Non‐invasive mechanical ventilation in elderly patients: A narrative review

Piroddi, Ines Maria Grazia; Barlascini, Cornelius; Esquinas, António M.; Braido, Fulvio; Banfi, Paolo; Nicolini, Antonello

doi:10.1111/ggi.12810

Cited by 23 publications

(14 citation statements)

References 58 publications

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“…Our study makes several important contributions to the literature. When elderly patients are admitted to ICUs, intensivists find it difficult to decide whether aggressive treatment is appropriate, because advanced age is associated with poorer outcomes after mechanical ventilation, and survival does not always ensure a satisfactory quality of life [ 12 , 13 , 14 , 15 , 19 , 20 , 23 , 24 ]. Some intensivists prefer to treat elderly patients as noninvasively as possible, often choosing NIV for those with acute RF.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, many clinicians prefer to use a noninvasive approach, such as NIV, in elderly patients with acute RF to avoid intubations. However, in elderly patients, particularly those with pneumonia, there is concern regarding the possibility of NIV failure and the increased mortality caused by delayed intubation [ 19 , 20 ]. Thus, in elderly patients with pneumonia, NIV may be delayed, because its utility in this setting remains controversial, and excessive secretion (e.g., due to pneumonia) is a contraindication for the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Factors for Predicting Noninvasive Ventilation Failure in Elderly Patients with Respiratory Failure

Park

Cho

Chang

et al. 2020

JCM

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Noninvasive ventilation (NIV) is useful when managing critically ill patients. However, it is not easy to apply to elderly patients, particularly those with pneumonia, due to the possibility of NIV failure and the increased mortality caused by delayed intubation. In this prospective observational study, we explored whether NIV was appropriate for elderly patients with pneumonia, defined factors that independently predicted NIV failure, and built an optimal model for prediction of such failure. We evaluated 78 patients with a median age of 77 years. A low PaCO2 level, a high heart rate, and the presence of pneumonia were statistically significant independent predictors of NIV failure. The predictive power for NIV failure of Model III (pneumonia, PaCO2 level, and heart rate) was better than that of Model I (pneumonia alone). Considering the improvement in parameters, patients with successful NIV exhibited significantly improved heart rates, arterial pH and PaCO2 levels, and patients with NIV failure exhibited a significantly improved PaCO2 level only. In conclusion, NIV is reasonable to apply to elderly patients with pneumonia, but should be done with caution. For the early identification of NIV failure, the heart rate and arterial blood gas parameters should be monitored within 2 h after NIV commencement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors for Predicting Noninvasive Ventilation Failure in Elderly Patients with Respiratory Failure

Park

Cho

Chang

et al. 2020

JCM

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“…In this study, the extremely elderly and patients with cancer comprised a very high proportion (52.0% of those aged ≥ 80 years and 25.8% of those with a history of cancer) of NIV users, and cancer occupied the second place among the associated discharge diagnoses in NIV users. This phenomenon may be influenced by the administration of palliative care for individuals with extremely old age and advanced stage of cancer [19][20][21][22]. Palliative NIV could be administered either to offer a chance for survival or to alleviate the symptoms of respiratory distress in terminally ill patients [19].…”

Section: Discussionmentioning

confidence: 99%

“…One of the primary benefits of using NIV in this setting is the preservation of communication between the patient and the family. This technique is also widely used in patients with acute RF and in a DNR order, particularly for the extremely elderly [22]. Unfortunately, information on the number of persons who had DNR orders or received hospice care was absent from the database.…”

Section: Discussionmentioning

confidence: 99%

The application of non-invasive and invasive mechanical ventilation in the first episode of acute respiratory failure

Huang

Muo

et al. 2020

Intern Emerg Med

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Acute respiratory failure (RF) is a life-threatening syndrome. This study investigated the application of two major clinical strategies, non-invasive mechanical ventilation (NIV) and invasive mechanical ventilation (IMV), in the first episode of acute RF. Data from the longitudinal health insurance database, which included 1,000,000 insured citizens, were used. The NIV group consisted of 1201 patients and the IMV group consisted of 16,072 patients. Chi-square test and t test were applied to determine the differences in categorical and continuous variables. Further analysis was performed by using univariate and multivariable logistic regression and Poisson regression. There was a significant increase of 733% in the number of NIV users from 2000 to 2012. NIV use was frequently observed in old-age persons (aOR 3.99, 95% CI 3.06-5.21 for those aged ≥ 80 years), women (aOR 1.33, 95% CI 1.18-1.50), patients admitted to a high-level hospital (aOR 1.95, 95% CI 1.63−2.34 for those admitted to a medical center), and patients with a higher Charlson comorbidity index (CCI, aOR 1.38−1.66 for those CCI ≥ 2). In addition, patients with chronic pulmonary disease, cancer, and congestive heart failure were predominant in NIV users and were significantly associated with NIV use. Overall, the use of NIV has markedly increased over the past few years. Persons of advanced age, women, patients admitted to a high-level hospital, and patients with multiple comorbidities were associated with more frequent NIV use. Chronic pulmonary disease, cancer, and congestive heart failure were most important comorbidities for NIV use. Keywords Acute respiratory failure (acute RF) • Non-invasive mechanical ventilation (NIV) • Invasive mechanical ventilation (IMV) • Intensive care Te-Chun Shen and Te-Chun Hsia contributed equally.

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“…El uso de la VMNI en el tratamiento de insuficiencia respiratoria aguda y crónica ha aumentado en los últimos años (1-3) demostrando disminución en la mortalidad y reducción de la estancia media en UCI y de la necesidad de intubación (4,5). Otros beneficios han sido: mejoría más rápida del PH, PCO2, PaO2, disnea y frecuencia respiratoria, así como la disminución de complicaciones y reducción de costos hospitalarios (6)(7)(8).…”

Section: Introductionunclassified

Corto circuito pulmonar, índice arterio-alveolar y gradiente alveolo-arterial de oxígeno previa ventilación mecánica no invasiva

Izquierdo

Muñoz

Diaz³

2015

rev. investig. andin.

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Objetivo. Describir el comportamiento de gradiente alveolo-arterial oxígeno (Grad[A-a]O2), índice arterio-alveolar de oxígeno (Ind[a-A]O2) y corto circuito pulmonar (Qs/Qt) en un grupo de pacientes previa instauración de ventilación mecánica no invasiva –VMNI- en una unidad de cuidado intensivo UCI.Metodología. Estudio transversal retrospectivo. Calculamos el Grad[A-a]O2) mediante la ecuación: PAO2 = [[(pAtm-pH2O)xFiO2]-(pCO2/RespQ)]-PaO2], para: RespQ = (0,8); (pAtm = 560mmHg para Bogotá, 2640 metros sobre nivel del mar); pH2O = (47mmHg); el (Ind[a-A]O2) y (Qs/Qt) con la fórmula: (Cco2- Cao2)/ (Cco2- Cvo2). Ámbito: Hospital terciario. Pacientes: 16 sujetos de UCI mediante muestra no probabilística consecutiva, que recibieron VMNI en un periodo de medición de 3 meses. Variables de interés principal: diagnóstico, edad, gasometría sanguínea, se calcularon las variables: (Grad [A-a]O2), (Ind[a-A]O2) y (Qs/Qt).Resultados. El promedio de edad de la población objeto de estudio fue de 59,6; de los cuales el 56% (n=9) fueron mujeres. La VMNI se utilizó en el 14% (n=16) de los pacientes con una población total de 116 en un periodo de tres meses. Los valores gasométricos encontrados (media ± desviación estándar) fueron: (Ind [a-A]O2)= (0,38mmHg ± 0,2mmHg), (Qs/Qt) = (25% ± 8.1%) y (Grad [A-a]O2) = (159mmHg ± 64.1mmHg), FiO2 suministrada de acuerdo a los requerimientos de cada paciente, PaCO2 (42mmhg ± 15mmHg), PaO2/FiO2 = (149 ± 44.2), SvO2 (n=8) = (66,2% ± 9.3%), PH = (7,38 ± 0.1), SaO2 = (92% ± 2.8%), y PaO2 = (70mmHg ± 15.4mmHg).Conclusiones. Los valores gasométricos (Qs/Qt = >25 ± 8.1%), (Ind[a-A]O2 = < 0,38 ± 0.2mmHg) y (Grad[A-a]O2 = >159 ± 64.1mmHg), identificados en este grupo de pacientes, pueden ser tenidos en cuenta previa instauración de VMNI en sujetos con características similares a una altura de 2.640 metros sobre el nivel del mar.

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Non‐invasive mechanical ventilation in elderly patients: A narrative review

Cited by 23 publications

References 58 publications

Factors for Predicting Noninvasive Ventilation Failure in Elderly Patients with Respiratory Failure

Factors for Predicting Noninvasive Ventilation Failure in Elderly Patients with Respiratory Failure

The application of non-invasive and invasive mechanical ventilation in the first episode of acute respiratory failure

Corto circuito pulmonar, índice arterio-alveolar y gradiente alveolo-arterial de oxígeno previa ventilación mecánica no invasiva

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