Non-invasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomised controlled trial

作者：Nava Stefano^*; Grassi Mario; Fanfulla Francesco; Domenighetti Guido; Carlucci Annalisa; Perren Andreas; Dell'Orso Daniela; Vitacca Michele; Ceriana Piero; Karakurt Zuhal; Clini Enrico

来源：Age and Ageing, 2011, 40(4): 444-450.

DOI：10.1093/ageing/afr003

• non-invasive ventilation
• COPD
• acute respiratory failure
• intubation rate
• survival rate
• ICU admission
• elderly

Participants and design: eighty-two patients aged > 75 years (mean age 81.3 +/- 3.5 years) were randomised to receive NIV or SMT.
Settings: three respiratory units.
Measurements: the primary outcome was the rate of meeting the endotracheal intubation (ETI) criteria. Secondary outcomes were the mortality rate, the respiratory rate, dyspnoea score, arterial blood gases.
Results: the rate of meeting the ETI criteria was lower in the NIV group compared with the SMT group (7.3 versus 63.4%, respectively; P < 0.001), as was the mortality rate [(odds ratios) OR = 0.40; 95% CI: 0.19-0.83; P = 0.014]. Twenty-two of 41 SMT patients with DNI orders received NIV as a rescue therapy. The mortality rate in this subgroup was comparable with the NIV group and significantly lower compared with patients receiving ETI (OR = 0.60, 95% CI: 0.18-1.92 versus 4.03, 95% CI: 2.35-6.94, respectively; P = 0.009). Arterial blood gases, respiratory rate and dyspnoea improved significantly faster with NIV than with SMT.
Conclusions: compared with SMT, NIV decreased the rate of meeting the ETI criteria and the mortality rate of very old patients with AHRF. NIV should be offered as an alternative to patients considered poor candidates for intubation and those with a DNI order.

• 出版日期2011-7