Integrated Respiratory Care for Patients on Prolonged Home Mechanical Ventilation: Outcomes of the Caivent Program

Introduction: The use of Home Mechanical Ventilation (HMV) has been increasing, but home surveillance and monitoring has not been sufficient to ensure consistent therapeutic efficacy. The CAIVent Program proposes a patient-centered organizational alternative with the aim of maintaining continuity of care at home. The aim of this study is to describe the organizational aspects of the CAIVent program and the impact of this program in the reduction of the use of hospital resources. Materials and Methods: Patients followed at the ULS São João Hospital from 2018 to 2024 with criteria to be included in the CAIVent program (HMV >12h/day) were analyzed. Ventilator monitoring was obtained with ventilator memory card reading. Number of ER visits, number of hospitalizations, hospitalization length of stay and number of outpatient consultations before and after inclusion in the program were analyzed. Results: 119 patients (45 women) with a mean age of 64.9 years±18.9 years with the following diagnoses: COPD (n=52, 43.7%), Neuromuscular Diseases (n=43, 36.1%), Obesity Hypoventilation Syndrome (n=9, 7.5%), Kyphoscoliosis (n=13, 10.9%), Interstitial lung disease (n=3, 2.5%), other chronic lung disease (n=53, 44.5%) with a median HMV use of 15.1±5.8 hours/day. There was a significant increase of mean HMV usage before and after entering the program (13.8±6.1h/day versus 16.2±6.6h/day). We observed a significant reduction in the number of ER visits (288 episodes versus 203 episodes, p=0.012) and in the number of outpatient consultations (447 Versus 287, p<0.001). Although there was a reduction in the number of hospitalizations (133 versus 103, p=0,146) and respective length of stay (1349 days versus 1023 days, p=0.171), these were not significant. During the 6 year period, 72 patients (60.5%) died. Conclusions: The implementation of an integrated support program for chronic severe patients with prolonged HMV allows better monitoring at home, promoting patient and caregiver literacy, early therapeutic interventions and avoiding the use of hospital resources.