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Impacto da ventilação não-invasiva domiciliária na gestão da doença respiratória antes, durante e pós pandemia COVID-19: Revisão Sistemática de Literatura
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Abstract(s)
Introdução: A insuficiência respiratória é um problema de saúde global crescente,
agravado pelo envelhecimento da população e pelo aumento da prevalência de obesidade.
Doenças, como a doença pulmonar obstrutiva crónica, doenças intersticiais pulmonares e
síndrome de apneia obstrutiva do sono, frequentemente levam à insuficiência respiratória
crónica. A ventilação não-invasiva domiciliária tem-se destacado como uma estratégia
terapêutica essencial para melhorar a qualidade de vida dos doentes e reduzir
hospitalizações. A pandemia COVID-19 evidenciou ainda mais a importância desta
terapêutica na continuidade dos cuidados em contextos de recursos limitados.
Objetivos: Avaliar o impacto da ventilação não-invasiva domiciliária na gestão das
doenças respiratórias em três períodos distintos: antes da pandemia, durante a pandemia
COVID-19 e no período pós-pandémico. Explorar os benefícios clínicos, a adesão dos
doentes, a eficiência económica e os avanços tecnológicos, bem como identificar desafios e
perspetivas futuras.
Métodos: Seguindo as diretrizes PRISMA, foi realizada uma pesquisa sistemática nas
bases de dados PubMed, Cochrane Library e Web of Science, abrangendo o período de 2014
a 2024. Foram incluídos estudos com diferentes metodologias, como desenhos
observacionais, descritivos, exploratórios, qualitativos e de intervenção. A pesquisa foi
limitada a artigos publicados em inglês, espanhol e português. Os artigos foram
selecionados com base nos critérios PICO, focando-se em pacientes adultos submetidos à
ventilação não-invasiva domiciliária para condições respiratórias crónicas. Os estudos
foram avaliados criticamente utilizando a ferramenta de avaliação de qualidade de Hawker
et al..
Resultados: De um total inicial de 518 artigos, 40 foram incluídos na revisão. A ventilação
não-invasiva domiciliária demonstrou benefícios clínicos significativos, como melhorias na
troca gasosa, redução da hipercapnia, aumento da capacidade de exercício e melhor
qualidade de vida. A adesão foi influenciada por fatores como a educação do paciente, o
conforto do dispositivo e o suporte social, com taxas geralmente altas para pacientes que
usavam o dispositivo por mais de 4 horas diárias. Economicamente, esta terapia reduziu
taxas de hospitalização e os custos associados. Durante a pandemia, a integração da telemedicina e da monitorização remota facilitou a adaptação da ventilação não-invasiva
domiciliária, mesmo com desafios logísticos.
Conclusão: A ventilação não-invasiva domiciliária é uma ferramenta crucial na gestão de
doenças respiratórias, demonstrando benefícios clínicos, económicos e logísticos. Pesquisas
futuras devem abordar lacunas em subgrupos específicos de pacientes e explorar
tecnologias inovadoras para aprimorar a prestação de cuidados. É fundamental que os
decisores políticos e os prestadores de saúde integrem a ventilação não-invasiva
domiciliária em estruturas de saúde mais amplas para maximizar o seu potencial.
Introduction: Respiratory failure is a growing global health concern, exacerbated by population aging and the increasing prevalence of obesity. Diseases such as chronic obstructive pulmonary disease, interstitial lung diseases, and obstructive sleep apnea syndrome often lead to chronic respiratory failure. Home non-invasive ventilation has emerged as an essential therapeutic strategy to improve patients' quality of life and reduce hospitalizations. The COVID-19 pandemic further highlighted the importance of this therapy in ensuring continuity of care in resource-constrained settings. Objectives: To evaluate the impact of home non-invasive ventilation on the management of respiratory diseases across three distinct periods: pre-pandemic, during the COVID-19 pandemic, and post-pandemic. The study aimed to explore its clinical benefits, patient adherence, economic efficiency, and technological advancements, as well as identify challenges and future perspectives. Methods: Following PRISMA guidelines, a systematic search was conducted in the PubMed, Cochrane Library, and Web of Science databases, covering the period from 2014 to 2024. Studies employing various methodologies, such as observational, descriptive, exploratory, qualitative, and interventional designs, were included. The search was limited to articles published in English, Spanish, and Portuguese. Articles were selected based on PICO criteria, focusing on adult patients receiving home non-invasive ventilation for chronic respiratory conditions. The studies were critically appraised using Hawker et al.'s quality assessment tool. Results: Out of an initial total of 518 articles, 40 were included in the review. Home noninvasive ventilation demonstrated significant clinical benefits, such as improved gas exchange, reduced hypercapnia, enhanced exercise capacity, and better quality of life. Adherence was influenced by factors like patient education, device comfort, and social support, with generally high adherence rates among patients using the device for more than 4 hours daily. Economically, this therapy reduced hospitalization rates and associated costs. During the pandemic, the integration of telemedicine and remote monitoring facilitated the adaptation of home non-invasive ventilation, despite logistical challenges Conclusion: Home non-invasive ventilation is a crucial tool in the management of respiratory diseases, demonstrating clinical, economic, and logistical benefits. Future research should address gaps in specific patient subgroups and explore innovative technologies to enhance care delivery. It is essential for policymakers and healthcare providers to integrate home non-invasive ventilation into broader healthcare systems to maximize its potential.
Introduction: Respiratory failure is a growing global health concern, exacerbated by population aging and the increasing prevalence of obesity. Diseases such as chronic obstructive pulmonary disease, interstitial lung diseases, and obstructive sleep apnea syndrome often lead to chronic respiratory failure. Home non-invasive ventilation has emerged as an essential therapeutic strategy to improve patients' quality of life and reduce hospitalizations. The COVID-19 pandemic further highlighted the importance of this therapy in ensuring continuity of care in resource-constrained settings. Objectives: To evaluate the impact of home non-invasive ventilation on the management of respiratory diseases across three distinct periods: pre-pandemic, during the COVID-19 pandemic, and post-pandemic. The study aimed to explore its clinical benefits, patient adherence, economic efficiency, and technological advancements, as well as identify challenges and future perspectives. Methods: Following PRISMA guidelines, a systematic search was conducted in the PubMed, Cochrane Library, and Web of Science databases, covering the period from 2014 to 2024. Studies employing various methodologies, such as observational, descriptive, exploratory, qualitative, and interventional designs, were included. The search was limited to articles published in English, Spanish, and Portuguese. Articles were selected based on PICO criteria, focusing on adult patients receiving home non-invasive ventilation for chronic respiratory conditions. The studies were critically appraised using Hawker et al.'s quality assessment tool. Results: Out of an initial total of 518 articles, 40 were included in the review. Home noninvasive ventilation demonstrated significant clinical benefits, such as improved gas exchange, reduced hypercapnia, enhanced exercise capacity, and better quality of life. Adherence was influenced by factors like patient education, device comfort, and social support, with generally high adherence rates among patients using the device for more than 4 hours daily. Economically, this therapy reduced hospitalization rates and associated costs. During the pandemic, the integration of telemedicine and remote monitoring facilitated the adaptation of home non-invasive ventilation, despite logistical challenges Conclusion: Home non-invasive ventilation is a crucial tool in the management of respiratory diseases, demonstrating clinical, economic, and logistical benefits. Future research should address gaps in specific patient subgroups and explore innovative technologies to enhance care delivery. It is essential for policymakers and healthcare providers to integrate home non-invasive ventilation into broader healthcare systems to maximize its potential.
Description
Keywords
Covid-19 Cuidados Domiciliários Doenças Respiratórias Crónicas Economia da Saúde Telemedicina Ventilação Não-Invasiva