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01-02-2013 | Original

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

Published in: Intensive Care Medicine | Issue 2/2013

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).

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Morrison RS, Meier DE (2004) Clinical practice Palliative care. N Engl J Med 350:2582–2590PubMedCrossRef

Bailey FA, Burgio KL, Woodby LL, Williams BR, Redden DT, Kovac SH, Durham RM, Goode PS (2005) Improving processes of hospital care during the last hours of life. Arch Intern Med 165:1722–1727PubMedCrossRef

Abernethy AP, McDonald CF, Frith PA, Clark K, Herndon JE 2nd, Marcello J, Young IH, Bull J, Wilcock A, Booth S, Wheeler JL, Tulsky JA, Crockett AJ, Currow DC (2010) Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet 376:784–793PubMedCrossRef

(1996) Good care of the dying patient. Council on Scientific Affairs, American Medical Association. Jama 275:474–478

Singer PA, Lowy FH (1992) Rationing, patient preferences, and cost of care at the end of life. Arch Intern Med 152:478–480PubMedCrossRef

Benhamou D, Girault C, Faure C, Portier F, Muir JF (1992) Nasal mask ventilation in acute respiratory failure. Experience in elderly patients. Chest 102:912–917PubMedCrossRef

Nava S, Sturani C, Hartl S, Magni G, Ciontu M, Corrado A, Simonds A (2007) End-of-life decision-making in respiratory intermediate care units: a European survey. Eur Respir J 30:156–164PubMedCrossRef

Curtis JR, Cook DJ, Sinuff T, White DB, Hill N, Keenan SP, Benditt JO, Kacmarek R, Kirchhoff KT, Levy MM (2007) Noninvasive positive pressure ventilation in critical and palliative care settings: understanding the goals of therapy. Crit Care Med 35:932–939PubMedCrossRef

Azoulay E, Demoule A, Jaber S, Kouatchet A, Meert AP, Papazian L, Brochard L (2011) Palliative noninvasive ventilation in patients with acute respiratory failure. Intensive Care Med 37:1250–1257PubMedCrossRef

10.

Meduri GU, Fox RC, Abou-Shala N, Leeper KV, Wunderink RG (1994) Noninvasive mechanical ventilation via face mask in patients with acute respiratory failure who refused endotracheal intubation. Crit Care Med 22:1584–1590PubMed

11.

Fernandez R, Baigorri F, Artigas A (2007) Noninvasive ventilation in patients with “do-not-intubate” orders: medium-term efficacy depends critically on patient selection. Intensive Care Med 33:350–354PubMedCrossRef

12.

Chu CM, Chan VL, Wong IW, Leung WS, Lin AW, Cheung KF (2004) Noninvasive ventilation in patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease who refused endotracheal intubation. Crit Care Med 32:372–377PubMedCrossRef

13.

Schettino G, Altobelli N, Kacmarek RM (2005) Noninvasive positive pressure ventilation reverses acute respiratory failure in select “do-not-intubate” patients. Crit Care Med 33:1976–1982PubMedCrossRef

14.

Bulow HH, Thorsager B (2009) Non-invasive ventilation in do-not-intubate patients: five-year follow-up on a two-year prospective, consecutive cohort study. Acta Anaesthesiol Scand 53:1153–1157PubMedCrossRef

15.

Levy M, Tanios MA, Nelson D, Short K, Senechia A, Vespia J, Hill NS (2004) Outcomes of patients with do-not-intubate orders treated with noninvasive ventilation. Crit Care Med 32:2002–2007PubMedCrossRef

16.

Brun-Buisson C, Richard JC, Mercat A, Thiebaut AC, Brochard L (2011) Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome. Am J Respir Crit Care Med 183:1200–1206PubMedCrossRef

17.

Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, Garrouste-Orgeas M, Georges H, Goldgran-Toledano D, Jourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Barnes NK, Pochard F, Schlemmer B, Azoulay E (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478PubMedCrossRef

18.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRef

19.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710PubMedCrossRef

20.

Tsolaki V, Pastaka C, Karetsi E, Zygoulis P, Koutsokera A, Gourgoulianis KI, Kostikas K (2008) One-year non-invasive ventilation in chronic hypercapnic COPD: effect on quality of life. Respir Med 102:904–911PubMedCrossRef

21.

Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM (2011) Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 364:1293–1304PubMedCrossRef

22.

Zatzick DF, Marmar CR, Weiss DS, Browner WS, Metzler TJ, Golding JM, Stewart A, Schlenger WE, Wells KB (1997) Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry 154:1690–1695PubMed

23.

Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171:987–994. Epub 2005 Jan 2021

24.

Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRef

25.

de Miranda S, Pochard F, Chaize M, Megarbane B, Cuvelier A, Bele N, Gonzalez-Bermejo J, Aboab J, Lautrette A, Lemiale V, Roche N, Thirion M, Chevret S, Schlemmer B, Similowski T, Azoulay E (2011) Postintensive care unit psychological burden in patients with chronic obstructive pulmonary disease and informal caregivers: a multicenter study. Crit Care Med 39:112–118PubMedCrossRef

26.

Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693PubMedCrossRef

27.

Cuomo A, Delmastro M, Ceriana P, Nava S, Conti G, Antonelli M, Iacobone E (2004) Noninvasive mechanical ventilation as a palliative treatment of acute respiratory failure in patients with end-stage solid cancer. Palliat Med 18:602–610PubMedCrossRef

28.

Brochard L, Isabey D, Piquet J, Amaro P, Mancebo J, Messadi AA, Brun-Buisson C, Rauss A, Lemaire F, Harf A (1990) Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med 323:1523–1530PubMedCrossRef

29.

Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F et al (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822PubMedCrossRef

30.

Delclaux C, L’Her E, Alberti C, Mancebo J, Abroug F, Conti G, Guerin C, Schortgen F, Lefort Y, Antonelli M, Lepage E, Lemaire F, Brochard L (2000) Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA 284:2352–2360PubMedCrossRef

31.

Demoule A, Girou E, Richard JC, Taille S, Brochard L (2006) Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 32:1747–1755. Epub 2006 Jun 1724

32.

Curtis JR, Nielsen EL, Treece PD, Downey L, Dotolo D, Shannon SE, Back AL, Rubenfeld GD, Engelberg RA (2011) Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial. Am J Respir Crit Care Med 183:348–355PubMedCrossRef

Title: 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
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2746-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Noninvasive mechanical ventilation in patients having declined tracheal intubation

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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