Outcomes of non-invasive ventilation in ‘very old’ patients with acute respiratory failure: a retrospective study

Abstract

BackgroundNon-invasive ventilation (NIV) is increasingly used to support very old (aged ≥85 years) patients with acute respiratory failure (ARF). This retrospective observational study evaluated the impact of NIV on the prognosis of very old patients who have been admitted to the intermediate care unit (IMC) of the Emergency Department of the University Hospital Policlinico-Vittorio Emanuele of Catania for ARF.MethodsAll patients admitted to the IMC between January and December 2015 who received NIV as the treatment for respiratory failure were included in this study. Outcomes of patients aged ≥85 years were compared with lower ages. The expected intrahospital mortality was calculated through the Simplified Acute Physiology Score (SAPS) II and compared with the observed mortality.ResultsThe mean age was 87.9±2.9 years; the M:F ratio was approximately 1:3. The average SAPS II was 50.1±13.7. The NIV failure rate was 21.7%. The mortality in the very old group was not statistically different from the younger group (20% vs 25.6%; d=5.6%; 95% CI −8% to 19%; p=0.404). The observed mortality was significantly lower than the expected mortality in both the group ≥85 (20.0% vs 43.4%, difference=23.4%; 95% CI 5.6% to 41.1%, p=0.006) and the younger group (25.6% vs 38.5%, difference=12.9%; 95% CI −0.03% to 25.8%, p=0.046). In both age groups, patients treated with NIV for chronic obstructive pulmonary disease had lower mortalities than those treated for other illnesses, although this was statistically significant only in the younger group.ConclusionIn very old patients, when used with correct indications, NIV was associated with mortality similar to younger patients. Patients receiving NIV had lower than expected mortality in all age groups.

Clinical Outcomes in Patients Aged 80 Years or Older Receiving Non-Invasive Respiratory Support for Hypoxemic Acute Respiratory Failure Consequent to COVID-19

“…This led the authors to recommend caution when considering NIRS in very old patients. In contrast, a subsequent retrospective, observational study on patients undergoing NIRS to treat ARF of various aetiologies (i.e., COPD exacerbation, acute pulmonary oedema, sepsis, and pneumonia) [ 28 ] showed that the in-hospital mortality rate of very old individuals (≥85 years) was comparable to that observed in younger patients, despite a higher predicted mortality in the former population. We believe that these contrasting observations may be attributable to the fact that NIRS outcomes in old age patients can be heavily influenced by the baseline disease, with hypoxemic ARF being the least responsive to treatment [ 28 ].…”

Non-Invasive Ventilation in the Elderly at Emergency Department: Epidemiological Data and Results

“…Emergency departments are receiving a growing up number of elderly patients with acute respiratory failure (ARF). 1 As the prevalence of chronic respiratory and cardiovascular diseases increases with age 2 , it is common that elderly patients often present to the emergency department (ED) for an exacerbation of their chronic pathologies manifested by an ARF in most serious cases. 1,2 The therapeutic approach with ARF must be critical elderly.…”

“…1 As the prevalence of chronic respiratory and cardiovascular diseases increases with age 2 , it is common that elderly patients often present to the emergency department (ED) for an exacerbation of their chronic pathologies manifested by an ARF in most serious cases. 1,2 The therapeutic approach with ARF must be critical elderly. 2,5 According to the literature and current guidelines, NIV represents a first choice ventilatory technique to be considered in the management of some diseases which have a high prevalence in the elderly and this concerns particularly acute heart failure (AHF) and acute exacerbation of chronic obstructive pulmonary diseases (AECOPD) for which NIV has widely established effectiveness.…”

“…2,5 According to the literature and current guidelines, NIV represents a first choice ventilatory technique to be considered in the management of some diseases which have a high prevalence in the elderly and this concerns particularly acute heart failure (AHF) and acute exacerbation of chronic obstructive pulmonary diseases (AECOPD) for which NIV has widely established effectiveness. 1,2,6 These causes of ARF are frequent in the elderly and often more than one cause is present, which can complicate their therapeutic management. 2,7,8 Specific data regarding the effectiveness of this technique in the Middle East and North Africa (MENA) region remains limited in this population.…”