LONG-TERM NONINVASIVE DOMICILIARY ASSISTED VENTILATION FOR RESPIRATORY-FAILURE FOLLOWING THORACOPLASTY

Background - Ventilatory failure is a well recognised complication of patients who have had a thoracoplasty for tuberculosis, but there are few data regarding the value of long term non-invasive assisted ventil ation ion in this situation. Methods - Thirty two patients who had had a thoracoplasty 20-46 years previously and who had developed respirat ory failure were treated with nocturnal cuirass assisted ventilation o r nasal positive pressure ventilation. Their survival and changes in a rterial blood gases, nocturnal oximetry, and pulmonary function tests were assessed. Results - The actuarial survival rates at one, three, f ive, and seven years after starting treatment were 98%, 74%, 64%, and 55%, respectively. Only seven of the 13 deaths were directly attributa ble to chronic respiratory or cardiac failure. The arterial PO2, PCO2, , mean nocturnal oxygen saturation, vital capacity, and maximal inspir atory and expiratory pressures had all improved at the time of the ini tial posttreatment assessment (mean 12 days after starting treatment), but no subsequent improvements were seen after up to 48 months of fol low up. Neither survival nor physiological improvements were correlate d with the patients' age, the interval since thoracoplasty, or the pre treatment arterial blood gas tensions or results of pulmonary function tests. Conclusions - These results show that, even when ventilatory f ailure has developed, the prognosis with non-invasive assisted ventila tion is good and the physiological abnormalities can be partially reve rsed. Patients who develop respiratory failure after a thoracoplasty s hould be considered for this type of long term domiciliary treatment.