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Home Mechanical Ventilation In Norway

Home Mechanical Ventilation In Norway. 4 regional Health enterprises Owned by the state. Health care system structure in Norway. LTMV in Norway 1990-2000. Dedicated individual health professionals Lack of standard of care LTMV initiated after acute respiratory failure.

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Home Mechanical Ventilation In Norway

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  1. Home Mechanical Ventilation In Norway

  2. 4 regional Health enterprisesOwned by the state

  3. Health care system structure in Norway

  4. LTMV in Norway 1990-2000 • Dedicated individual health professionals • Lack of standard of care • LTMV initiated after acute respiratory failure

  5. Long term mechanical ventilation • Includes • Dependent of mechanical ventilation • Partly or 24/7> 6 weeks • Out of hospital • Invasiv and noninvasive • Not included • Cpap /bilevel /adaptiv servoventilation • Obstructive or sentral sleep apne syndrom or Cheyne Stokes syndrom

  6. Distribution of HMV patients by counties (n=340, july 2001) Prevalence rates per 100 000 population • 15 – 20 • 10 – 15 • 5 - 10 • < 5

  7. Trends and Challenges in HMV in Norway 2000 • Increasing number of patients • Need of skills in respiratory care • Regional diversity • Non invasive ventilation dominating treatment modality • Ethical • Financial

  8. National Centre of excellence for Home Mechanical Ventilation 2002 • Expertise included: • Pediatric • Neurological • Frontline service

  9. Tasks for the HMV Centre • Competence • Diagnostic and therapeutic procedures in adults and children • Norwegian Registry of Patients receiving LTMV • Educating • Health care professionals in hospitals • Care givers in the community • Counseling and technical support • Equal access to treatment for the patients • Develop new knowledge • Establish national professional guidelines

  10. National Registry for LTMV Established in 2002 • Registry's main purpose: • Monitoring LTMV to contribute to a geographically equitable treatment • Quality for patients treatment • Research • Register chaired by an academic committee with representatives from all four health regions • 2012, the registry approved by the Ministry of Health as a national medical grade registry

  11. Home visits to the patient:by the ContactNurse • Customize ventilatory and pressure support • Replacing mask or ventilator • Spot pulse oximetry, kapnometri or art. blood gas sample • Download ventilator data • Education to caregivers in the home / nursing homes

  12. Website • Internal Website for the HMV Network for the participants in the network • External Website for health care professional in the hospitals and health care givers in the community • Communication of new research • Weekly news and information

  13. The coordinators and project participants assignments • Organizing HMV facilities in each region • Ensuring quality of the national patient registry • Survey of regional resources and knowledge • Action Plan for implementation of the national guidelines • Create education material • Standardize training, teaching and checklists

  14. The national professional guidelines for long-term mechanical ventilation (published 2012)

  15. Interfaces - flowchart National guidelines for LTMV

  16. Acute initiation of LTMV Patient at risk Intubation weaning Referral for initiationof LTMV Starting LTMV Acuterespiratoryfailure NIV Patientcare plan Death Follow-up

  17. Planned initiation of LTMV Controll in 3-12 months NO Out-patientevaluation Indication for LTMV? Patient at risk YES Follow-up Patientcare plan Start treatment

  18. http://helsedirektoratet.no/publikasjoner/nasjonal-faglig-retningslinje-for-langtids-mekanisk-ventilasjon-ltmvhttp://helsedirektoratet.no/publikasjoner/nasjonal-faglig-retningslinje-for-langtids-mekanisk-ventilasjon-ltmv

  19. Health care system structure in Norway

  20. Regional Survey and report • 2011/2012 • Regional plan of action • 2012/2013

  21. Develop new knowledge Tidsskr Nor Laegeforen. 2009 Mar 26;129(7):628-31 Termination of mechanical ventilation in amyotrophic lateral sclerosis Holmøy T, Aarrestad S, Engstrand P, Ottesen S, Syse A, Førde R. Tidsskr Nor Laegeforen. 2009 Oct 22;129(20):2094-7. Prevalence of home ventilation therapy in Norway] • Tollefsen E, Gulsvik A, Bakke P, Fondenes O Tidsskr Nor Laegeforen. 2012 May 15;132(9):1111-4. Respiratory complications associated with spinal cord injury. Tollefsen E, Fondenes O

  22. Laryngeal response patterns to mechanical insufflation-exsufflation in healthy subjects. Andersen T, Sandnes A, Hilland M, Halvorsen T, Fondenes O, Heimdal JH, Tysnes OB, Røksund OD. Am J Phys Med Rehabil. 2013 Oct;92(10):920-9. [PubMed - in process] The Norwegian version of the Severe Respiratory Insufficiency (SRI) questionnaire. Translation, adaptation and validation of The SRI Questionnaire. A cross sectional survey including patients receiving long-term mechanical ventilation in Norway. Markussen H, Lehmann S, Nilsen RM, Natvig GK. International J of Nursing Practice .2013 accept Jun. 17.

  23. Projects “When the breath fail” A six years closed cohort study of outcomes in patients requiring long-term mechanical ventilation (LTMV). Heidi Markussen, Sverre Lehmann, Ove Fondenes, Roy Nilsen, Gerd- Karin Natvig • The aims of these studies are to characterize and measure outcomes in LTMV in patents in the western region of Norway. • Examines: • Sociodemographic, physiological and clinical predictors for changes in HRQoL. • Predictors of hospitalisations, treatment compliance, use of out-patient clinic and length of life in the six years period.

  24. Visualizing the larynx during MI-E in ALS • Andersen, Tiina et al. Norwegian Centre of Excellence in Home Mechanical Ventilation, Bergen, Norway

  25. Monitoring of Noninvasive Ventilation Project leader Sigurd Aarrestad, MD Oslo UniverUllevål OUS og Regional koordinator Helse Sør-Øst Nasjonal kompetansetjeneste for hjemmerespiratorbehandling. NKH Haukeland US • Prosjektmedarbeidere: • Elin Tollefsen, seksjonsoverlege St. Olavs Hospital. Dr.med. • Ole Henning Skjønsberg, Professor. Dr. Med. Lungemedisinsk avdeling Ullevål OUS • Anne Louise Kleiven . Fagsykepleier. Lungemedisinsk avdeling Ullevål OUS • Magnus Qvarfort. Overlege. Lungemedisinsk avdeling Ullevål OUS og NKH • Jean-Paul Janssens. Professor. Dr. Med. Genève. Sveits

  26. Project ”Breathe" • Quality assurance and standardization of training in the use of LTMV • Target group: • Adolescents receiving LTMV • Caregivers without professional health care education • A collaborative • National center of excellence in: • Home mechanical ventilation • Neuromuscular diseases • Telemedicine • 2 year project (2013-2014) • E-learning

  27. LTMV diagnosisdevelopment in Norway 2001-2010

  28. LTMV in Norway (2010) • Prevalence adults: 26,5 / 100.000 • Prevalence children: 8,1 / 100.000 • Tracheostomy: 6,7%

  29. Challenges • Full implementation of national guidelines in LTMV at the individual level to all health care professional • Equal access to treatment in the country • Maintain or increase Health related Quality of life • Ethical issues • Increase research in the field of HMV • Lack of health professionals • Assess the possibilities for education in respiratory care

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