Mechanical Ventilation: Analysis of Increasing Use and Patient Survival

Abstract

To quantitate and assess an increase in the use of me chanical ventilation, we retrospectively analyzed the records of 1,589 patients treated with mechanical ven tilation. Between 1974 and 1983, there was a 156% increase in the number of patients treated each year. There were significant increases in the number of pa tients with cardiac pulmonary edema (p < 0.001), adult respiratory distress syndrome (p < 0.01), chronic ob structive lung disease (p < 0.005), neuromuscular dis ease (p < 0.025), and cardiopulmonary arrest (p < 0.005). Regression analysis versus time shows that older patients (p < 0.025) and more chronically ill patients (p < 0.05) are now being treated with mechanical ven tilation. Overall survival was 41.4%, and yearly survival rates remained constant during the ten-year period. Sur vival was 55.3% for patients with cardiogenic pulmo nary edema, 34.1 % for the adult respiratory distress syn drome, 65.7% for chronic obstructive lung disease, 90.5% for asthma, 38.7% for neuromuscular disease, 92.1% for drug overdose, 33.7% for pneumonia, and 19.1 % for cardiopulmonary arrest. Studies are needed that will determine predictors of survival from acute respiratory failure for patients with chronic heart and lung disease. Such predictors will help physicians coun sel their patients when making the decision to be treated with mechanical ventilation in the event of re spiratory failure.