Survival of patients with kyphoscoliosis receiving mechanical ventilation or oxygen at home.
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).


CONCLUSIONS
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.
Gustafson
Torbjörn
T
Department of Medicine, Skellefteå Hospital, SE-931 86 Skellefteå, Sweden. torbjorn.gustafson@vll.se
Franklin
Karl A
KA
Midgren
Bengt
B
Pehrsson
Kerstin
K
Ranstam
Jonas
J
Ström
Kerstin
K
D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007738:Kyphosis / Q000150:complications* / Q000401:mortality; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012600:Scoliosis / Q000150:complications* / Q000401:mortality; D016019:Survival Analysis