S123 10-year all-cause-mortality of home mechanical ventilation. (December 2018)

• Record Type: Journal Article
• Authors: Schwarz, EI; Mackie, M; Tincknell, L; Beghal, G; Ramsay, M; Suh, E; Kaltsakas, G; Pattani, H; Marino, P; Murphy, P; Hart, N; Steier, J
• Is Part Of: Thorax. Volume 73(2018)Supplement 4
• Page Start: A77
• Page End: A77
• Publication Date: 2018-12
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2018-212555.129
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction: Home mechanical ventilation (HMV) is used to treat chronic hypercapnic respiratory failure. There is mounting evidence that HMV impacts on long-term outcomes in different disease groups with chronic hypercapnic respiratory failure. However, outcomes differ according to the underlying condition. Methods: All-cause mortality data of patients on HMV between 2008 and 2018 were collected from patients treated in a large tertiary referral centre for non-invasive ventilation and weaning, currently treating around 2000 patients on HMV. Cumulative mortality on HMV was compared between patients with neuromuscular disease/chest wall disease (NMD/CWD), obstructive airway disease (OAD), obesity-related respiratory failure (ORRF), overlap of OAD and ORRF (Overlap Syndrome) and others (e.g. traumatic spinal cord injury). The main outcome was time on HMV until death in the key groups. Results are reported as median [interquartile range]. Results: In total, 1081 deaths of patients on HMV were recorded within a 10 year period. Time until death on HMV was 19 [6–54] months for the entire cohort but differed between the groups (Kruskal Wallis p<0.001). Patients with ORRF (n=189, 32 [12–68] months) and Overlap Syndrome (n=39, 28 [13–63] months) had a longer median survival than patients with OAD (n=261, 20 [7–42] months), NMD/CWD (n=469, 16 [5–59] months) or others (n=123, 14 [3–38] months; figure 1). Within the heterogeneous group of NMD/CWD, patients with CWD (n=51, 97 [19–120] months) and myopathy (n=146, 62 [28–120] months) had a longer survival than patients with motor neurone disease (n=225, 7 [2–14] months). Daily usage of >4 hour on HMV was associated with longer survival in those who were not dependent on 24h-HMV. There was no relevant difference in outcomes between patients on non-invasive ventilation (NIV; n=940) and tracheostomy (n=141), but the latter group was relatively small. Over 33% of patients on HMV died outside and 45% in the hospital, for 22% the exact location of death was unknown. Conclusion: Long-term mortality in patients treated with HMV for chronic hypercapnic respiratory differs significantly between disease groups. Patients with chest wall disease, myopathy or obesity-related respiratory failure have a lower mortality than patients with MND, neuropathy, OAD or traumatic spinal cord injuries.