Intensive Care Medicine

, Volume 39, Issue 2, pp 292–301 | Cite as

Noninvasive mechanical ventilation in patients having declined tracheal intubation

  • 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
Original

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 

Supplementary material

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

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • Élie Azoulay
    • 1
  • Achille Kouatchet
    • 2
  • Samir Jaber
    • 3
  • Jérôme Lambert
    • 4
  • Ferhat Meziani
    • 5
  • Matthieu Schmidt
    • 6
  • David Schnell
    • 1
  • Satar Mortaza
    • 2
  • Matthieu Conseil
    • 3
  • Xavier Tchenio
    • 7
  • Patrick Herbecq
    • 8
  • Pierre Andrivet
    • 9
  • Emmanuel Guerot
    • 10
  • Ariane Lafabrie
    • 1
  • Sébastien Perbet
    • 11
  • Laurent Camous
    • 12
  • Ralf Janssen-Langenstein
    • 5
  • François Collet
    • 13
  • Jonathan Messika
    • 14
  • Stéphane Legriel
    • 15
  • Xavier Fabre
    • 16
  • Olivier Guisset
    • 17
  • Samia Touati
    • 18
  • Sarah Kilani
    • 19
  • Michael Alves
    • 20
  • Alain Mercat
    • 2
  • Thomas Similowski
    • 6
  • Laurent Papazian
    • 21
  • Anne-Pascale Meert
    • 22
  • Sylvie Chevret
    • 4
  • Benoît Schlemmer
    • 1
  • Laurent Brochard
    • 23
  • Alexandre Demoule
    • 6
  1. 1.Medical ICU, Saint-Louis Hospital AP-HP, Medical ICU, Faculté de médecineUniversité Paris-DiderotParisFrance
  2. 2.Medical ICUAngers HospitalAngersFrance
  3. 3.Surgical ICUSaint-Eloi University HospitalMontpellierFrance
  4. 4.Biostatistics DepartmentSaint-Louis Hospital and Paris 7 UniversityParisFrance
  5. 5.Medical ICUCentral University HospitalStrasbourgFrance
  6. 6.Pulmonary and Critical Care DepartmentLa Pitié-Salpêtrière University HospitalParisFrance
  7. 7.Bourg en Bresse ICUBourg en Bresse HospitalBourg en BresseFrance
  8. 8.Roubaix ICURoubaix HospitalRoubaixFrance
  9. 9.Bligny ICUBligny Medical CenterBriis-sous-ForgesFrance
  10. 10.Medical ICUPompidou HospitalParisFrance
  11. 11.Surgical ICUHotel Dieu University HospitalClermont-FerrandFrance
  12. 12.Medical ICUBicêtre University HospitalLe Kremlin-BicêtreFrance
  13. 13.St-Malo ICUSaint-Malo HospitalSaint-MaloFrance
  14. 14.Tenon ICUTenon University HospitalParisFrance
  15. 15.Versailles ICUVersailles HospitalVersaillesFrance
  16. 16.Roanne ICURoanne HospitalRoanneFrance
  17. 17.Bordeaux ICUSaint-André HospitalBordeauxFrance
  18. 18.Saint-Joseph HospitalParisFrance
  19. 19.Quimper ICUBretagne Sud HospitalLorientFrance
  20. 20.Saint-Antoine ICUSaint-Antoine University HospitalParisFrance
  21. 21.Marseille Nord ICUNorth University HospitalMarseilleFrance
  22. 22.Brussels ICUJules Bordet InstituteBrusselsBelgium
  23. 23.Geneva ICUHôpitaux universitaires de GenèveGenevaSwitzerland

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