Original

Intensive Care Medicine

, Volume 39, Issue 2, pp 292-301

First online:

Noninvasive mechanical ventilation in patients having declined tracheal intubation

  • Élie AzoulayAffiliated withMedical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecine, Université Paris-Diderot Email author 
  • , Achille KouatchetAffiliated withMedical ICU, Angers Hospital
  • , Samir JaberAffiliated withSurgical ICU, Saint-Eloi University Hospital
  • , Jérôme LambertAffiliated withBiostatistics Department, Saint-Louis Hospital and Paris 7 University
  • , Ferhat MezianiAffiliated withMedical ICU, Central University Hospital
  • , Matthieu SchmidtAffiliated withPulmonary and Critical Care Department, La Pitié-Salpêtrière University Hospital
  • , David SchnellAffiliated withMedical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecine, Université Paris-Diderot
  • , Satar MortazaAffiliated withMedical ICU, Angers Hospital
  • , Matthieu ConseilAffiliated withSurgical ICU, Saint-Eloi University Hospital
    • , Xavier TchenioAffiliated withBourg en Bresse ICU, Bourg en Bresse Hospital
    • , Patrick HerbecqAffiliated withRoubaix ICU, Roubaix Hospital
    • , Pierre AndrivetAffiliated withBligny ICU, Bligny Medical Center
    • , Emmanuel GuerotAffiliated withMedical ICU, Pompidou Hospital
    • , Ariane LafabrieAffiliated withMedical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecine, Université Paris-Diderot
    • , Sébastien PerbetAffiliated withSurgical ICU, Hotel Dieu University Hospital
    • , Laurent CamousAffiliated withMedical ICU, Bicêtre University Hospital
    • , Ralf Janssen-LangensteinAffiliated withMedical ICU, Central University Hospital
    • , François ColletAffiliated withSt-Malo ICU, Saint-Malo Hospital
    • , Jonathan MessikaAffiliated withTenon ICU, Tenon University Hospital
    • , Stéphane LegrielAffiliated withVersailles ICU, Versailles Hospital
    • , Xavier FabreAffiliated withRoanne ICU, Roanne Hospital
    • , Olivier GuissetAffiliated withBordeaux ICU, Saint-André Hospital
    • , Samia TouatiAffiliated withSaint-Joseph Hospital
    • , Sarah KilaniAffiliated withQuimper ICU, Bretagne Sud Hospital
    • , Michael AlvesAffiliated withSaint-Antoine ICU, Saint-Antoine University Hospital
    • , Alain MercatAffiliated withMedical ICU, Angers Hospital
    • , Thomas SimilowskiAffiliated withPulmonary and Critical Care Department, La Pitié-Salpêtrière University Hospital
    • , Laurent PapazianAffiliated withMarseille Nord ICU, North University Hospital
    • , Anne-Pascale MeertAffiliated withBrussels ICU, Jules Bordet Institute
    • , Sylvie ChevretAffiliated withBiostatistics Department, Saint-Louis Hospital and Paris 7 University
    • , Benoît SchlemmerAffiliated withMedical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecine, Université Paris-Diderot
    • , Laurent BrochardAffiliated withGeneva ICU, Hôpitaux universitaires de Genève
    • , Alexandre DemouleAffiliated withPulmonary and Critical Care Department, La Pitié-Salpêtrière University Hospital

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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 ventilation Intubation Palliative care Quality of dying and death Family members End-of-life Dyspnea Breathlessness