title: Noninvasive mechanical ventilation in patients having declined tracheal intubation.
abstract: OBJECTIVE
  Noninvasive ventilation (NIV) is a treatment option in patients with acute respiratory failure who are good candidates for intensive care but have declined tracheal intubation. The aim of our study was to report outcomes after NIV in patients with a do-not-intubate (DNI) order.
  
  
  METHODS
  Prospective observational cohort study in all patients who received NIV for acute respiratory failure in 54 ICUs in France and Belgium, in 2010/2011.
  
  
  RESULTS
  Goals of care, comfort, and vital status were assessed daily. On day 90, a telephone interview with patients and relatives recorded health-related quality of life (HRQOL), posttraumatic stress disorder-related symptoms, and symptoms of anxiety and depression. Post-ICU burden was compared between DNI patients and patients receiving NIV with no treatment-limitation decisions (TLD). Of 780 NIV patients, 574 received NIV with no TLD, and 134 had DNI orders. Hospital mortality was 44 % in DNI patients and 12 % in the no-TLD group. Mortality in the DNI group was lowest in COPD patients compared to other patients in the DNI group (34 vs. 51 %, P = 0.01). In the DNI group, HRQOL showed no significant decline on day 90 compared to baseline; day-90 data of patients and relatives did not differ from those in the no-TLD group.
  
  
  CONCLUSIONS
  Do-not-intubate status was present among one-fifth of ICU patients who received NIV. DNI patients who were alive on day 90 experienced no decrease in HRQOL compared to baseline. The prevalences of anxiety, depression, and PTSD-related symptoms in these patients and their relatives were similar to those seen after NIV was used as part of full-code management (clinicaltrial.govNCT01449331).
authors.affiliation: Medical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecine, Université Paris-Diderot, Sorbonne Paris-Cité, 1 avenue Claude Vellefaux, 75010 Paris, France. elie.azoulay@sls.ap-hop-paris.fr
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Jérôme
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authors.lastname: Lambert
authors.forename: Ferhat
authors.initials: F
authors.lastname: Meziani
authors.forename: Matthieu
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authors.lastname: Schmidt
authors.forename: David
authors.initials: D
authors.lastname: Schnell
authors.forename: Satar
authors.initials: S
authors.lastname: Mortaza
authors.forename: Matthieu
authors.initials: M
authors.lastname: Conseil
authors.forename: Xavier
authors.initials: X
authors.lastname: Tchenio
authors.forename: Patrick
authors.initials: P
authors.lastname: Herbecq
authors.forename: Pierre
authors.initials: P
authors.lastname: Andrivet
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Guerot
authors.forename: Ariane
authors.initials: A
authors.lastname: Lafabrie
authors.forename: Sébastien
authors.initials: S
authors.lastname: Perbet
authors.forename: Laurent
authors.initials: L
authors.lastname: Camous
authors.forename: Ralf
authors.initials: R
authors.lastname: Janssen-Langenstein
authors.forename: François
authors.initials: F
authors.lastname: Collet
authors.forename: Jonathan
authors.initials: J
authors.lastname: Messika
authors.forename: Stéphane
authors.initials: S
authors.lastname: Legriel
authors.forename: Xavier
authors.initials: X
authors.lastname: Fabre
authors.forename: Olivier
authors.initials: O
authors.lastname: Guisset
authors.forename: Samia
authors.initials: S
authors.lastname: Touati
authors.forename: Sarah
authors.initials: S
authors.lastname: Kilani
authors.forename: Michael
authors.initials: M
authors.lastname: Alves
authors.forename: Alain
authors.initials: A
authors.lastname: Mercat
authors.forename: Thomas
authors.initials: T
authors.lastname: Similowski
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
authors.forename: Anne-Pascale
authors.initials: AP
authors.lastname: Meert
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Benoît
authors.initials: B
authors.lastname: Schlemmer
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.forename: Alexandre
authors.initials: A
authors.lastname: Demoule
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D015331:Cohort Studies; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000009:adverse effects; D011446:Prospective Studies; D011788:Quality of Life; D012131:Respiratory Insufficiency / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology; D016312:Treatment Refusal