Control of hypercapnia and mortality in home mechanical ventilation: the population-based DISCOVERY study
Background Studies on the survival of patients with home mechanical ventilation (HMV) are sparse. We aimed to analyse the impact of controlled hypercapnia on survival over 27 years among patients with HMV in Sweden. Study design and methods Population-based cohort study of adult patients starting HM...
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| Format: | Article |
| Language: | English |
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European Respiratory Society
2024-12-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/10/6/00461-2024.full |
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| _version_ | 1841537044777533440 |
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| author | Andreas Palm Magnus Ekström Össur Emilsson Karin Ersson Mirjam Ljunggren Josefin Sundh Ludger Grote |
| author_facet | Andreas Palm Magnus Ekström Össur Emilsson Karin Ersson Mirjam Ljunggren Josefin Sundh Ludger Grote |
| author_sort | Andreas Palm |
| collection | DOAJ |
| description | Background
Studies on the survival of patients with home mechanical ventilation (HMV) are sparse. We aimed to analyse the impact of controlled hypercapnia on survival over 27 years among patients with HMV in Sweden.
Study design and methods
Population-based cohort study of adult patients starting HMV in the Swedish Registry for Respiratory Failure (Swedevox) during 1996–2022 cross-linked with the National Cause of Death registry. Mortality risk factors were analysed using crude and multivariable Cox regression models, including adjustments for anthropometrics, comorbidities, the underlying diagnosis causing chronic hypercapnic respiratory failure (CRF) and the control of hypercapnia (PaCO2 ≤6.0 kPa) at follow-up.
Results
We included 10 190 patients (50.1% women, age 62.9±14.5 years). Control of hypercapnia at follow-up after 1.3±0.9 years was associated with lower mortality, hazard ratio (HR) 0.74 (95% CI 0.68–0.80) and the association was strongest in those with pulmonary disease, restrictive thoracal disease (RTD), obesity hypoventilation syndrome (OHS) and amyotrophic lateral sclerosis (ALS). Predictors for increased mortality included age, Charlson Comorbidity Index, supplemental oxygen therapy and acute start of HMV therapy. Median survival varied between 0.8 years (95% CI 0.8–0.9 (n=1401)) for ALS and 7.6 years (95% CI 6.9–8.6 (n=1061)) for neuromuscular disease. Three-year survival decreased from 76% (95% CI 71–80) between 1996 and 1998 to 52% (95% CI 50–55) between 2017 and 2019. When adjusting for underlying diagnosis and age, the association between start year and decreased survival disappeared, HR 1.00 (95% CI 0.99–1.01).
Conclusion
Controlling PaCO2 is a key treatment goal for survival in HMV therapy. Survival differed markedly between diagnosis and age groups, and survival rates have declined as the patient group has aged. |
| format | Article |
| id | doaj-art-99bda9ec8721406ab23c92462b58919c |
| institution | Kabale University |
| issn | 2312-0541 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj-art-99bda9ec8721406ab23c92462b58919c2025-01-14T09:50:22ZengEuropean Respiratory SocietyERJ Open Research2312-05412024-12-0110610.1183/23120541.00461-202400461-2024Control of hypercapnia and mortality in home mechanical ventilation: the population-based DISCOVERY studyAndreas Palm0Magnus Ekström1Össur Emilsson2Karin Ersson3Mirjam Ljunggren4Josefin Sundh5Ludger Grote6 Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden Department of Clinical Sciences, Respiratory Medicine, Allergology and Palliative Medicine, Faculty of Medicine, Lund University, Lund, Sweden Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden Background Studies on the survival of patients with home mechanical ventilation (HMV) are sparse. We aimed to analyse the impact of controlled hypercapnia on survival over 27 years among patients with HMV in Sweden. Study design and methods Population-based cohort study of adult patients starting HMV in the Swedish Registry for Respiratory Failure (Swedevox) during 1996–2022 cross-linked with the National Cause of Death registry. Mortality risk factors were analysed using crude and multivariable Cox regression models, including adjustments for anthropometrics, comorbidities, the underlying diagnosis causing chronic hypercapnic respiratory failure (CRF) and the control of hypercapnia (PaCO2 ≤6.0 kPa) at follow-up. Results We included 10 190 patients (50.1% women, age 62.9±14.5 years). Control of hypercapnia at follow-up after 1.3±0.9 years was associated with lower mortality, hazard ratio (HR) 0.74 (95% CI 0.68–0.80) and the association was strongest in those with pulmonary disease, restrictive thoracal disease (RTD), obesity hypoventilation syndrome (OHS) and amyotrophic lateral sclerosis (ALS). Predictors for increased mortality included age, Charlson Comorbidity Index, supplemental oxygen therapy and acute start of HMV therapy. Median survival varied between 0.8 years (95% CI 0.8–0.9 (n=1401)) for ALS and 7.6 years (95% CI 6.9–8.6 (n=1061)) for neuromuscular disease. Three-year survival decreased from 76% (95% CI 71–80) between 1996 and 1998 to 52% (95% CI 50–55) between 2017 and 2019. When adjusting for underlying diagnosis and age, the association between start year and decreased survival disappeared, HR 1.00 (95% CI 0.99–1.01). Conclusion Controlling PaCO2 is a key treatment goal for survival in HMV therapy. Survival differed markedly between diagnosis and age groups, and survival rates have declined as the patient group has aged.http://openres.ersjournals.com/content/10/6/00461-2024.full |
| spellingShingle | Andreas Palm Magnus Ekström Össur Emilsson Karin Ersson Mirjam Ljunggren Josefin Sundh Ludger Grote Control of hypercapnia and mortality in home mechanical ventilation: the population-based DISCOVERY study ERJ Open Research |
| title | Control of hypercapnia and mortality in home mechanical ventilation: the population-based DISCOVERY study |
| title_full | Control of hypercapnia and mortality in home mechanical ventilation: the population-based DISCOVERY study |
| title_fullStr | Control of hypercapnia and mortality in home mechanical ventilation: the population-based DISCOVERY study |
| title_full_unstemmed | Control of hypercapnia and mortality in home mechanical ventilation: the population-based DISCOVERY study |
| title_short | Control of hypercapnia and mortality in home mechanical ventilation: the population-based DISCOVERY study |
| title_sort | control of hypercapnia and mortality in home mechanical ventilation the population based discovery study |
| url | http://openres.ersjournals.com/content/10/6/00461-2024.full |
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