The Role of Noninvasive Ventilation in Patients with “Do Not Intubate” Order in the Emergency Setting

Vilaca, M.; Aragão, Irene; Cardoso, Teresa; Dias, Cláudia Camila; Cabral-Campello, G.

doi:10.1371/journal.pone.0149649

Cited by 33 publications

(22 citation statements)

References 22 publications

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“…Vilaca et al [20] Portugal "Withholding therapy decision" group, comprised patients for whom a decision was made by the attending physician not to start or increase a life-sustaining intervention. "…”

Section: Country Description Of Dni Decision Making Processmentioning

confidence: 99%

Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis

et al. 2019

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To assess the rates and variability of do-not-intubate orders in patients with acute respiratory failure. Methods: We conducted a systematic review of observational studies that enrolled adult patients with acute respiratory failure requiring noninvasive ventilation or high-flow nasal cannula oxygen from inception to 2019. Results: Twenty-six studies evaluating 10,755 patients were included. The overall pooled rate of do-not-intubate orders was 27%. The pooled rate of do-not-intubate orders in studies from North America was 14% (range 9-22%), from Europe was 28% (range 13-58%), and from Asia was 38% (range 9-83%), p = 0.001. Do-not-intubate rates were higher in studies with higher patient age and in studies where do-not-intubate decisions were made without reported patient/family input. There were no significant differences in do-not-intubate orders according to illness severity, observed mortality, malignancy comorbidity, or methodological quality. Rates of do-not-intubate orders increased over time from 9% in 2000-2004 to 32% in 2015-2019. Only 12 studies (46%) reported information about do-not-intubate decision-making processes. Only 4 studies (15%) also reported rates of do-not-resuscitate. Conclusions: One in four patients with acute respiratory failure (who receive noninvasive ventilation or high-flow nasal cannula oxygen) has a do-not-intubate order. The rate of do-not-intubate orders has increased over time. There is high inter-study variability in do-not-intubate rates-even when accounting for age and illness severity. There is high variability in patient/family involvement in do-not-intubate decision making processes. Few studies reported differences in rates of do-not-resuscitate and do-not-intubate-even though recovery is very different for acute respiratory failure and cardiac arrest.

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Section: Country Description Of Dni Decision Making Processmentioning

confidence: 99%

Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis

et al. 2019

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“… 35 Only one study has reported poor sleep during NIV in 76% of the studied patients. 36 In the OXYPAL study, particular attention will be paid to quality of sleep in all the included patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

Robert

Frasca

Badin³

et al. 2021

BMJ Open

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IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631

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“…In this context, invasive mechanical ventilation is considered a controversial intervention that deprives patients of their dignity and ability to recognise their family members 12. Indeed, advanced age or the presence of significant comorbidities are indications for DNI status, and in these cases, the use of NIV represents an alternative treatment.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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The Role of Noninvasive Ventilation in Patients with “Do Not Intubate” Order in the Emergency Setting

Cited by 33 publications

References 22 publications

Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis

Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis

Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

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

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