital care&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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ISSN: 21735115
Original language: English
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