Noninvasive Ventilation in Patients with "do-not-intubate" Orders: Medium-term Efficacy Depends Critically on Patient Selection

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2006 Nov 10

PMID 17093982

Citations 14

Authors

Rafael Fernandez

Francisco Baigorri

Antonio Artigas

Affiliations

Soon will be listed here.

Abstract

Objective: Randomized clinical trials demonstrating benefits of noninvasive ventilation (NIV) systematically exclude patients with "do-not-intubate" (DNI) orders, but in daily clinical practice these patients are frequently treated with NIV. A recent North American study found a 43% hospital survival rate in patients with DNI orders. Our hypothesis was that, due to the very different social and cultural setting, written DNI orders in a southern European country would be restricted to a population with a poor outcome, independently of whether they receive NIV, and we analyzed hospital survival in patients receiving NIV and the impact of DNI orders on survival.

Design And Setting: Retrospective cohort study in a general ICU in a university-affiliated hospital.

Patients And Methods: All 233 patients treated with NIV during 2002-2004. We recorded clinical characteristics on admission, mortality risk by APACHE II and ICU and hospital outcome, and 6-month outcome.

Results: Hospital survival was 66%. Survival was better in the 199 patients without DNI orders than in the 36 with DNI orders both during hospitalization (74% vs. 26%, OR 7.9) and after 6 months (64% vs. 15%, OR 10.2). In both groups the presence of COPD was associated with better prognosis during hospitalization, but not in the medium-term.

Conclusion: Our study suggests that NIV offers low expectations for medium-term survival in DNI patients.

Citing Articles

Focus on the Role of Non-Invasive Respiratory Support (NRS) during Palliative Care in Patients with Life-Limiting Respiratory Disease.

Spinazzola G, Ferrone G, Michi T, Torrini F, Postorino S, Sbaraglia F J Clin Med. 2024; 13(17).

PMID: 39274381 PMC: 11396473. DOI: 10.3390/jcm13175165.

Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL.

Robert R, Frasca D, Badin J, Girault C, Guitton C, Djibre M BMJ Open. 2021; 11(2):e045659.

PMID: 33579774 PMC: 7883857. DOI: 10.1136/bmjopen-2020-045659.

Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis.

Wilson M, Mittal A, Karki B, Dobler C, Wahab A, Curtis J Intensive Care Med. 2019; 46(1):36-45.

PMID: 31659387 PMC: 7223954. DOI: 10.1007/s00134-019-05828-2.

Resource use, characteristics and outcomes of prolonged non-invasive ventilation: a single-centre observational study in China.

Duan J, Bai L, Zhou L, Han X, Jiang L, Huang S BMJ Open. 2018; 8(12):e019271.

PMID: 30518577 PMC: 6286472. DOI: 10.1136/bmjopen-2017-019271.

Recent advances in the role of non-invasive ventilation in acute respiratory failure.

Bhattacharyya D, Prasad B, Rajput A Med J Armed Forces India. 2016; 67(2):187-91.

PMID: 27365800 PMC: 4920747. DOI: 10.1016/S0377-1237(11)60034-8.

References

Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito J . Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA. 2005; 294(24):3124-30. DOI: 10.1001/jama.294.24.3124. View

Meduri G, FOX R, Leeper K, Wunderink R . Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation. Crit Care Med. 1994; 22(10):1584-90. View

Schettino G, Altobelli N, Kacmarek R . Noninvasive positive pressure ventilation reverses acute respiratory failure in select "do-not-intubate" patients. Crit Care Med. 2005; 33(9):1976-82. DOI: 10.1097/01.ccm.0000178176.51024.82. View

Chu C, Chan V, Lin A, Wong I, Leung W, Lai C . Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure. Thorax. 2004; 59(12):1020-5. PMC: 1746916. DOI: 10.1136/thx.2004.024307. View

Auriant I, Jallot A, Herve P, Cerrina J, Le Roy Ladurie F, Fournier J . Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med. 2001; 164(7):1231-5. DOI: 10.1164/ajrccm.164.7.2101089. View

Caples S, Gay P . Noninvasive positive pressure ventilation in the intensive care unit: a concise review. Crit Care Med. 2005; 33(11):2651-8. DOI: 10.1097/01.ccm.0000186768.61570.69. View

Antonelli M, Conti G, Bufi M, Costa M, Lappa A, Rocco M . Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA. 2000; 283(2):235-41. DOI: 10.1001/jama.283.2.235. View

King M, Nazareth I, Lampe F, Bower P, Chandler M, Morou M . Impact of participant and physician intervention preferences on randomized trials: a systematic review. JAMA. 2005; 293(9):1089-99. DOI: 10.1001/jama.293.9.1089. View

Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A . Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med. 2003; 168(12):1438-44. DOI: 10.1164/rccm.200301-072OC. View

10.

Selecky P, Eliasson C, Hall R, Schneider R, Varkey B, McCaffree D . Palliative and end-of-life care for patients with cardiopulmonary diseases: American College of Chest Physicians position statement. Chest. 2005; 128(5):3599-610. DOI: 10.1378/chest.128.5.3599. View

11.

Confalonieri M, Potena A, Carbone G, Porta R, Tolley E, Meduri G . Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med. 1999; 160(5 Pt 1):1585-91. DOI: 10.1164/ajrccm.160.5.9903015. View

12.

Keenan S, Sinuff T, Cook D, Hill N . Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review. Crit Care Med. 2004; 32(12):2516-23. DOI: 10.1097/01.ccm.0000148011.51681.e2. View

13.

Cuomo A, Delmastro M, Ceriana P, Nava S, Conti G, Antonelli M . Noninvasive mechanical ventilation as a palliative treatment of acute respiratory failure in patients with end-stage solid cancer. Palliat Med. 2004; 18(7):602-10. DOI: 10.1191/0269216304pm933oa. View

14.

Levy M, Tanios M, Nelson D, Short K, Senechia A, Vespia J . Outcomes of patients with do-not-intubate orders treated with noninvasive ventilation. Crit Care Med. 2004; 32(10):2002-7. DOI: 10.1097/01.ccm.0000142729.07050.c9. View

15.

Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M . Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med. 2001; 344(7):481-7. DOI: 10.1056/NEJM200102153440703. View

16.

Tanvetyanon T . Which patient with a do-not-intubate order is a candidate for noninvasive ventilation?. Crit Care Med. 2004; 32(10):2148-50. DOI: 10.1097/01.ccm.0000142903.66336.e6. View

17.

van Delden J, Lofmark R, Deliens L, Bosshard G, Norup M, Cecioni R . Do-not-resuscitate decisions in six European countries. Crit Care Med. 2006; 34(6):1686-90. DOI: 10.1097/01.CCM.0000218417.51292.A7. View