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01.02.2013 | Original

Noninvasive mechanical ventilation in patients having declined tracheal intubation

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

Erschienen in: Intensive Care Medicine | Ausgabe 2/2013

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Abstract

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).

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Titel: Noninvasive mechanical ventilation in patients having declined tracheal intubation
verfasst von: Élie Azoulay
Achille Kouatchet
Samir Jaber
Jérôme Lambert
Ferhat Meziani
Matthieu Schmidt
David Schnell
Satar Mortaza
Matthieu Conseil
Xavier Tchenio
Patrick Herbecq
Pierre Andrivet
Emmanuel Guerot
Ariane Lafabrie
Sébastien Perbet
Laurent Camous
Ralf Janssen-Langenstein
François Collet
Jonathan Messika
Stéphane Legriel
Xavier Fabre
Olivier Guisset
Samia Touati
Sarah Kilani
Michael Alves
Alain Mercat
Thomas Similowski
Laurent Papazian
Anne-Pascale Meert
Sylvie Chevret
Benoît Schlemmer
Laurent Brochard
Alexandre Demoule
Publikationsdatum: 01.02.2013
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 2/2013
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2746-2

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Noninvasive mechanical ventilation in patients having declined tracheal intubation