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Noninvasive mechanical ventilation in patients having declined tracheal intubation
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
Affiliation: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:

Purpose

Noninvasive 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.

Methods

Prospective observational cohort study in all patients who received NIV for acute respiratory failure in 54 ICUs in France and Belgium, in 2010/2011.

Results

Goals 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.

Conclusions

Do-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).
Keywords:
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