Résumé :
|
Neuromuscular Diseases (NMD) management had a significant improved in last decades (Bonekat, 1998). The management of NMD patients includes home ventilation ( non-invasive or invasive ventilation), specific chest physiotherapy techniques and parental education. These full management lead to reduce hospitalization (Tzeng&Bach, 2000; Katz et al, 2004). The benefits of non invasive ventilation (NIV) result on less morbidity and cost, when compared to invasive ventilation (IV) (Hill et al, 1998; Simons, 1998). Hospital Infantil João Paulo II /FHEMIG is a public hospital, in Belo Horizonte city - Brazil, which has a Homecare Program aimed to NMD children. Objective : To demonstrate the impact of the specific homecare management on NMD children on lowering days of hospitalization, comparing the period before and after admittance on program. Design : Retrospective study. The data of 20 NMD children (spinal muscular atrophy, congenital miopathies, Duchenne muscular dystrophy), five on IV and 15 on NIV, were reviewed from november 2002 to april 2008. A comparative analisys was done on hospitalization data before and after the admittance on the Hospital Infantil João Paulo II /FHEMIG Homecare Programto NMD children. A correction factor was calculated to adjust the time before and after admittance on program. Correlation analisys was done between mean number of hospitalizations and mean number of days spent in hospital before and after admittance on Program, using t-Student test with P = 0.05 as the level of statistical significance. Results : The age of admittance ranged between 0.94 to 13.12 years (mean 7.38 years). The time after admittance ranged between 0.36 to 5.42 years (mean 3.37 years). To adjust the age of admittance and time after admittance, a correction factor was run. The number of hospitalizations of each patient ranged between zero to 17 episodes (mean : 1.5) before and zero to six episodes (mean : 1.5) after admittance. The total number of hospitalizations was 117 versus 37 episodes, before and after admittance on program, respectively. The total number of days spent in hospital of each patient ranged between zero to 465 days (mean : 70) before and zero to 33 days (mean : 5.5) after the admittance. The sum of days spent in hospital of all patients were 2,107 and 189 days before and after admittance on program. There was no diference between the mean number of hospitalization before and after admittance on the NMD program. The sum of days spent in hospital of all patients was much lower after then before admittance on the NMD program, and had statistically significance (P = 0.007). Conclusion : The specific management of NMD children had a positive impact on lowering days of hospitalization when compared with the time before the specific treatment. 1 BACH, J.R. Noninvasive mechanical ventilation. Philadelphia : Hanley e Belfus, 2002 2 BACH, J.R.; CAMPAGNOLO, D.I. Psycosocial adjustment of post-poliomuelitis ventilator assisted individuals . Arch Phys. Med. Rehabil., v .73, p. 934-939, 1992. 3 BONEKAT, H.W. Noninvasive ventilation in neuromuscular disease. Crit. Care Clin.,v.14, p.775-795, 1998. 4 HILL,N.S., BRAMAN,S.S. Noninvasive Ventilation in Neuromuscular Disease. In : CHERNIAK, N.S.; MURRAY, D.A.; HOMMA, I. Rehabilitation of the Patient with Respiratory Disease . MacGraw, 1999. 5 KATZ,S.; SELVADURAI,H.;MITCHELL,M.,MAC LUSKY,I. Outcome of Non-Invasive Positive Ventilation Paediatric Neuromuscular Disease. Arch Dis Child, v. 89, p. 121-124, 2004. 6 REED, U. Doenças neuromusculares. J.Pediatr, 2002; (Supl.1) :S89-S203. 7 SÁNCHEZ, I D; VALENZUEL, A S; BERTRAND, P N; ALVAREZ, C G; HOLMGREN, N L P; VILCHES, S J; JEREZ, C T; RONCO, R M. Apoyo ventilatorio domiciliário en niños con insuficiencia respiratoria crónica. Rev. chil. pediatr., Santiago, v. 73, n. 1, p. 1-7, 2002 8 SIMONS, M.S. Management of Neuromuscular Disease In : CHERNIAK, N.S.; ALTOSE, M.D.; HOMMA, I. Reabilitation of the Patient with Pulmonary Disease. MacGraw -Hill, London, 1998. 9 TZENG, A.; BACH, J.R.. Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest, v. 118, p. 1390-1396, 2000.
|