Predictors of mortality in chest wall disease treated with noninvasive home mechanical ventilation

Rationale: The long-term evolution of patients with chest wall disease and chronic respiratory failure treated with noninvasive home mechanical ventilation (NIHMV) is poorly known. Objectives: The aim of this prospective observational study was to analyze the variables associated with mortality in a cohort of chest wall disease patients with chronic respiratory failure undergoing long-term follow-up after starting treatment with NIHMV. Methods: Chest wall disease patients who began NIHMV between 1996 and 2005 were followed up, with death as the primary outcome. The patients' clinical characteristics, lung function, and arterial blood gases were recorded at the start of treatment. Patients were seen and evaluated 1 month after starting NIHMV. The prognostic value of clinical and functional variables were assessed by Cox regression analyses. Main results: We included 110 patients, 61 with tuberculosis sequelae and 49 with kyphoscoliosis. By the end of follow-up, 34 patients (28%) had died. The 5-year survival was 69% in those with tuberculosis sequelae and 75% in kyphoscoliosis. PaCO2 ≥50 mmHg at 1 month of home ventilation and comorbidity (Charlson Index ≥3) were independent predictors of mortality. Conclusion: Our results suggest that PaCO2 levels ≥50 mmHg at 1 month after starting noninvasive home mechanical ventilation and the presence of comorbid conditions are risk factors for mortality in patients with chest wall disease. The importance of early detection of suboptimal home ventilation as well as comorbidities is highlighted. © 2010 Elsevier Ltd. All rights reserved.