Intensive Care Medicine

, Volume 39, Issue 2, pp 292–301

Noninvasive mechanical ventilation in patients having declined tracheal intubation

Authors

    • Medical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecineUniversité Paris-Diderot
  • Achille Kouatchet
    • Medical ICUAngers Hospital
  • Samir Jaber
    • Surgical ICUSaint-Eloi University Hospital
  • Jérôme Lambert
    • Biostatistics DepartmentSaint-Louis Hospital and Paris 7 University
  • Ferhat Meziani
    • Medical ICUCentral University Hospital
  • Matthieu Schmidt
    • Pulmonary and Critical Care DepartmentLa Pitié-Salpêtrière University Hospital
  • David Schnell
    • Medical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecineUniversité Paris-Diderot
  • Satar Mortaza
    • Medical ICUAngers Hospital
  • Matthieu Conseil
    • Surgical ICUSaint-Eloi University Hospital
  • Xavier Tchenio
    • Bourg en Bresse ICUBourg en Bresse Hospital
  • Patrick Herbecq
    • Roubaix ICURoubaix Hospital
  • Pierre Andrivet
    • Bligny ICUBligny Medical Center
  • Emmanuel Guerot
    • Medical ICUPompidou Hospital
  • Ariane Lafabrie
    • Medical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecineUniversité Paris-Diderot
  • Sébastien Perbet
    • Surgical ICUHotel Dieu University Hospital
  • Laurent Camous
    • Medical ICUBicêtre University Hospital
  • Ralf Janssen-Langenstein
    • Medical ICUCentral University Hospital
  • François Collet
    • St-Malo ICUSaint-Malo Hospital
  • Jonathan Messika
    • Tenon ICUTenon University Hospital
  • Stéphane Legriel
    • Versailles ICUVersailles Hospital
  • Xavier Fabre
    • Roanne ICURoanne Hospital
  • Olivier Guisset
    • Bordeaux ICUSaint-André Hospital
  • Samia Touati
    • Saint-Joseph Hospital
  • Sarah Kilani
    • Quimper ICUBretagne Sud Hospital
  • Michael Alves
    • Saint-Antoine ICUSaint-Antoine University Hospital
  • Alain Mercat
    • Medical ICUAngers Hospital
  • Thomas Similowski
    • Pulmonary and Critical Care DepartmentLa Pitié-Salpêtrière University Hospital
  • Laurent Papazian
    • Marseille Nord ICUNorth University Hospital
  • Anne-Pascale Meert
    • Brussels ICUJules Bordet Institute
  • Sylvie Chevret
    • Biostatistics DepartmentSaint-Louis Hospital and Paris 7 University
  • Benoît Schlemmer
    • Medical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecineUniversité Paris-Diderot
  • Laurent Brochard
    • Geneva ICUHôpitaux universitaires de Genève
  • Alexandre Demoule
    • Pulmonary and Critical Care DepartmentLa Pitié-Salpêtrière University Hospital
Original

DOI: 10.1007/s00134-012-2746-2

Cite this article as:
Azoulay, É., Kouatchet, A., Jaber, S. et al. Intensive Care Med (2013) 39: 292. doi:10.1007/s00134-012-2746-2

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

Mechanical ventilationIntubationPalliative careQuality of dying and deathFamily membersEnd-of-lifeDyspneaBreathlessness

Supplementary material

134_2012_2746_MOESM1_ESM.doc (40 kb)
Supplementary material 1 (DOC 40 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012