Chest
Original ResearchRESPIRATORY ADJUNCT THERAPYIncreased Survival With Mechanical Ventilation in Posttuberculosis Patients With the Combination of Respiratory Failure and Chest Wall Deformity
Section snippets
Materials and Methods
Swedish men and women with the combination of respiratory failure and chest wall deformity from tuberculosis who commenced home mechanical ventilation or long-term oxygen therapy from January 1, 1996, to December 31, 2004, were eligible. They were included prospectively in a nationwide register (Swedevox), which covers approximately 90% of Swedish patients starting home mechanical ventilation and long term oxygen therapy.81011 All centers prescribing oxygen and home mechanical ventilation took
Results
A total of 188 patients with the combination of respiratory failure and chest wall deformity from tuberculosis were included, corresponding to 2.4 new cases per million inhabitants per year. They were 75 ± 7 years old at study start, and 105 were women and 83 were men (Table 1). Of these, 103 patients received long-term oxygen therapy alone, prescribed for 16 to 24 h/d. Eighty-five patients received home mechanical ventilation, with 15 of these patients also receiving supplemental oxygen
Discussion
Patients with the combination of respiratory failure and chest wall deformity from tuberculosis had an almost threefold-better survival when treated with home mechanical ventilation instead of long-term oxygen therapy alone, with adjustments for a series of confounders. Despite international consensus to use mechanical ventilation in patients with chest wall deformity, a majority of Swedish patients with this disorder received treatment with long-term oxygen therapy alone during the inclusion
ACKNOWLEDGMENT
We thank all of the Swedish physicians and nurses who contributed data to the study. We also thank Jonas Ranstam, PhD, for statistical analysis.
References (28)
- et al.
Sleep fragmentation in kyphoscoliotic individuals with alveolar hypoventilation treated by NIPPV
Chest
(1995) - et al.
Noninvasive positive pressure ventilation and not oxygen may prevent overt ventilatory failure in patients with chest wall diseases
Chest
(1997) - et al.
Home mechanical ventilation in Sweden, with reference to Danish experiences: Swedish Society of Chest Medicine
Respir Med
(2000) - et al.
Survival of patients with kyphoscoliosis receiving mechanical ventilation or oxygen at home
Chest
(2006) - et al.
Survival of patients on home mechanical ventilation: a nationwide prospective study
Respir Med
(2007) - et al.
Acute respiratory failure in scoliosis or kyphosis: prolonged survival and treatment
Am J Med
(1982) - et al.
Kyphoscoliotic ventilatory insufficiency: effects of long-term intermittent positive-pressure ventilation
Chest
(2003) - et al.
Nasal intermittent positive pressure ventilation: long-term follow-up in patients with severe chronic respiratory insufficiency
Chest
(1994) - et al.
Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva lake area
Chest
(2003) - et al.
Noninvasive mechanical ventilation improves endurance performance in patients with chronic respiratory failure due to thoracic restriction
Chest
(2001)
Home mechanical ventilation in Sweden: inequalities within a homogenous health care system
Respir Med
2006 tuberculosis facts
Conservative management of tuberculous spondylitits in a developing country
Niger J Med
Tuberculosis of the spine in children at Muhimbili Medical Centre, Dar es Salaam
East Afr Med J
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This study was funded by grants from the Swedish National Board of Health and Welfare and Blekinge County Council.
The authors have no financial or other potential conflicts of interest to disclose.