AP-HP, Groupe Hospitalier Albert Chenevier-Henri Mondor, Réanimation Médicale, Créteil, France.
Ann Intensive Care. 2012 Feb 21;2(1):5. doi: 10.1186/2110-5820-2-5.
Noninvasive ventilation (NIV) is frequently used for the management of acute respiratory failure (ARF) in very old patients (≥ 80 years), often in the context of a do-not-intubate order (DNI). We aimed to determine its efficacy and long-term outcome.
Prospective cohort of all patients admitted to the medical ICU of a tertiary hospital during a 2-year period and managed using NIV. Characteristics of patients, context of NIV, and treatment intensity were compared for very old and younger patients. Six-month survival and functional status were assessed in very old patients.
During the study period, 1,019 patients needed ventilatory support and 376 (37%) received NIV. Among them, 163 (16%) very old patients received ventilatory support with 60% of them managed using NIV compared with 32% of younger patients (p < 0.0001). Very old patients received NIV more frequently with DNI than in younger patients (40% vs. 8%). Such cases were associated with high mortality for both very old and younger patients. Hospital mortality was higher in very old than in younger patients but did not differ when NIV was used for cardiogenic pulmonary edema or acute-on-chronic respiratory failure (20% vs. 15%) and in postextubation (15% vs. 17%) out of a context of DNI. Six-month mortality was 51% in very old patients, 67% for DNI patients, and 77% in case of NIV failure and endotracheal intubation. Of the 30 hospital survivors, 22 lived at home and 13 remained independent for activities of daily living.
Very old patients managed using NIV have an overall satisfactory 6-month survival and functional status, except for endotracheal intubation after NIV failure.
无创通气（NIV）常用于管理非常老年患者（≥80 岁）的急性呼吸衰竭（ARF），通常在不插管医嘱（DNI）的情况下使用。我们旨在确定其疗效和长期结果。
前瞻性纳入在 2 年内入住三级医院内科重症监护病房并接受 NIV 治疗的所有患者。比较非常老年患者和年轻患者的患者特征、NIV 应用情况和治疗强度。评估非常老年患者的 6 个月生存率和功能状态。
在研究期间，1019 名患者需要通气支持，其中 376 名（37%）接受了 NIV。在这些患者中，163 名（16%）非常老年患者接受了通气支持，其中 60%使用 NIV 治疗，而年轻患者为 32%（p<0.0001）。非常老年患者比年轻患者更频繁地接受 NIV，且 DNI 使用率更高（40% vs. 8%）。无论非常老年患者还是年轻患者，这种情况下死亡率都很高。非常老年患者的院内死亡率高于年轻患者，但在 DNI 情况下用于心源性肺水肿或急性加重性慢性呼吸衰竭（20% vs. 15%）以及拔管后（15% vs. 17%）时，死亡率无差异。非常老年患者的 6 个月死亡率为 51%，DNI 患者为 67%，NIV 失败和气管插管患者为 77%。在 30 名出院存活患者中，22 名患者居家生活，13 名患者日常生活活动独立。
除 NIV 失败后气管插管外，接受 NIV 治疗的非常老年患者的 6 个月总体生存率和功能状态令人满意。
