Journal Article

Noninvasive mechanical ventilation in patients having declined tracheal intubation

Janssen-Langenstein, Ralf, Messika, Jonathan, Meert, Anne-Pascale, Azoulay, Élie, Schmidt, Matthieu, Jaber, Samir, Mortaza, Satar, Guisset, Olivier, Alves, Michael, Legriel, Stéphane, Demoule, Alexandre, Kouatchet, Achille, Perbet, Sébastien, Meziani, Ferhat, Lafabrie, Ariane, Brochard, Laurent, Lambert, Jérôme, Fabre, Xavier, Similowski, Thomas, Conseil, Matthieu, Andrivet, Pierre, Schnell, David, Herbecq, Patrick, Schlemmer, Benoît, Mercat, Alain, Chevret, Sylvie, Touati, Samia, Papazian, Laurent, Guerot, Emmanuel, Kilani, Sarah, Tchenio, Xavier, Collet, François, Camous, Laurent

2013

Overview

Purpose Noninvasive ventilation (NIV) is a treatment option in patients with acute respiratory failure who are good candidates for intensive care but have declined tracheal intubation. The aim of our study was to report outcomes after NIV in patients with a do-not-intubate (DNI) order. Methods Prospective observational cohort study in all patients who received NIV for acute respiratory failure in 54 ICUs in France and Belgium, in 2010/2011. Results Goals of care, comfort, and vital status were assessed daily. On day 90, a telephone interview with patients and relatives recorded health-related quality of life (HRQOL), posttraumatic stress disorder-related symptoms, and symptoms of anxiety and depression. Post-ICU burden was compared between DNI patients and patients receiving NIV with no treatment-limitation decisions (TLD). Of 780 NIV patients, 574 received NIV with no TLD, and 134 had DNI orders. Hospital mortality was 44 % in DNI patients and 12 % in the no-TLD group. Mortality in the DNI group was lowest in COPD patients compared to other patients in the DNI group (34 vs. 51 %, P  = 0.01). In the DNI group, HRQOL showed no significant decline on day 90 compared to baseline; day-90 data of patients and relatives did not differ from those in the no-TLD group. Conclusions Do-not-intubate status was present among one-fifth of ICU patients who received NIV. DNI patients who were alive on day 90 experienced no decrease in HRQOL compared to baseline. The prevalences of anxiety, depression, and PTSD-related symptoms in these patients and their relatives were similar to those seen after NIV was used as part of full-code management (clinicaltrial.govNCT01449331).

• Publisher: Springer-Verlag,Springer,Springer Nature B.V,Springer Verlag
• Subject: Acute respiratory distress syndrome / Aged / Aged, 80 and over / Anesthesiology / Anxiety / Anxiety - etiology / Belgium / Biochemistry, Molecular Biology / Care and treatment / Cellular Biology / Chronic obstructive pulmonary disease / Cohort analysis / Cohort Studies / Critical Care Medicine / Decision making / Depression - etiology / Do-not-resuscitate orders / Dyspnea / Emergency Medicine / Female / France / Hospitals / Humans / Intensive / Intensive care / Intubation / Intubation, Intratracheal / Life Sciences / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Mortality / Noninvasive Ventilation - adverse effects / Original / Pain Medicine / Pediatrics / Pneumology/Respiratory System / Post traumatic stress disorder / Prospective Studies / Quality of Life / Respiratory failure / Respiratory Insufficiency - therapy / Stress Disorders, Post-Traumatic - etiology / Treatment Refusal / Ventilators