NEUROMUSCULAR VENTILATORY INSUFFICIENCY - EFFECT OF HOME MECHANICAL VENTILATOR USE V OXYGEN-THERAPY ON PNEUMONIA AND HOSPITALIZATION RATES

The purpose of this study was to determine rates of pneumonia and hosp italization for patients receiving oxygen therapy, patients having ind welling tracheostomy tubes, and those using tracheostomy or noninvasiv e methods of home mechanical ventilation. Six hundred eighty-four user s of assisted ventilation for 13,751 patient-years or 19.8 years per p atient were surveyed by mail and twice by telephone over a span of fou r years. Pneumonia and hospitalization rates were significantly higher for ventilator users with chronic obstructive pulmonary disease or wi th neuromuscular ventilatory insufficiency and gastrostomy tubes than for ventilator users with neuromuscular ventilatory insufficiency with out gastrostomy tubes. Of the latter group, more than 90% of the pneum onias and hospitalizations were triggered by otherwise benign intercur rent upper respiratory tract infections. Oxygen therapy was associated with a significantly (P < 0.001) higher rate of pneumonias and hospit alizations than that seen for untreated patients after initial episode s of respiratory distress or during the use of either tracheostomy int ermittent positive pressure ventilation or noninvasive ventilatory ass istance methods. The lowest pneumonia and hospitalization rates (P < 0 .001) were by full-time, noninvasive intermittent positive pressure ve ntilation users. We conclude that oxygen therapy is not an effective s ubstitute for assisted ventilation for patients with primarily ventila tory insufficiency. Noninvasive ventilatory aids can be used effective ly for up to full-time ventilatory support for patients with neuromusc ular conditions whose bulbar muscle function is adequate to avert the need for gastrostomy tube placement.