Chest
Volume 106, Issue 1, July 1994, Pages 201-209
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Clinical Investigations in Critical Care
Survival and Long-term Follow-up of Tracheostomized Patients With COPD Treated by Home Mechanical Ventilation: A Multicenter French Study in 259 Patients

https://doi.org/10.1378/chest.106.1.201Get rights and content

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.

Section snippets

Materials and Methods

This French multicenter retrospective study was initiated in 1985 and was completed on January 1, 1990, allowing a minimum observation period of 6 years post-T for all patients, with a follow-up of up to 10 years for some patients.

Results

Two hundred and fifty nine of the 265 eligible patients were considered to satisfy the inclusion requirements after verification of all of the questionnaires returned. All these 259 COPD patients were tracheostomized before January 3, 1984 and followed-up until January 1, 1990.

The general and respiratory characteristics of the COPD patients before tracheostomy are presented in Table 2. The mean age was 63 years with a very marked male predominance. The principal clinical type of COPD consisted

Discussion

Only a few papers published in the international literature have reported the results of HMVT in tracheostomized COPD patients in contrast with the large number of studies in patients with CRRF.3,4,19 Furthermore, the published studies are based generally on small populations,10,13,15 apart from the most recent studies that do not always distinguish between COPD and CRRF for survival analysis.6,11,12,14

A concomitant disease frequently appeared to be associated in advanced COPD patients,

ACKNOWLEDGMENTS

We would like to thank Mrs. L. Mounier and Mrs. A. Ludot (ANTADIR, France) for their statistic and logistic help.

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    French Cooperative Study Group: Hospitals and Associations Régionales d'Aide aux Insuffisants Respiratoires: Rouen (Pr. Muir, Drs. Girault, Stain, and Ben Messaoud), Montpellier (Pr. Bertrand, Dr. Milane), Paris (Pr. Raphaël, Dr. Vercken), Tours (Prs. Ginies and Perrotin), Bordeaux (Pr. Cardinaud, Dr. Mathieu), Nantes (Pr. Chailleux, Dr. Ordronneau), Angers (Prs. Achard and Alquier), Dijon (Pr. Jeannin, Dr. Reybet-Degat), Lille (Prs. Wattel and Voisin, and Drs. Berzin and Mallart), Amiens (Dr. Defouilloy), Caen (Pr. Brun, Dr. Poncey), Grenoble (Pr. Paramelle, Dr. Barjhoux), Nancy (Prs. Sadoul and Polu), Toulouse (Pr. Genestal), Chauny (Dr. Loison), and Clermont-Ferrand (Pr. Molina).

    Study sponsored by the Association Nationale pour le Traitement à Domicile de l'Insuffisance Respiratoire (Antadir), Paris, France.

    Manuscript revision accepted December 29.

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