Survival and Long-term Follow-up of Tracheostomized Patients With COPD Treated by Home Mechanical Ventilation

A Multicenter French Study in 259 Patients

¹ From the Service de Pneumologie, Centre Hospitalier Universitaire (Hôpital de Bois-Guillaume), Rouen, France and ERPUR (Etudes et Recherches en Pneumologie de l'Université de Rouen/Unité INSERM U295)
² From the Service de Réanimation Médicale, Centre Hospitalier Universitaire, Bordeaux, France
³ From the Service de Pneumologie, Centre Hospitalier Universitaire, Nancy, France, and Commission Médico-Technique et Sociale, Antadir, Paris, France

To define more clearly the value of home mechanical ventilation by tracheostomy (HMVT) in patients with advanced COPD, a retrospective French multicenter study group analyzed the prognostic factors and long-term survival of 259 patients with severe COPD, who were tracheostomized for at least 1 year. Seventy-eight percent of the patients died by the end of the observation period. The actuarial survival rate for the overall study population was, therefore, 70 percent at 2 years, 44 percent at 5 years, and 20 percent at 10 years. These results appear to be better than those of the major published series and compare to the prognosis of COPD patients treated by long-term oxygen therapy (LTO) 15 hr/24 hr. The parameters most closely correlated with a survival for more than 5 years were age <65 years, use of an uncuffed cannula, and a PaO₂ >55 mm Hg in room air during the 3 months after tracheostomy (p<0.01). This study, therefore, confirmed the feasibility of HMVT in COPD and should lead to a review of the place of permanent tracheostomy in the long-term prognosis of severe COPD patients.

Key Words: acute respiratory failure • chronic obstructive pulmonary disease • home mechanical ventilation • long-term survival • prognostic factors • rehabilitation • tracheostomy

Submitted on August 11, 1993
Accepted on December 29, 2007

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