Long-term Survival in Elderly Patients with a Do-not-intubate Order Treated with Noninvasive Mechanical Ventilation

Overview

Journal Int J Chron Obstruct Pulmon Dis

Publisher Dove Medical Press

Specialty Pulmonary Medicine

Date 2011 Aug 5

PMID 21814461

Citations 6

Authors

Paolo Scarpazza

Cristoforo Incorvaia

Paolo Amboni

Giuseppe di Franco

Stefania Raschi

Pierfranco Usai

Monica Bernareggi

Cristiano Bonacina

Chiara Melacini

Roberta Cattaneo

Serena Bencini

Chiara Pravettoni

Gian Galeazzo Riario-Sforza

Gianni Passalacqua

Walter Casali

Affiliations

Soon will be listed here.

Abstract

Background: Noninvasive mechanical ventilation (NIMV) is an effective tool in treating patients with acute respiratory failure (ARF), since it reduces both the need for endotracheal intubation and the mortality in comparison with nonventilated patients. A particular issue is represented by the outcome of NIMV in patients referred to the emergency department for ARF and with a do-not-intubate (DNI) status because of advanced age or excessively critical conditions. This study evaluated long-term survival in a group of elderly patients with acute hypercapnic ARF who had a DNI order and who were successfully treated by NIMV.

Methods: The population consisted of 54 patients with a favorable outcome after NIMV for ARF. They were followed up for 3 years by regular control visits, with at least one visit every 4 months, or as needed according to the patient's condition. Of these, 31 continued NIMV at home and 23 were on long-term oxygen therapy (LTOT) alone.

Results: A total of 16 of the 52 patients had not survived at the 1-year follow-up, and another eight patients died during the 3-year observation, with an overall mortality rate of 30.8% after 1 year and 46.2% after 3 years. Comparing patients who continued NIMV at home with those who were on LTOT alone, 9 of the 29 patients on home NIMV died (6 after 1 year and 3 after 3 years) and 15 of the 23 patients on LTOT alone died (10 after 1 year and 5 after 3 years).

Conclusion: These results show that elderly patients with ARF successfully treated by NIMV following a DNI order have a satisfactory long-term survival.

Citing Articles

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Do not intubate order, is the misunderstanding finally over?.

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