Chest
Volume 130, Issue 6, December 2006, Pages 1828-1833
Journal home page for Chest

Original Research: Prolonged Mechanical Ventilation
Survival of Patients With Kyphoscoliosis Receiving Mechanical Ventilation or Oxygen at Home

https://doi.org/10.1378/chest.130.6.1828Get rights and content

Background

Home mechanical ventilation (HMV) and long-term oxygen therapy (LTOT) are the two treatment alternatives when treating respiratory insufficiency in patients with kyphoscoliosis. We aimed to study the effect on survival with regard to HMV or LTOT alone in patients with respiratory insufficiency due to kyphoscoliosis.

Methods

Swedish patients with nonparalytic kyphoscoliosis (ie, scoliosis not related to neuromuscular disorders) who started LTOT or HMV between 1996 and 2004 were followed up prospectively until February 14, 2006, with death as the primary outcome. Treatment modality, arterial blood gas levels, the presence of concomitant respiratory diseases, and age were recorded at the onset of treatment. No patient was lost to follow-up.

Results

One hundred patients received HMV, and 144 patients received oxygen therapy alone. Patients treated with HMV experienced better survival, even when adjusting for age, gender, concomitant respiratory diseases, and blood gas levels, with a hazard ratio of 0.30 (95% confidence interval, 0.18 to 0.51).

Conclusion

The survival of patients with kyphoscoliosis receiving HMV was better than that of patients treated with LTOT alone. We suggest HMV and not oxygen therapy alone as the primary therapy for patients with respiratory failure due to kyphoscoliosis, regardless of gender, age, and the occurrence of concomitant respiratory diseases.

Section snippets

Materials and Methods

All Swedish men and women with respiratory failure due to nonparalytic kyphoscoliosis (ie, scoliosis not related to neuromuscular disorders) who commenced long-term oxygen therapy (LTOT) or HMV from January 1, 1996, to December 31, 2004, were eligible for inclusion in the study. All of the departments of respiratory medicine and all other medical units prescribing oxygen or HMV in all 24 Swedish counties agreed on the inclusion criteria and prospectively to register all patients who started

Results

The study group comprised 244 patients with kyphoscoliosis who were starting treatment with HMV or oxygen in Sweden during the study period. Their mean age was 69 ± 11 years; 167 were women and 77 were men. One hundred patients received HMV, and 27 of them also received supplementary oxygen therapy. Three patients were ventilated via tracheostomy, and the rest by nasal or oronasal masks. Mechanical ventilation was prescribed during sleep (ie, for < 8 h) to 75% of the patients and for > 12 h to

Discussion

Survival in patients who were treated with HMV was three times higher than that in patients who were treated with oxygen alone, even when adjusting for age, gender, concomitant respiratory diseases, and blood gas levels, in the present cohort of patients with respiratory insufficiency due to kyphoscoliosis. Survival was influenced by age and treatment modality but not by gender, concomitant respiratory disease, or the degree of hypoxia or hypercapnia before the onset of treatment.

Domiciliary

ACKNOWLEDGMENT

We thank all of the nurses and physicians who collected data.

References (22)

  • PiperAJ et al.

    Effects of long-term nocturnal nasal ventilation on spontaneous breathing during sleep in neuromuscular and chest wall disorders

    Eur Respir J

    (1996)
  • Cited by (66)

    • Domiciliary noninvasive ventilation for chronic respiratory diseases

      2022, Medical Journal Armed Forces India
      Citation Excerpt :

      The use of NIV in KS improves daytime PCO2 and even PO2 levels.21–23 A study by Gustafson et al. had shown that domiciliary NIV increases the survival in KS by three times when compared with long-term oxygen therapy alone.24 Another study by Ellis et al. confirmed that using NIV in KS improved the length and quality of REM sleep, increased PO2 and decreased PCO2 levels; however, there was no improvement in spirometry parameters.25

    • NIV in Ventilatory Failure Due to Neuromuscular and Chest Wall Disorders

      2021, Encyclopedia of Respiratory Medicine, Second Edition
    • The Respiratory System and Chest Wall Diseases

      2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth Edition
    • Getting It Right in Restrictive Lung Disease

      2023, Journal of Clinical Medicine
    View all citing articles on Scopus

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    The study was funded by grants from the Swedish Heart and Lung Foundation, the Swedish Board of Health and Welfare, and BREAS Medical AB.

    View full text