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Yoon, Jun, Kim, Lee, Kim, Cha, Park, Jung, and Kim: Long-term Prognosis and Physiologic Status of Patients Requiring Ventilatory Support Secondary to Chest wall Disorders
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 61(3): 265-272.

Published online: 30 September 2006

DOI: https://doi.org/10.4046/trd.2006.61.3.265

Long-term Prognosis and Physiologic Status of Patients Requiring Ventilatory Support Secondary to Chest wall Disorders

Seok Jin Yoon, M.D., Hee Jung Jun, M.D., Yong Joo Kim, M.D., Seung Jun Lee, M.D., Eun Jin Kim, M.D., Seung Ick Cha, M.D., Jae Yong Park, M.D., Tae Hoon Jung, M.D., Chang Ho Kim, M.D.

Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.

Address for correspondence: Chang Ho Kim, M.D. Departments of internal medicine, Kyungpook University Hospital, 50, Samdeok 2-Ga, Jung-Gu, Daegu, Korea, 700-721. Tel: 053-420-5537, Fax: 053-427-1098, kimch@knu.ac.kr

Received 8 June 2006       Accepted 28 August 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Chest wall deformities such as kyphoscoliosis, thoracoplasty, and fibrothorax cause ventilatory insufficiency that can lead to chronic respiratory failure, with recurrent fatal acute respiratory failure(ARF). This study evaluated the frequency and outcome of ARF, the physiologic status, and the long-term prognosis of these patients.

Methods

Twenty-nine patients with chest wall disorders, who experienced the first requirement of ventilatory support from ARF were examined. The mortality and recurrence rate of ARF, the pulmonary functions with arterial blood gas analysis, the efficacy of home oxygen therapy, and the long-term survival rate were investigated.

Results

1) The mortality of the first ARF was 24.1%. ARF recurred more than once in 72.7% of the remaining 22 patients, and overall rate of successful weaning was 73.2%. 2) Twenty-two patients who recovered from the first ARF showed a restrictive ventilatory impairment with a mean FVC and TLC of 37.2% and 62.4 % of predicted value, respectively, and a mean PaCO2 of 57mmHg. Among the parameters of pulmonaty functions. the FVC(p=0.01) and VC(p=0.02) showed a significant correlation with the PaCO2 level. 3) There were no significant differences between the patients treated with conservative medical treatment only and those with additional home oxygen therapy due to significant hypoxemia in the patients with recurrent ARF and the mortality. 4) The 1, 3, 5-year survival rates were 75%, 66%, and 57%, respectively, in the 20 patients who had recovered from the first ARF, excluding the two patients managed by non-invasive nocturnal ventilatory support.

Conclusion

These results suggest that active ventilatory support should be provided to patients with ARF and chest wall disorders. However, considering recurrent ARF and weak effect of home oxygen therapy, non-invasive domiciliary ventilation is recommended in those patients with these conditions to achieve a better long-term prognosis.

Keywords: Chest wall disorder, Pulmonary functions, Respiratory failure, Home oxygen therapy

Figures and Tables

Figure 1
Episodes and outcomes of acute respiratory failure(ARF) requiring ventilatory support in 29 patients with chest wall disorders.
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Figure 2
Pulmonary functions after recovery from the first acute respiratory failure in patients with chest wall disorders. KS=kyphoscoliosis; TP=thoracoplasty; FT=fibrothorax.
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Figure 3
Correlations between arterial carbon dioxide tension(PaCO2) and pulmonaty functions. A: PaCO2 vs. vital capacity(VC); B: PaCO2 vs. forced vital capacity(FVC).
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Figure 4
Survival curve after recovery from the first acute respiratory failure in 20 patients with chest wall disorders.
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Table 1
Characteristics of subjects
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Table 2
Arterial blood gases after recovery from the first acute respiratory failure in patients with chest wall disorders
trd-61-265-i002

KS=kyphoscoliosis; TP=thoracoplasty; FT=fibrothorax.

Table 3
Comparisons between the patients treated with only conservative management and those with additional home-oxygen therapy
trd-61-265-i003

ARF=acute respiratory failure.

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