Scala Raffaele, Ciarleglio Giuseppina, Maccari Uberto, Granese Valentina, Salerno Laura, Madioni Chiara
Division of Pulmonology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy.
Turk Thorac J. 2020 Jan;21(1):54-60. doi: 10.5152/TurkThoracJ.2020.201401. Epub 2020 Jan 1.
Elderly patients suffering from chronic cardio-pulmonary diseases commonly experience acute respiratory failure. As in younger patients, a well-known therapeutic approach of noninvasive mechanical ventilation is able to prevent orotracheal intubation in a large number of severe scenarios in elderly patients. In addition, this type of ventilation is frequently applied in elderly patients who refuse intubation for invasive mechanical ventilation. The rate of failure of noninvasive ventilation may be reduced by means of the integration of new technological devices (i.e., high-flow nasal cannula, extracorporeal CO removal, cough assistance and high-frequency chest wall oscillation, and fiberoptic bronchoscopy). Ethical issues with end-of-life decisions and the choice of the environment are not clearly defined in the treatment of elderly with acute respiratory insufficiency.
患有慢性心肺疾病的老年患者常出现急性呼吸衰竭。与年轻患者一样，一种广为人知的无创机械通气治疗方法能够在大量严重情况下防止老年患者进行气管插管。此外，这种通气方式常用于拒绝有创机械通气插管的老年患者。通过整合新技术设备（即高流量鼻导管、体外二氧化碳清除、咳嗽辅助和高频胸壁振荡以及纤维支气管镜检查），可降低无创通气的失败率。在老年急性呼吸功能不全的治疗中，临终决策和环境选择方面的伦理问题尚无明确界定。
