Patterns of use, survival and prognostic factors in patients receiving home mechanical ventilation in Western Australia: A single centre historical cohort study

Geak Poh Tan, Nigel McArdle, Satvinder Singh Dhaliwal, Jane Douglas, Clare Siobhan Rea, Bhajan Singh

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Abstract

Home mechanical ventilation (HMV) is used in a wide range of disorders associated with chronic hypoventilation. We describe the patterns of use, survival and predictors of death in Western Australia. We identified 240 consecutive patients (60% male; mean age 58 years and body mass index 31 kg m−2) referred for HMV between 2005 and 2010. The patients were grouped into four categories: motor neurone disorders (MND; 39%), pulmonary disease (PULM; 25%, mainly chronic obstructive pulmonary disease), non-MND neuromuscular and chest wall disorders (NMCW; 21%) and the obesity hypoventilation syndrome (OHS; 15%). On average, the patients had moderate ventilatory impairment (forced vital capacity: 51%predicted), sleep apnoea (apnoea-hypopnea index: 25 events h−1), sleep-related hypoventilation (transcutaneous carbon dioxide rise of 20 mmHg) and daytime hypercarbia (PCO2: 54 mmHg). Median durations of survival from HMV initiation were 1.0, 4.2, 9.9 and >11.5 years for MND, PULM, NMCW and OHS, respectively. Independent predictors of death varied between primary indications for HMV; the predictors included (a) age in all groups except for MND (hazard ratios (HRs) 1.03–1.10); (b) cardiovascular disease (HR: 2.35, 95% confidence interval (CI): 1.08–5.10) in MND; (c) obesity (HR: 0.28, 95% CI: 0.13–0.62) and oxygen therapy (HR: 0.33, 95% CI: 0.14–0.79) in PULM; and (d) forced expiratory volume in 1 s (%predicted; HR: 0.93, 95% CI: 0.88–1.00) in OHS.

Original languageEnglish
Pages (from-to)356-364
Number of pages9
JournalChronic Respiratory Disease
Volume15
Issue number4
DOIs
Publication statusPublished - 1 Nov 2018

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Western Australia
Artificial Respiration
Cohort Studies
Confidence Intervals
Hypoventilation
Survival
Obesity Hypoventilation Syndrome
Hypercapnia
Vital Capacity
Sleep Apnea Syndromes
Forced Expiratory Volume
Thoracic Wall
Motor Neurons
Apnea
Carbon Dioxide
Chronic Obstructive Pulmonary Disease
Lung Diseases
Sleep
Body Mass Index
Cardiovascular Diseases

Cite this

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title = "Patterns of use, survival and prognostic factors in patients receiving home mechanical ventilation in Western Australia: A single centre historical cohort study",
abstract = "Home mechanical ventilation (HMV) is used in a wide range of disorders associated with chronic hypoventilation. We describe the patterns of use, survival and predictors of death in Western Australia. We identified 240 consecutive patients (60{\%} male; mean age 58 years and body mass index 31 kg m−2) referred for HMV between 2005 and 2010. The patients were grouped into four categories: motor neurone disorders (MND; 39{\%}), pulmonary disease (PULM; 25{\%}, mainly chronic obstructive pulmonary disease), non-MND neuromuscular and chest wall disorders (NMCW; 21{\%}) and the obesity hypoventilation syndrome (OHS; 15{\%}). On average, the patients had moderate ventilatory impairment (forced vital capacity: 51{\%}predicted), sleep apnoea (apnoea-hypopnea index: 25 events h−1), sleep-related hypoventilation (transcutaneous carbon dioxide rise of 20 mmHg) and daytime hypercarbia (PCO2: 54 mmHg). Median durations of survival from HMV initiation were 1.0, 4.2, 9.9 and >11.5 years for MND, PULM, NMCW and OHS, respectively. Independent predictors of death varied between primary indications for HMV; the predictors included (a) age in all groups except for MND (hazard ratios (HRs) 1.03–1.10); (b) cardiovascular disease (HR: 2.35, 95{\%} confidence interval (CI): 1.08–5.10) in MND; (c) obesity (HR: 0.28, 95{\%} CI: 0.13–0.62) and oxygen therapy (HR: 0.33, 95{\%} CI: 0.14–0.79) in PULM; and (d) forced expiratory volume in 1 s ({\%}predicted; HR: 0.93, 95{\%} CI: 0.88–1.00) in OHS.",
keywords = "Neuromuscular disease, non-invasive ventilation, obesity hypoventilation syndrome, respiratory insufficiency, survival",
author = "Tan, {Geak Poh} and Nigel McArdle and Dhaliwal, {Satvinder Singh} and Jane Douglas and Rea, {Clare Siobhan} and Bhajan Singh",
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T1 - Patterns of use, survival and prognostic factors in patients receiving home mechanical ventilation in Western Australia

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AU - Tan, Geak Poh

AU - McArdle, Nigel

AU - Dhaliwal, Satvinder Singh

AU - Douglas, Jane

AU - Rea, Clare Siobhan

AU - Singh, Bhajan

PY - 2018/11/1

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N2 - Home mechanical ventilation (HMV) is used in a wide range of disorders associated with chronic hypoventilation. We describe the patterns of use, survival and predictors of death in Western Australia. We identified 240 consecutive patients (60% male; mean age 58 years and body mass index 31 kg m−2) referred for HMV between 2005 and 2010. The patients were grouped into four categories: motor neurone disorders (MND; 39%), pulmonary disease (PULM; 25%, mainly chronic obstructive pulmonary disease), non-MND neuromuscular and chest wall disorders (NMCW; 21%) and the obesity hypoventilation syndrome (OHS; 15%). On average, the patients had moderate ventilatory impairment (forced vital capacity: 51%predicted), sleep apnoea (apnoea-hypopnea index: 25 events h−1), sleep-related hypoventilation (transcutaneous carbon dioxide rise of 20 mmHg) and daytime hypercarbia (PCO2: 54 mmHg). Median durations of survival from HMV initiation were 1.0, 4.2, 9.9 and >11.5 years for MND, PULM, NMCW and OHS, respectively. Independent predictors of death varied between primary indications for HMV; the predictors included (a) age in all groups except for MND (hazard ratios (HRs) 1.03–1.10); (b) cardiovascular disease (HR: 2.35, 95% confidence interval (CI): 1.08–5.10) in MND; (c) obesity (HR: 0.28, 95% CI: 0.13–0.62) and oxygen therapy (HR: 0.33, 95% CI: 0.14–0.79) in PULM; and (d) forced expiratory volume in 1 s (%predicted; HR: 0.93, 95% CI: 0.88–1.00) in OHS.

AB - Home mechanical ventilation (HMV) is used in a wide range of disorders associated with chronic hypoventilation. We describe the patterns of use, survival and predictors of death in Western Australia. We identified 240 consecutive patients (60% male; mean age 58 years and body mass index 31 kg m−2) referred for HMV between 2005 and 2010. The patients were grouped into four categories: motor neurone disorders (MND; 39%), pulmonary disease (PULM; 25%, mainly chronic obstructive pulmonary disease), non-MND neuromuscular and chest wall disorders (NMCW; 21%) and the obesity hypoventilation syndrome (OHS; 15%). On average, the patients had moderate ventilatory impairment (forced vital capacity: 51%predicted), sleep apnoea (apnoea-hypopnea index: 25 events h−1), sleep-related hypoventilation (transcutaneous carbon dioxide rise of 20 mmHg) and daytime hypercarbia (PCO2: 54 mmHg). Median durations of survival from HMV initiation were 1.0, 4.2, 9.9 and >11.5 years for MND, PULM, NMCW and OHS, respectively. Independent predictors of death varied between primary indications for HMV; the predictors included (a) age in all groups except for MND (hazard ratios (HRs) 1.03–1.10); (b) cardiovascular disease (HR: 2.35, 95% confidence interval (CI): 1.08–5.10) in MND; (c) obesity (HR: 0.28, 95% CI: 0.13–0.62) and oxygen therapy (HR: 0.33, 95% CI: 0.14–0.79) in PULM; and (d) forced expiratory volume in 1 s (%predicted; HR: 0.93, 95% CI: 0.88–1.00) in OHS.

KW - Neuromuscular disease

KW - non-invasive ventilation

KW - obesity hypoventilation syndrome

KW - respiratory insufficiency

KW - survival

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