Increased survival with mechanical ventilation in post-tuberculosis patients with the combination of respiratory failure and chest wall deformity

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Increased survival with mechanical ventilation in post-tuberculosis patients with the combination of respiratory failure and chest wall deformity. / Jäger, Linda; Franklin, Karl A; Midgren, Bengt; Löfdahl, Kerstin; Ström, Kerstin.

I: Chest, Vol. 133, Nr. 1, 2008, s. 156-160.

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Jäger, Linda ; Franklin, Karl A ; Midgren, Bengt ; Löfdahl, Kerstin ; Ström, Kerstin. / Increased survival with mechanical ventilation in post-tuberculosis patients with the combination of respiratory failure and chest wall deformity. I: Chest. 2008 ; Vol. 133, Nr. 1. s. 156-160.

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TY - JOUR

T1 - Increased survival with mechanical ventilation in post-tuberculosis patients with the combination of respiratory failure and chest wall deformity

AU - Jäger, Linda

AU - Franklin, Karl A

AU - Midgren, Bengt

AU - Löfdahl, Kerstin

AU - Ström, Kerstin

PY - 2008

Y1 - 2008

N2 - Background Patients who have suffered from tuberculosis are at risk of 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 prospectively until October 2006, with death as the primary outcome. Results A cohort of 188 patients was included. Eighty-five received mechanical ventilation and 103 received oxygen therapy alone. No patients were excluded and none was lost to 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% CI 0.17-0.70). 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.

AB - Background Patients who have suffered from tuberculosis are at risk of 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 prospectively until October 2006, with death as the primary outcome. Results A cohort of 188 patients was included. Eighty-five received mechanical ventilation and 103 received oxygen therapy alone. No patients were excluded and none was lost to 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% CI 0.17-0.70). 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.

KW - survival

KW - respiratory insufficiency

KW - recommendations

KW - mechanical ventilation

KW - oxygen inhalation therapy

KW - treatment

KW - tuberculosis

U2 - 10.1378/chest.07-1522

DO - 10.1378/chest.07-1522

M3 - Article

C2 - 18071021

VL - 133

SP - 156

EP - 160

JO - Chest

JF - Chest

SN - 1931-3543

IS - 1

ER -