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Increased Survival With Mechanical Ventilation in Posttuberculosis Patients With the Combination of Respiratory Failure and Chest Wall Deformity^*

^* From the Department of Obstetrics and Gynecology (Dr. Jäger), Örebro University Hospital, Örebro; Department of Respiratory Medicine (Dr. Franklin), University Hospital, Umeå; Department of Respiratory Medicine (Dr. Midgren), University Hospital, Lund; Department of Respiratory Medicine and Allergology (Dr. Löfdahl), Sahlgrenska University Hospital, Göteborg; and Department of Respiratory Medicine (Dr. Ström), Blekinge Hospital, Karlskrona, Sweden.

Correspondence to: Linda Jäger, MD, Department of Obstetrics and Gynecology, Örebro University Hospital, SE-701 85 Örebro, Sweden; e-mail: linda_jager{at}yahoo.se

Abstract

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.

Key Words: mechanical ventilation • oxygen inhalation therapy • recommendations • respiratory insufficiency • survival • treatment • tuberculosis