Non-invasive ventilation for very old patients with limitations to respiratory care in half-open geriatric ward: experience on a consecutive cohort of patients

Abstract

Very old DNI patients with ARF could be treated with NIV in half-open geriatric ward with trained physicians and nurses. The presence of family members may improve patients' comfort and reduce anxiety level even at the end of life. Further studies are needed to address the effective role of NIV in very old patients with DNI decisions.

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

“…When NIV is applied in a geriatric ward by experienced physicians, and if patients were closely assisted by family members and nurses, the mortality was approximately 25%. 2 In conclusion, the specialized respiratory care setting is a more appropriate setting for the DNI patient than the ICU. 16 This position is supported by a recent Italian study in which the authors reported a NIV success rate of 62% among DNI patients despite their poorer clinical condition.…”

“…Vargas et al showed that in a cohort of very old patients (age >80 years) with ARF and DNI decision, 12 h of NIV, carried out in a setting of a half-open geriatric ward with close nursing and family support, ameliorated respiratory function, which allowed the discharge of 75% of patients. 2 In-hospital mortality was related to the admission diagnosis, and was high in very old DNI patients with hypoxemic respiratory failure or end-stage cancer. 14 Previous clinical trials on NIV for very old patients with ARF were carried out all in ICU, respiratory ICU or subintensive care unit by intensive care physicians and included patients with the median age of 75 years.…”

“…Vargas et al. showed that in a cohort of very old patients (age >80 years) with ARF and DNI decision, 12 h of NIV, carried out in a setting of a half‐open geriatric ward with close nursing and family support, ameliorated respiratory function, which allowed the discharge of 75% of patients . In‐hospital mortality was related to the admission diagnosis, and was high in very old DNI patients with hypoxemic respiratory failure or end‐stage cancer .…”

“…In‐hospital geriatric ward mortality was related to the admission diagnosis. When NIV is applied in a geriatric ward by experienced physicians, and if patients were closely assisted by family members and nurses, the mortality was approximately 25% …”

“…These patients represent 10-15% of ICU admissions. 2 Many of these subjects are subsequently discharged on NIV home mechanical ventilation (NIHMV) in an effort to reduce subsequent hospital admissions, maintain quality of life and relieve chronic hypoventilation related symptoms; all of which decreases healthcare utilization. 3 In patients aged 65 years or more, complications during mechanical ventilation increase hospital mortality.…”