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Noninvasive mechanical ventilation in patients having declined tracheal intubation |
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| Authors: | Élie Azoulay Achille Kouatchet Samir Jaber Jérôme Lambert Ferhat Meziani Matthieu Schmidt David Schnell Satar Mortaza Matthieu Conseil Xavier Tchenio Patrick Herbecq Pierre Andrivet Emmanuel Guerot Ariane Lafabrie Sébastien Perbet Laurent Camous Ralf Janssen-Langenstein François Collet Jonathan Messika Stéphane Legriel Xavier Fabre Olivier Guisset Samia Touati Sarah Kilani Michael Alves Alain Mercat Thomas Similowski Laurent Papazian Anne-Pascale Meert Sylvie Chevret Benoît Schlemmer Laurent Brochard Alexandre Demoule |
| Institution: | 1. Medical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecine, Université Paris-Diderot, Sorbonne Paris-Cité, 1 avenue Claude Vellefaux, 75010, Paris, France 2. Medical ICU, Angers Hospital, Angers, France 3. Surgical ICU, Saint-Eloi University Hospital, Montpellier, France 4. Biostatistics Department, Saint-Louis Hospital and Paris 7 University, Paris, France 5. Medical ICU, Central University Hospital, Strasbourg, France 6. Pulmonary and Critical Care Department, La Pitié-Salpêtrière University Hospital, Paris, France 7. Bourg en Bresse ICU, Bourg en Bresse Hospital, Bourg en Bresse, France 8. Roubaix ICU, Roubaix Hospital, Roubaix, France 9. Bligny ICU, Bligny Medical Center, Briis-sous-Forges, France 10. Medical ICU, Pompidou Hospital, Paris, France 11. Surgical ICU, Hotel Dieu University Hospital, Clermont-Ferrand, France 12. Medical ICU, Bicêtre University Hospital, Le Kremlin-Bicêtre, France 13. St-Malo ICU, Saint-Malo Hospital, Saint-Malo, France 14. Tenon ICU, Tenon University Hospital, Paris, France 15. Versailles ICU, Versailles Hospital, Versailles, France 16. Roanne ICU, Roanne Hospital, Roanne, France 17. Bordeaux ICU, Saint-André Hospital, Bordeaux, France 18. Saint-Joseph Hospital, Paris, France 19. Quimper ICU, Bretagne Sud Hospital, Lorient, France 20. Saint-Antoine ICU, Saint-Antoine University Hospital, Paris, France 21. Marseille Nord ICU, North University Hospital, Marseille, France 22. Brussels ICU, Jules Bordet Institute, Brussels, Belgium 23. Geneva ICU, H?pitaux universitaires de Genève, Geneva, Switzerland |
| Abstract: | PurposeNoninvasive ventilation (NIV) is a treatment option in patients with acute respiratory failure who are good candidates for intensive care but have declined tracheal intubation. The aim of our study was to report outcomes after NIV in patients with a do-not-intubate (DNI) order.MethodsProspective observational cohort study in all patients who received NIV for acute respiratory failure in 54 ICUs in France and Belgium, in 2010/2011.ResultsGoals of care, comfort, and vital status were assessed daily. On day 90, a telephone interview with patients and relatives recorded health-related quality of life (HRQOL), posttraumatic stress disorder-related symptoms, and symptoms of anxiety and depression. Post-ICU burden was compared between DNI patients and patients receiving NIV with no treatment-limitation decisions (TLD). Of 780 NIV patients, 574 received NIV with no TLD, and 134 had DNI orders. Hospital mortality was 44 % in DNI patients and 12 % in the no-TLD group. Mortality in the DNI group was lowest in COPD patients compared to other patients in the DNI group (34 vs. 51 %, P = 0.01). In the DNI group, HRQOL showed no significant decline on day 90 compared to baseline; day-90 data of patients and relatives did not differ from those in the no-TLD group.ConclusionsDo-not-intubate status was present among one-fifth of ICU patients who received NIV. DNI patients who were alive on day 90 experienced no decrease in HRQOL compared to baseline. The prevalences of anxiety, depression, and PTSD-related symptoms in these patients and their relatives were similar to those seen after NIV was used as part of full-code management (clinicaltrial.govNCT01449331). |
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