title: [Non-invasive ventilation in 'do-not-intubate' patients in a chronic disease hospital. One year follow-up study].
abstract: Elderly patients with multiple morbidity and do not intubate (DNI) orders frequently present with acute respiratory failure. There are data supporting the effectiveness of non-invasive ventilation (NIV) in this context. Our chronic disease hospital developed an integrated care clinical pathway for the use of NIV in acute respiratory failure in the emergency room and wards in 2010. The aim of this study was to assess the outcome of NIV in patients with acute respiratory failure who had a DNI order in a sub-acute care hospital.
  
  
  METHODS
  Observational, one year-follow up study. The main variables were in-hospital mortality and one year mortality. Other variables recorded were: demographics, clinical data, functional data, performance of daily life activities, dementia, arterial blood gases and re-admissions.
  
  
  RESULTS
  The study included a total of 102 patients, of which 22% were in institutions. The mean age 81±7.47% males, with a Charlson index 3.7±1, and Barthel index 54±31. The overall mortality during the admission was 33% (34 patients). Among those patients ventilated outside the protocol indication, the mortality was significantly greater, at 71% (P>.05). Overall one-year survival rate was 46%. This survival rate was statistically higher in patients with obesity hypoventilation syndrome and a Barthel >50.
  
  
  CONCLUSIONS
  NIV is a useful technique in a hospital for chronic patients in an elderly population with a therapeutic ceiling. Despite their disease severity and comorbidity, acceptable survival rates are achieved. A correct case selection is needed. Obesity hypoventilation syndrome and those with Barthel index >50 have a better prognosis.
authors.affiliation: Servicio de Neumología, Hospital de Santa Marina, Bilbao, España. Electronic address: evataberna@yahoo.es.
authors.forename: Eva
authors.initials: E
authors.lastname: Tabernero Huguet
authors.affiliation: Servicio de Neumología, Hospital de Santa Marina, Bilbao, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Gil Alaña
authors.affiliation: Unidad de Investigación, Hospital de Cruces, Barakaldo, España.
authors.forename: Eunate
authors.initials: E
authors.lastname: Arana-Arri
authors.affiliation: Unidad de Investigación, Hospital de Cruces, Barakaldo, España.
authors.forename: Leyre
authors.initials: L
authors.lastname: Citores Martín
authors.affiliation: Servicio de Neumología, Hospital de Santa Marina, Bilbao, España.
authors.forename: Ramon
authors.initials: R
authors.lastname: Alkiza Basañez
authors.affiliation: Servicio de Neumología, Hospital de Santa Marina, Bilbao, España.
authors.forename: Anibal
authors.initials: A
authors.lastname: Hernandez Gil
authors.affiliation: Servicio de Urgencias, Hospital de Santa Marina, Bilbao, España.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Gil Molet
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006763:Hospitals, Chronic Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D011247:Pregnancy; D029424:Pulmonary Disease, Chronic Obstructive; D012131:Respiratory Insufficiency / Q000628:therapy*; D016414:Resuscitation Orders
keywords: Acute respiratory failure; Ancianos; Do not intubate; Elderly; Fracaso ventilatorio agudo; Limitación terapéutica; Non-invasive ventilation; Ventilación mecánica no invasiva