Aylin Ozsancak Ugurlu1, Samy S Sidhom2, Ali Khodabandeh3, Michael Ieong4, Chester Mohr5, Denis Y Lin6, Irwin Buchwald7, Imad Bahhady8, John Wengryn9, Vinay Maheshwari10, Nicholas S Hill11. 1. Department of Pulmonary Disease, Baskent University, Istanbul, Turkey. aozsancak@hotmail.com. 2. Pulmonary Department, Newton-Wellesley Hospital, Newton, Massachusetts. 3. Mass Lung and Allergy PC, Leominster, Massachusetts. 4. Boston Medical Center, Boston, Massachusetts. 5. Cape Cod Health Systems, Hyannis, Massachusetts. 6. Lowell General Hospital, Lowell, Massachusetts. 7. Saints Medical Center, Lowell, Massachusetts. 8. Steward Morton Hospital, Taunton, Massachusetts. 9. Jordan Hospital, Plymouth, Massachusetts. 10. Pulmonary Associates, Newark, Delaware. 11. Department of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts.
Abstract
BACKGROUND: The prevalence of chronic disease and do-not-intubate status increases with age. Thus, we aimed to determine characteristics and outcomes associated with noninvasive ventilation (NIV) use for acute respiratory failure (ARF) in different age groups. METHODS: A database comprising prospective data collected on site on all adult patients with ARF requiring ventilatory support from 8 acute care hospitals in Massachusetts was used. RESULTS: From a total of 1,225 ventilator starts, overall NIV utilization, success, and in-hospital mortality rates were 22, 54, and 18% in younger (18-44 y); 34, 65, and 13% in middle-aged (45-64 y); 49, 68, and 17% in elderly (65-79 y); and 47, 76, and 24% in aged (≥ 80 y) groups, respectively (P < .001, P = .08, and P = .11, respectively). NIV use for cardiogenic pulmonary edema and subjects with a do-not-intubate order increased significantly with advancing age (25, 57, 57, and 74% and 7, 12, 18, and 31%, respectively, in the 4 age groups [P < .001 and P = .046, respectively]). For subjects receiving NIV with a do-not-intubate order, success and in-hospital mortality rates were similar in different age groups (P = .27 and P = .98, respectively). CONCLUSIONS: NIV use and a do-not-intubate status are more frequent in subjects with ARF ≥ 65 y than in those <65 y, especially for subjects with cardiogenic pulmonary edema. However, NIV success and mortality rates were similar between age groups. (ClinicalTrials.gov registration NCT00458926.).
BACKGROUND: The prevalence of chronic disease and do-not-intubate status increases with age. Thus, we aimed to determine characteristics and outcomes associated with noninvasive ventilation (NIV) use for acute respiratory failure (ARF) in different age groups. METHODS: A database comprising prospective data collected on site on all adult patients with ARF requiring ventilatory support from 8 acute care hospitals in Massachusetts was used. RESULTS: From a total of 1,225 ventilator starts, overall NIV utilization, success, and in-hospital mortality rates were 22, 54, and 18% in younger (18-44 y); 34, 65, and 13% in middle-aged (45-64 y); 49, 68, and 17% in elderly (65-79 y); and 47, 76, and 24% in aged (≥ 80 y) groups, respectively (P < .001, P = .08, and P = .11, respectively). NIV use for cardiogenic pulmonary edema and subjects with a do-not-intubate order increased significantly with advancing age (25, 57, 57, and 74% and 7, 12, 18, and 31%, respectively, in the 4 age groups [P < .001 and P = .046, respectively]). For subjects receiving NIV with a do-not-intubate order, success and in-hospital mortality rates were similar in different age groups (P = .27 and P = .98, respectively). CONCLUSIONS: NIV use and a do-not-intubate status are more frequent in subjects with ARF ≥ 65 y than in those <65 y, especially for subjects with cardiogenic pulmonary edema. However, NIV success and mortality rates were similar between age groups. (ClinicalTrials.gov registration NCT00458926.).
Authors: Michael E Wilson; Aniket Mittal; Bibek Karki; Claudia C Dobler; Abdul Wahab; J Randall Curtis; Patricia J Erwin; Abdul M Majzoub; Victor M Montori; Ognjen Gajic; M Hassan Murad Journal: Intensive Care Med Date: 2019-10-28 Impact factor: 41.787