title: Results of noninvasive ventilation in very old patients.
abstract: BACKGROUND
  Noninvasive ventilation (NIV) is frequently used for the management of acute respiratory failure (ARF) in very old patients (≥ 80 years), often in the context of a do-not-intubate order (DNI). We aimed to determine its efficacy and long-term outcome.
  
  
  METHODS
  Prospective cohort of all patients admitted to the medical ICU of a tertiary hospital during a 2-year period and managed using NIV. Characteristics of patients, context of NIV, and treatment intensity were compared for very old and younger patients. Six-month survival and functional status were assessed in very old patients.
  
  
  RESULTS
  During the study period, 1,019 patients needed ventilatory support and 376 (37%) received NIV. Among them, 163 (16%) very old patients received ventilatory support with 60% of them managed using NIV compared with 32% of younger patients (p < 0.0001). Very old patients received NIV more frequently with DNI than in younger patients (40% vs. 8%). Such cases were associated with high mortality for both very old and younger patients. Hospital mortality was higher in very old than in younger patients but did not differ when NIV was used for cardiogenic pulmonary edema or acute-on-chronic respiratory failure (20% vs. 15%) and in postextubation (15% vs. 17%) out of a context of DNI. Six-month mortality was 51% in very old patients, 67% for DNI patients, and 77% in case of NIV failure and endotracheal intubation. Of the 30 hospital survivors, 22 lived at home and 13 remained independent for activities of daily living.
  
  
  CONCLUSIONS
  Very old patients managed using NIV have an overall satisfactory 6-month survival and functional status, except for endotracheal intubation after NIV failure.
authors.affiliation: AP-HP, Groupe Hospitalier Albert Chenevier-Henri Mondor, Réanimation Médicale, Créteil, France. frederique.schortgen@hmn.aphp.fr.
authors.forename: Frederique
authors.initials: F
authors.lastname: Schortgen
authors.forename: Arnaud
authors.initials: A
authors.lastname: Follin
authors.forename: Lucilla
authors.initials: L
authors.lastname: Piccari
authors.forename: Ferran
authors.initials: F
authors.lastname: Roche-Campo
authors.forename: Guillaume
authors.initials: G
authors.lastname: Carteaux
authors.forename: Elodie
authors.initials: E
authors.lastname: Taillandier-Heriche
authors.forename: Sebastien
authors.initials: S
authors.lastname: Krypciak
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille
authors.forename: Elena
authors.initials: E
authors.lastname: Paillaud
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard