The impact of frailty on noninvasive mechanical ventilation in elderly medical intensive care unit patients

Abstract

We identified no significant differences in NIV success when age and specific comorbidities were considered [5]. But since patient inclusion criteria of our study were not designed to investigate the answers of these questions we cannot interpret our results as these factors do not have any impact on NIV success. We can just say that both groups have similar percentages of patients with COPD and HF and there was no significant difference in their ages.On the other hand and more importantly with our results, we wanted to draw attention to potential and less investigated causes of NIV failure such as Edmonton Frailty Scale (EFS) criteria (cognition, general health status, functional independence, social support, medications, nutrition, mood, and functional performance). Interestingly compared to age and comorbidities which are unmodifible factors many of EFS criteria are modifiable. We believe not only age and comorbidities but also these frailty factors should be investigated as causes of NIV failure in future.We totally agree with these recommendations and want to thank them for their contribution. References

Association of Frailty With the Risk of Mortality and Resource Utilization in Elderly Patients in Intensive Care Units: A Meta-Analysis

“…Frailty was recognized initially in the field of geriatric medicine, and it has recently been increasingly identified as an essential determinant of prognosis in patients admitted to ICU. Our results were consistent with those of a previous study which showed that frail patients were at higher risk than non-frail patients of poor outcomes in different settings ( 44 – 46 ). The explanation for this finding involves the changes in pathophysiology in frail patients.…”

S2k-Leitlinie Nichtinvasive Beatmung als Therapie der akuten respiratorischen Insuffizienz

“…Dies sind im Wesentlichen dieselben Prädiktoren, die auch für den Therapieerfolg herangezogen werden. So erwiesen sich in den jeweiligen Studien ein niedriger pH-und hoher pCO 2 -Wert, eine hohe Herzfrequenz ein, erhöhter APACHE-II-Score (> 29), ein erhöhtes BNP, ein niedriger Glasgow-Coma-Scale, ein unter NIV niedriger pO 2 , begleitende Komorbiditäten, wie u. a. eine Tumorerkrankung, höheres Lebensalter mit Gebrechtlichkeit sowie vorausgegangene NIV-pflichtige Exazerbationen [29,34,44,[46][47][48][49][50][51][52][53][54] als Prädiktoren für ein NIV-Versagen. Zusätzlich konnte eine pneumonische Ursache des hyperkapnischen Atemversagens [40,55,56] als Risikofaktoren für einen ungünstigen Verlauf mit Intubation, längerem Krankhausaufenthalt und erhöhter Mortalität gefunden werden.…”

Incidence, Predictors, and Outcomes of Failure of Noninvasive Ventilation in Acute Heart Failure Hospitalization

“…We report that worsening cardiac disease, in the form of cardiogenic shock and cardiac arrest, are associated with NIV failure. Shock, 29 more severe heart failure, 7,9 multisystem organ failure defined by Sequential Organ Failure Assessment (SOFA) score, 22 frailty, 30 poor mental status, 8 weak cough, 31 and higher tidal volume on NIV 29 are factors that have been reported in the literature to be associated with NIV failure. Similar to our findings, Liu and colleagues 18 also reported that older age was associated with lower risk of NIV intolerance.…”