title: Long-term survival in elderly patients with a do-not-intubate order treated with noninvasive mechanical ventilation.
abstract: BACKGROUND
  Noninvasive mechanical ventilation (NIMV) is an effective tool in treating patients with acute respiratory failure (ARF), since it reduces both the need for endotracheal intubation and the mortality in comparison with nonventilated patients. A particular issue is represented by the outcome of NIMV in patients referred to the emergency department for ARF and with a do-not-intubate (DNI) status because of advanced age or excessively critical conditions. This study evaluated long-term survival in a group of elderly patients with acute hypercapnic ARF who had a DNI order and who were successfully treated by NIMV.
  
  
  METHODS
  The population consisted of 54 patients with a favorable outcome after NIMV for ARF. They were followed up for 3 years by regular control visits, with at least one visit every 4 months, or as needed according to the patient's condition. Of these, 31 continued NIMV at home and 23 were on long-term oxygen therapy (LTOT) alone.
  
  
  RESULTS
  A total of 16 of the 52 patients had not survived at the 1-year follow-up, and another eight patients died during the 3-year observation, with an overall mortality rate of 30.8% after 1 year and 46.2% after 3 years. Comparing patients who continued NIMV at home with those who were on LTOT alone, 9 of the 29 patients on home NIMV died (6 after 1 year and 3 after 3 years) and 15 of the 23 patients on LTOT alone died (10 after 1 year and 5 after 3 years).
  
  
  CONCLUSIONS
  These results show that elderly patients with ARF successfully treated by NIMV following a DNI order have a satisfactory long-term survival.
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: Paolo
authors.initials: P
authors.lastname: Amboni
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: Roberta
authors.initials: R
authors.lastname: Cattaneo
authors.forename: Serena
authors.initials: S
authors.lastname: Bencini
authors.forename: Chiara
authors.initials: C
authors.lastname: Pravettoni
authors.forename: Gian Galeazzo
authors.initials: GG
authors.lastname: Riario-Sforza
authors.forename: Gianni
authors.initials: G
authors.lastname: Passalacqua
authors.forename: Walter
authors.initials: W
authors.lastname: Casali
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006699:Home Care Services; D006801:Humans; D007442:Intubation, Intratracheal; D007558:Italy; D016015:Logistic Models; D008297:Male; D010102:Oxygen Inhalation Therapy; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D016414:Resuscitation Orders; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome