Chest
Volume 133, Issue 1, January 2008, Pages 156-160
Journal home page for Chest

Original Research
RESPIRATORY ADJUNCT THERAPY
Increased Survival With Mechanical Ventilation in Posttuberculosis Patients With the Combination of Respiratory Failure and Chest Wall Deformity

https://doi.org/10.1378/chest.07-1522Get rights and content

Background

Patients who have had tuberculosis are at risk for respiratory failure with hypercapnea from chest wall deformity and hypoxia from pulmonary sequelae. The combination of hypercapnea and hypoxia justifies both mechanical ventilation and oxygen therapy as treatment options. We aimed to study which treatment mode is associated with the best survival in patients with the combination of respiratory failure and chest wall deformity from tuberculosis.

Methods

Swedish patients starting oxygen therapy or mechanical ventilation between 1996 and 2004 due to the combination of respiratory failure and chest wall deformity from tuberculosis were eligible for conclusion. They were followed up prospectively until October 2006, with death as the primary outcome.

Results

A cohort of 188 patients was included. Eighty-five patients received mechanical ventilation, and 103 received oxygen therapy alone. No patients were excluded, and no patients were unavailable for follow-up. Mechanical ventilation was associated with a significantly better survival than oxygen therapy alone, even after adjustments for age, gender, concomitant respiratory disease, blood gas tensions, and vital capacity, with an adjusted hazard risk of death of 0.35 (95% confidence interval, 0.17 to 0.70).

Conclusion

Patients with the combination of respiratory failure and chest wall deformity from tuberculosis had a significantly better survival when treated with home mechanical ventilation than with long-term oxygen therapy alone. We recommend home mechanical ventilation with or without supplementary oxygen as the first choice of treatment for these patients.

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)

  • M Laub et al.

    Home mechanical ventilation in Sweden: inequalities within a homogenous health care system

    Respir Med

    (2004)
  • World Health Organization

    2006 tuberculosis facts

  • AU Ekere et al.

    Conservative management of tuberculous spondylitits in a developing country

    Niger J Med

    (2005)
  • EN Sayi et al.

    Tuberculosis of the spine in children at Muhimbili Medical Centre, Dar es Salaam

    East Afr Med J

    (1995)
  • Cited by (35)

    • Time-to-death in chronic respiratory failure on home mechanical ventilation: A cohort study

      2020, Respiratory Medicine
      Citation Excerpt :

      The use of HMV in the management of patients with slowly progressive NMD and CWD has dramatically increased time-to-death in recent decades [11,12]. A survival benefit has also been shown in other key groups [5,8,13–16]. The rapidly increasing prevalence of obesity with patients who develop hypercapnic respiratory failure (OHS) frequently affects young patients, and long-term NIV has been shown to improve health-related quality of life, survival and reduce complications and hospitalisations in these patients.

    • Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome

      2016, Respiratory Medicine
      Citation Excerpt :

      The county council finances the ventilator and, unlike many other countries, patients do not need a private health-care insurance to obtain access to LTMV. Patients have been included prospectively since 1 January 1996, with a completeness of approximately 90% [11]. At the start of treatment, a physician or a delegated nurse from every center prescribing LTMV fills in a standardized computerized form for every patient, with information including starting date of LTMV, gender, age, height, weight, arterial blood gas tensions when breathing air, spirometer values, score on the Epworth Sleepiness Scale (ESS) [12], primary diagnosis causing ventilatory failure and, when applicable, even secondary diagnosis, usage of concomitant oxygen therapy and type of ventilator interface.

    • Importance of the PaCO<inf>2</inf> from 3 to 6 months after initiation of long-term non-invasive ventilation

      2010, Respiratory Medicine
      Citation Excerpt :

      Domiciliary non-invasive positive pressure ventilation (NPPV) has been widely used in the treatment of patients with chronic hypercapnic respiratory failure.1–7

    • Predictors of mortality in chest wall disease treated with noninvasive home mechanical ventilation

      2010, Respiratory Medicine
      Citation Excerpt :

      Taking into account all patients, regardless of the therapy received, female sex, younger age, a high body mass index, and higher PaO2 and PaCO2 values were all favorable independent prognostic factors.11 Survival of patients with kyphoscoliosis12 and tuberculosis sequelae13 was also evaluated in the 2 Swedish studies mentioned above. In both studies, survival was associated with the therapy applied (NIHMV or LTOT) and this fact likely precluded the finding of associations between other independent variables and mortality.

    View all citing articles on Scopus

    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.

    View full text