Effect of noninvasive mechanical ventilation in elderly patients with hypercapnic acute-on-chronic respiratory failure and a do-not-intubate order

Paolo Scarpazza, Cristoforo Incorvaia, Giuseppe di Franco, Stefania Raschi, Pierfranco Usai, Monica Bernareggi, Cristiano Bonacina, Chiara Melacini, Silvia Vanni, Serena Bencini, Chiara Pravettoni, Giuseppe Di Cara, Mona Rita Yacoub, Gian Galeazzo Riario-Sforza, Enrico Guffanti, Walter Casali

Research output: Contribution to journalArticle

Abstract

Noninvasive mechanical ventilation (NIMV) is effective in the treatment of patients with acute respiratory failure (ARF). It proved to reduce the need of endotracheal intubation (ETI), the incidence of ETI-associated pneumonia, and mortality compared to nonventilated patients. A particular aspect concerns the outcome of NIMV in patients referring to an emergency room (ER) for ARF, and with a do-not-intubate (DNI) status due to advanced age or critical conditions. The aim of our study is to assess the outcome of NIMV in a group of elderly patients with acute hypercapnic ARF who had a DNI status. An overall number of 62 subjects (30 males, 32 females, mean age 81 ± 4.8 years, range 79-91 years) referred to our semi-intensive respiratory department were enrolled in the study. The underlying diseases were severe chronic obstructive pulmonary disease (COPD) in 50/62 subjects, restrictive thoracic disorders in 7/62 subjects, and multiorgan failure in 5/62 subjects. Fifty-four/62 patients were successfully treated with NIMV while 2/62 did not respond to NIMV and were therefore submitted to ETI (one survived). Among NIMV-treated patients, death occurred in 6 patients after a mean of 9.9 days; the overall rate of NIMV failure was 12.9%. Negative prognostic factors for NIMV response proved to be: an older age, a low Glasgow Coma Score, a high APACHE score at admission, a high PaCO2 after 12 hours and a low pH both after 1 and 12 hours of NIMV. We conclude that elderly patients with acute hypercapnic ARE with a DNI status can be successfully treated by NIMV.

Original languageEnglish
Pages (from-to)797-801
Number of pages5
JournalInternational Journal of COPD
Volume3
Issue number4
Publication statusPublished - 2008

Keywords

  • Acute respiratory failure
  • COPD
  • Do-not-intubate
  • Endotracheal intubation
  • Noninvasive mechanical ventilation
  • Oxygen therapy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Public Health, Environmental and Occupational Health
  • Health Policy

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  • Cite this

    Scarpazza, P., Incorvaia, C., di Franco, G., Raschi, S., Usai, P., Bernareggi, M., Bonacina, C., Melacini, C., Vanni, S., Bencini, S., Pravettoni, C., Di Cara, G., Yacoub, M. R., Riario-Sforza, G. G., Guffanti, E., & Casali, W. (2008). Effect of noninvasive mechanical ventilation in elderly patients with hypercapnic acute-on-chronic respiratory failure and a do-not-intubate order. International Journal of COPD, 3(4), 797-801.