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-dependent patients. DESIGN Retrospective study. SETTING A prolonged respiratory 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 medical complexity, these patients could not be discharged to a lower level of care. PATIENTS Of the 293 patients admitted to the PRCU over a 20-year period beginning January 1, 1977, 145 had respiratory failure from COPD, 22 from spinal cord disease or trauma, 34 from primary CNS disease, 50 from primary neuromuscular disease, and 16 from chest wall disease. Twenty-six patients were not classifiable into the above categories. MEASUREMENTS Demographics, diagnoses, and survival data were reviewed. The survival of patients with COPD was compared with the other diagnosis categories using the Cox proportional hazards model. RESULTS The median survival for the entire group was 9 months; younger age and female gender were both predictive of longer survival (both, p < 0.001). The median survival of those with COPD (5 months) was significantly shorter than that of patients with spinal cord disease (47 months), neuromuscular disease (17 months), and chest wall disease (27 months) (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 survival of patients with COPD. CONCLUSION Chronically ventilated patients with respiratory failure from COPD have a significantly worse prognosis than patients with respiratory failure from other causes.