title: Effect of noninvasive mechanical ventilation in elderly patients with hypercapnic acute-on-chronic respiratory failure and a do-not-intubate order.
abstract: Noninvasive mechanical ventilation (NIMV) is effective in the treatment of patients with acute respiratory failure (ARF). It proved to reduce the need of endotracheal intubation (ETI), the incidence of ETI-associated pneumonia, and mortality compared to nonventilated patients. A particular aspect concerns the outcome of NIMV in patients referring to an emergency room (ER) for ARF, and with a do-not-intubate (DNI) status due to advanced age or critical conditions. The aim of our study is to assess the outcome of NIMV in a group of elderly patients with acute hypercapnic ARF who had a DNI status. An overall number of 62 subjects (30 males, 32 females, mean age 81 +/- 4.8 years, range 79-91 years) referred to our semi-intensive respiratory department were enrolled in the study. The underlying diseases were severe chronic obstructive pulmonary disease (COPD) in 50/62 subjects, restrictive thoracic disorders in 7/62 subjects, and multiorgan failure in 5/62 subjects. Fifty-four/62 patients were successfully treated with NIMV while 2/62 did not respond to NIMV and were therefore submitted to ETI (one survived). Among NIMV-treated patients, death occurred in 6 patients after a mean of 9.9 days; the overall rate of NIMV failure was 12.9%. Negative prognostic factors for NIMV response proved to be: an older age, a low Glasgow Coma Score, a high APACHE score at admission, a high PaCO2 after 12 hours and a low pH both after 1 and 12 hours of NIMV. We conclude that elderly patients with acute hypercapnic ARF with a DNI status can be successfully treated by NIMV.
authors.affiliation: Divisione di Broncopneumotisiologia, Ospedale Civile,Vimercate, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Scarpazza
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Incorvaia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: di Franco
authors.forename: Stefania
authors.initials: S
authors.lastname: Raschi
authors.forename: Pierfranco
authors.initials: P
authors.lastname: Usai
authors.forename: Monica
authors.initials: M
authors.lastname: Bernareggi
authors.forename: Cristiano
authors.initials: C
authors.lastname: Bonacina
authors.forename: Chiara
authors.initials: C
authors.lastname: Melacini
authors.forename: Silvia
authors.initials: S
authors.lastname: Vanni
authors.forename: Serena
authors.initials: S
authors.lastname: Bencini
authors.forename: Chiara
authors.initials: C
authors.lastname: Pravettoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Cara
authors.forename: Mona-Rita
authors.initials: MR
authors.lastname: Yacoub
authors.forename: Gian Galeazzo
authors.initials: GG
authors.lastname: Riario-Sforza
authors.forename: Enrico
authors.initials: E
authors.lastname: Guffanti
authors.forename: Walter
authors.initials: W
authors.lastname: Casali
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000097:blood; D002908:Chronic Disease; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006935:Hypercapnia / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D007442:Intubation, Intratracheal; D008297:Male; D012121:Respiration, Artificial / Q000401:mortality; D012131:Respiratory Insufficiency / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016414:Resuscitation Orders; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D002245:Carbon Dioxide