title: Non-invasive ventilation for acute hypercapnic respiratory failure in older patients.
abstract: BACKGROUND
  This trial was conducted to carry out an age and etiology-based analysis of the clinical efficacy of non-invasive ventilation (NIV) in acute hypercapnic respiratory failure (AHRF).
  
  
  METHODS
  This single center, prospective, cohort study included patients aged ≥65 years with chronic obstructive pulmonary disease (COPD), acute cardiogenic pulmonary edema (ACPE), community-acquired pneumonia (CAP), bronchiectasis, and kyphoscoliosis, who were treated with NIV for AHRF in the intensive care unit within a 4-year period.
  
  
  RESULTS
  From 496 patients aged 65 years or older treated with NIV for AHRF, 162 patients were included. Of the patients 71 were aged 65-74 years, 70 were 75-84 years, and 21 were aged ≥85 years. Of the patients 90 had COPD, 31 had ACPE, 19 had CAP, 15 had bronchiectasis exacerbation and 7 had kyphoscoliosis as the AHRF etiology. The treatment with NIV was successful in 119 patients. No significant difference was found between the age groups regarding NIV success rates (p = 0.803). An etiology-based analysis revealed that NIV was significantly more successful in the COPD and ACPE groups (p = 0.029, p = 0.035). A multivariate analysis revealed that Glasgow coma scale (GCS) (hazard ratio HR 0.215, 95% confidence interval CI: 0.104 to 0.442; p < 0.001), COPD assessment test (CAT) (HR 1.563, 95%CI: 1.229 to 1.987; p < 0.001), and acute physiology and chronic health evaluation (APACHE) ΙΙ (HR 1.009, 95%CI: 1.001 to 1.018; p = 0.031) as significant independent predictors of NIV failure in patients with COPD and AHRF.
  
  
  CONCLUSIONS
  The efficacy of NIV was independent of age in patients aged ≥65 years with AHRF and NIV was most successful when the etiology of AHRF was COPD or ACPE. Dyspnea level, GCS, and APACHE-ΙΙ scores were independent predictors of NIV failure in COPD.
authors.affiliation: School of Medicine, Department of Chest Disease, Ankara University, Ankara, Turkey. fciftci@ankara.edu.tr.
authors.forename: Fatma
authors.initials: F
authors.lastname: Çiftci
authors.affiliation: School of Medicine, Department of Chest Disease, Ankara University, Ankara, Turkey.
authors.forename: Aydın
authors.initials: A
authors.lastname: Çiledağ
authors.affiliation: School of Medicine, Department of Chest Disease, Ankara University, Ankara, Turkey.
authors.forename: Serhat
authors.initials: S
authors.lastname: Erol
authors.affiliation: School of Medicine, Department of Chest Disease, Ankara University, Ankara, Turkey.
authors.forename: Akın
authors.initials: A
authors.lastname: Kaya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001987:Bronchiectasis / Q000175:diagnosis / Q000628:therapy; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000175:diagnosis / Q000628:therapy*; D007738:Kyphosis / Q000175:diagnosis / Q000628:therapy; D008297:Male; D063087:Noninvasive Ventilation; D011014:Pneumonia / Q000175:diagnosis / Q000628:therapy; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy; D011654:Pulmonary Edema / Q000175:diagnosis / Q000628:therapy; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000628:therapy*; D012600:Scoliosis / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
keywords: Acute cardiogenic pulmonary edema; Acute hypercapnic respiratory failure; Chronic obstructive pulmonary disease; Elderly; Non-invasive ventilation