title: Use of noninvasive ventilation on internal wards for elderly patients with limitations to respiratory care: a cohort study.
abstract: BACKGROUND
  The use of noninvasive positive pressure ventilation (NPPV) outside the intensive wards has been evaluated in patients with no limitation on life-sustaining support. Our aim was to evaluate its usefulness in general wards for patients with NPPV as the ceiling of ventilator care when admission to the intensive care unit (ICU) has been withheld.
  
  
  METHODS
  Noninvasive positive pressure ventilation was used in 44 patients with acute respiratory failure (ARF) and limitations to respiratory care- 22 with chronic obstructive pulmonary disease (COPD) exacerbations and 22 with acute cardiogenic pulmonary oedema (CPE). Survival at hospital discharge, and survival and readmission rate at 12 months were assessed.
  
  
  RESULTS
  Sixty-three per cent of COPD and 55% of CPE patients survived hospital discharge; and 50% and 37% respectively, were alive after 1 year. The cause of the in-hospital mortality was related to the admission diagnosis in 88% of cases. Cancer in COPD patients [P = 0·040, odds ratio (OR) = 15, 95% CI = 1·14-198] and the completion of NPPV treatment in both diseases (P = 0·008, OR = 0·03, 95% CI = 0·00-0·39 for COPD and P = 0·010, OR = 0·04, 95% CI = 0·00-0·45 for CPE) were related to in-hospital mortality. Fifty-six per cent of COPD and 33% of CPE patients that survived hospital admission were readmitted.
  
  
  CONCLUSIONS
  Our study suggests that the use of NPPV in general wards could be a safe and effective option, as a last choice treatment, in patients with NPPV as the ceiling of ventilator care when admission to ICU has been withheld.
authors.affiliation: Servicio de Medicina Interna, Hospital de los Montalvos, Hospital Universitario de Salamanca, Spain. lcorral@saludcastillayleon.es
authors.forename: Luis
authors.initials: L
authors.lastname: Corral-Gudino
authors.forename: Ramón José
authors.initials: RJ
authors.lastname: Jorge-Sánchez
authors.forename: Judit
authors.initials: J
authors.lastname: García-Aparicio
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Herrero-Herrero
authors.forename: Amparo
authors.initials: A
authors.lastname: López-Bernús
authors.forename: María
authors.initials: M
authors.lastname: Borao-Cengotita-Bengoa
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Martín-González
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Moreiro-Barroso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome