COPD AND OTHER DISEASES IN CHRONICALLY VENTILATED PATIENTS IN A PROLONGED RESPIRATORY CARE UNIT - A RETROSPECTIVE 20-YEAR SURVIVAL STUDY

Objectives: To evaluate the long-term prognosis of ventilator-dependen t patients. Design: Retrospective study. Setting: A prolonged respirat ory care unit (PRCU). The PRCU provides comprehensive medical, nursing , and respiratory care to tracheostomized, ventilator-dependent adult patients who had failed all attempts at weaning. Because of their medi cal complexity, these patients could not be discharged to a lower leve l of care. Patients: Of the 293 patients admitted to the PRCU over a 2 0-year period beginning January 1, 1977, 145 had respiratory failure f rom CORD, 22 from spinal cord disease or trauma, 34 from primary CNS d isease, 50 from primary neuromuscular disease, and 16 from chest wall disease, Twenty-six patients were not classifiable into the above cate gories. Measurements: Demographics, diagnoses, and survival data were reviewed. The survival of patients with COPD was compared with the oth er diagnosis categories using the Cox proportional hazards model. Resu lts: The median survival for the entire group was 9 months; younger ag e and female gender were both predictive of longer survival (both, p<0 .001). The median survival of those with COPD (5 months) was significa ntly shorter than that of patients with spinal cord disease (47 months ), neuromuscular disease (17 months), and chest wall disease (27 month s) (all, p<0.01). These differences in survival were present even with inclusion of gender and age in the model as covariates. The survival of patients with CNS disease was not significantly different from surv ival of patients with COPD. Conclusion: Chronically ventilated patient s with respiratory failure from COPD have a significantly worse progno sis than patients with respiratory failure from other causes.