Skip to main content
Download PDF

Palliative noninvasive ventilation in patients with acute respiratory failure

Intensive Care Medicine volume 37, pages 1250–1257 (2011)Cite this article

Abstract

Over the last two decades, the increasing use of noninvasive ventilation (NIV) has diminished the need for endotracheal ventilation, thus decreasing the rate of ventilation-induced complications. Thus, NIV has decreased both intubation rates and mortality rates in specific subsets of patients with acute respiratory failure (e.g., patients with hypercapnia, cardiogenic pulmonary edema, immune deficiencies, or post-transplantation acute respiratory failure). NIV is also increasingly used as a palliative strategy when endotracheal ventilation is deemed inappropriate. In this context, palliative NIV can either be administered to offer a chance for survival, or to alleviate the symptoms of respiratory distress in dying patients. The literature provides information from 10 studies published between 1992 and 2006, in which 458 patients received palliative NIV. The technique was feasible, usually well tolerated, and half of the patients survived. The objectives of this review article are to define palliative NIV, to delineate the place for palliative NIV among overall indications of NIV, and to define the contribution of NIV to the palliative strategies available for patients with acute respiratory failure. Potential benefits and harm from NIV in patients who are not eligible for endotracheal ventilation are discussed. The appropriateness of palliative NIV should be reported in a study that relies on both quantitative criteria (rate of palliative NIV use and mortality) and qualitative criteria (patient comfort, end-of-life process, family burden, and health-care provider satisfaction).

Introduction

The utilization of intensive care has changed over the last two decades. Patients with AIDS and acute respiratory failure (ARF) requiring mechanical ventilation or septic shock, who had mortality rates greater than 75% in the 1990s, now have far lower mortality rates than patients with other conditions such as New York Heart Association (NYHA) III heart failure, cirrhosis of the liver, or cancer [1]. Similarly, major survival gains have been achieved in patients with hematological malignancies and ARF. Advances in treatments for hematological malignancies [2–4], a systematic clinical approach [5], and noninvasive management strategies [6] have decreased the mortality rate in these patients from nearly 100% [7, 8] to less than 50% [9].

The radical transformation undergone by intensive care over the last half a century has increased survival rates among patients with the most severe conditions (cancer, transplantation, advanced AIDS, multiple injuries, burns, or major surgery) to the levels achieved in poliomyelitis patients with ARF in the 1950s [10]. Over the last decade, intensivists have been increasingly asked to admit patients experiencing severe but reversible acute events during the last few months of their lives. These patients are often very elderly and have major comorbidities and/or chronic disabilities (with musculoskeletal, respiratory, cardiac, and neurological impairments). The decision to admit a patient to the intensive care unit (ICU) depends on the wishes of the patient—when they are known—and on the medical data supplied by the professionals caring for the patient [11]. Not infrequently, decisions to limit active treatments (e.g., mechanical ventilation, catecholamines, cardiac massage, and dialysis) are taken immediately upon ICU admission to protect patients from useless interventions that contradict their preferences and values and would deprive them from communicating with their families during the very last moments of their lives [12]. Although intensivists are steeped in a culture of survival, they are now striving to prevent unreasonable therapeutic interventions by introducing palliative care into the ICU, in collaboration with health-care teams that regularly provide palliative care (e.g., in internal medicine, geriatrics, neurology, oncology, hematology, pulmonology, and cardiology) [13]. More recently, palliative care has become the standard of care in patients with inaugural malignancies, limiting side effects of undue chemotherapy, and increasing quality of life as well as duration of life [14].

Outside the palliative care setting, NIV has considerably improved the survival of patients with hypercapnic exacerbations of chronic obstructive pulmonary disease (COPD) [15]. This effect is ascribed to decreased use of endotracheal intubation [16, 17], which results in lower rates of ventilator-associated infection [18, 19]. NIV has also been used successfully in many other situations [20–22] including cardiogenic acute pulmonary edema [23], postoperative ARF [24], particularly in solid organ transplant recipients [25], and ARF in patients with immune deficiencies [26, 27]. However, the effects of NIV or continuous positive airway pressure (CPAP) in hypoxemic ARF remain somewhat controversial [28, 29].

Several studies provide evidence that denial of ICU admission is high, especially among older patients and those with chronic respiratory disorders and cancer [11, 30–34]. Implementing palliative NIV in the ICU or in the wards remains a controversial issue. Even though it is regularly performed [35], quantitative and qualitative data are scarce.

ARF and dyspnea are extremely common in patients receiving palliative care

Together with pain, dyspnea is among the most common symptoms in palliative care patients [36, 37]. The symptomatic treatment of dyspnea related to hypoxemia in a patient with ARF relies on supplemental oxygen [38]. Two situations can be distinguished according to whether the dyspnea is related to a reversible factor (e.g., pulmonary edema, infection, or drug overdose) or is a manifestation of an irreversible process (terminal dyspnea, due for instance to progression of a malignant or neurological disease such as carcinomatous lymphangitis, nerve compression, amyotrophic lateral sclerosis, or other advanced degenerative neuromuscular diseases).

When dyspnea is related to a reversible event, symptomatic treatment is combined with interventions that target the cause (e.g., diuretics, antibiotics, antidotes, or physical therapy). NIV has been evaluated in this situation. Terminal dyspnea, in contrast, is a symptom of the end of life and requires comfort care [38]. Opiates in subanalgesic dosages relieve the subjective sensation of dyspnea without improving ventilation or oxygenation [37, 38]. Anxiolytic agents may be required [39], but this is matter of debate [40, 41]. The use of NIV in patients with terminal dyspnea is controversial. NIV for terminal dyspnea has been described both as an example of futile care and as a tool for improving patient comfort at the end of life.

Palliative NIV in patients for whom endotracheal ventilation is not an option

The appropriateness of palliative NIV in patients with decisions to forego endotracheal mechanical ventilation has been a matter of debate for nearly 15 years (Table 1). The first published study was conducted in France in 30 elderly patients [42]. NIV was successful in 60% of these patients and well tolerated in 75%. All the survivors recovered their previous level of function [42]. A 1994 report describes the results of NIV in 11 patients with ARF during terminal illnesses [43]. Among them, four patients failed to benefit from NIV and died; NIV discontinuation in these four patients was not perceived as traumatic by the patients or families. In addition, palliative NIV relieved the sensation of dyspnea while allowing patients to communicate with their loved ones. Although the authors of this study concluded that NIV improved patient comfort and dignity, the sample size was small and the potential benefits of NIV were not measured rigorously using a questionnaire or a qualitative method. At the same time, palliative NIV was challenged on ethical and economic grounds [44, 45]. In addition to the two above-mentioned studies [42, 43], ten studies evaluated palliative NIV in patients with do-not-intubate decisions. Table 1 lists the main results from these ten studies in 458 patients. Five main conclusions can be drawn: NIV is often offered to patients receiving palliative care; among patients given palliative NIV for ARF related to reversible events, nearly half survive and can return home; survival varies with the underlying condition (being higher in patients with COPD or acute pulmonary edema than in patients with cancer) and with the cause of ARF; survival is lower in patients with a coma at NIV initiation or with an ineffective cough; and patient comfort and family satisfaction, although not specifically measured, are not described as poor.

Table 1 Studies of palliative NIV (10 studies, 458 patients)
Full size table

Interestingly, two practice surveys have evaluated whether palliative NIV is widely used in patients for whom endotracheal ventilation is not an option. In the UK, among 38 physicians specialized in Duchenne’s muscular dystrophy, nearly 80% reported discussing palliative NIV with the patients and families, and the same proportion had already used palliative NIV for their patients [46]. The other survey was done in Canada and the USA in intensivists, pulmonologists, and physical therapists [47]. The vast majority of respondents felt that NIV should be offered to patients with ARF and decisions to forego endotracheal ventilation. Nearly half the respondents perceived palliative NIV as a component of comfort care, and nearly 80% had used palliative NIV in patients with end-stage COPD or heart failure. Palliative NIV was less often used in patients with cancer and in those who had chosen comfort care only (60 and 50%, respectively). Table 2 lists the main advantages and disadvantages of palliative NIV. It is still controversial to consider that the ICU is the best place to offer NIV as a palliative tool or to state that the ICU is a good place to die. Along this line, a very recent paper has shown that cancer patients and their relatives considered that the ICU was a very bad place to die [48]. Studies are needed to compare palliative NIV in both places, because we know that in real life it is administrated in both the ICU and the wards [49].

Table 2 Possible advantages and disadvantages of palliative NIV in the ICU
Full size table

Despite this evidence that palliative NIV is widely used, further studies are needed, for several reasons. No accurate data are available on the rate of palliative NIV use in patients for whom endotracheal ventilation is not an option. The impact of palliative NIV has been measured in terms of overall survival but not quality of life. Qualitative assessments via interviews or questionnaires have not been performed, although a qualitative approach is crucial to assess the risk/benefit ratio of palliative NIV. The impact of palliative NIV has been evaluated in patients with a variety of underlying conditions (e.g., heart failure, COPD, and cancer) but has not been measured according to the cause of the respiratory deterioration. Finally, the perceptions of the health-care professionals along the chain of care (nurses and physicians in wards and ICUs) have not been reported. To date, a single qualitative study reported beneficial effects of palliative NIV in patients with amyotrophic lateral sclerosis in the absence of acute events [50]. Promising improvements in quality of life were obtained. However, none of these patients had ARF. Instead, they experienced a gradual deterioration in their respiratory status, and their quality of life and respiratory function were evaluated every 2 months.

Position of learned societies regarding NIV use in patients with decisions to forego intubation

Palliative care specialists have expressed concern about the increasing use of palliative NIV [51], and most surveyed physicians request that learned societies issue recommendations about palliative NIV [46]. Physicians worry that patients may perceive palliative NIV as a highly technical, uncomfortable, and aggressive procedure that conflicts with their preferences and values. The term “noninvasive” may not be fully justified. The noninvasiveness of NIV has never been qualitatively established from a patient or proxy perspective. Actually, recommendations have been issued for patients with degenerative neurological diseases in the absence of acute events [52].

According to the consensus statement on NIV for ARF issued in 2001 [American Thoracic Society (ATS), the European Society of Intensive Care Medicine (ESICM), Société de Réanimation de Langue Française (SRLF), the European Respiratory Society (ERS)], palliative NIV is appropriate in selected patients for whom endotracheal ventilation is not an option provided the cause of ARF is reversible and NIV improves patient comfort [53, 54]. Palliative NIV is not discussed in the 2002 recommendations issued by the British Thoracic Society [55]. A European survey coordinated by the ERS indicated that palliative NIV was used in a large proportion (31%) of patients with decisions to limit active treatments [35]. The authors concluded that a qualitative evaluation of palliative NIV was needed. In 2007, a Society for Critical Care Medicine (SCCM) task force suggested an approach for deciding when to offer NIV to patients for whom endotracheal ventilation is not an option [56]. This approach involves a daily evaluation of NIV objectives, which are classified into three categories (Tables 3, 4), among which patients may move from day to day: NIV as life support for patients without treatment-limitation decisions; NIV as life support for patients with do-not-intubate decisions, under the rationale that the adverse effects of NIV (e.g., some degree of patient discomfort, leaks, and alarms) are acceptable given the expected survival benefits; and NIV as a palliative measure in patients receiving comfort care only. The last two categories define palliative NIV. Preserved communication between the patient and family is considered one of the main benefits of NIV. NIV for comfort care is intended to relieve the sensation of dyspnea. In this situation, recovery is not a treatment objective and adverse effects of NIV are consequently unacceptable. This classification scheme can be expected to improve communication among physicians, other health-care professionals, patients, and families. It rests on an ethical scaffold involving clarification of treatment goals, respect for patient preferences and values, and communication with and between the patient and family.

Table 3 Classification of situations for NIV use established by the SCCM (from [56])
Full size table
Table 4 Data on situations for NIV use as established by the SCCM [56]
Full size table

A 2006 consensus statement on NIV in ARF [Société Française d’Anesthésie et de Réanimation (SFAR), Société de Pneumologie de Langue Française (SPLF), and SRLF with contributions from the Association des Anesthésistes Réanimateurs Pédiatriques d’Expression Française (ADARPEF), Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP), Services d’Aide Médicale Urgente (SAMU) de France, and Société Française de Médecine d’Urgence (SFMU)] describes the indications for palliative NIV as follows: “NIV can be used in patients who choose to forego endotracheal ventilation or whose prognosis is too poor to warrant endotracheal intubation (Grade 2+). In patients at the end of life, NIV is warranted only when it improves patient comfort.” This consensus conference did not specifically recommend the use of a code status such as “Do Not Perform NIV.”

Among the important issues not addressed by the current literature, studies are warranted to find answers to the three following points: (1) we do not know whether palliative ventilation increases duration of life or if it extends the dying process. Similarly, objective data are needed to guide the optimal duration of trial of palliative NIV so as to avoid extending non-beneficial care in patients who will inexorably die. (2) Qualitative observational data are also required to list actual benefits from palliative NIV, such as improvement of family experience, patient’s well-being, quality of end-of-life care, family satisfaction, global clinician’s perspective. (3) Should palliative NIV be performed in incapacitated patients in order to either get a chance of survival (SCCM 2 type) or to alleviate symptoms of respiratory distress?

Description of the OVNI study

OVNI is a longitudinal observational multicenter study performed between November 2010 and April 2011. All patients given NIV were monitored daily until hospital discharge to determine survival, treatment-limitation decisions (if any), and treatment intensity. In the ICUs, patients were classified daily according to SCCM task force criteria (Tables 3, 4) as receiving NIV as life support without treatment-limitation decisions, receiving NIV as life support with do-not-intubate orders, or receiving NIV as comfort care. The last two categories define palliative NIV. The patients and families will be followed up for 1 year, with phone calls on days 90, 180, and 365 to collect data on survival, quality of life, and self-sufficiency. Information will be obtained on family burden (symptoms of anxiety, depression, and stress). The nurses, intensivists, and referring physicians will be asked about their satisfaction with treatment-limitation decisions and with the results of palliative NIV. This study should provide qualitative and quantitative information on the results of NIV at the end-of-life.

Conclusion

Palliative NIV is regularly performed in the ICU as well as in the medical wards or the emergency department. The technique is perceived as feasible and provides survival benefits in hypercapnic patients and those with cardiac pulmonary edema. In cancer patients, benefit seems dismal. Current recommendations from teaching societies recognize the use of palliative NIV. However, no qualitative data are available to date. For instance, studies are needed to identify actual benefits from palliative NIV that are not related to survival. In patients who survive, quality of life data may convince clinicians that palliative NIV actually extends duration of life and does not merely extend the dying process. In patients who die, studies reporting quality of dying and death for patients and post-ICU burden in relatives (e.g., complicated grief, post-traumatic stress disorder, anxiety, and depression) are warranted. Further recommendations should help to increase the use of palliative NIV in patients who may benefit, but also highlight those patients in whom the technique provides no survival and no qualitative benefits.

References

  1. Barbier F, Coquet I, Legriel S, Pavie J, Darmon M, Mayaux J, Molina JM, Schlemmer B, Azoulay E (2009) Etiologies and outcome of acute respiratory failure in HIV-infected patients. Intensive Care Med 35:1678–1686

    PubMed  Article  Google Scholar 

  2. Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, Morel P, Van Den Neste E, Salles G, Gaulard P, Reyes F, Lederlin P, Gisselbrecht C (2002) CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346:235–242

    PubMed  Article  CAS  Google Scholar 

  3. O’Brien SG, Guilhot F, Larson RA, Gathmann I, Baccarani M, Cervantes F, Cornelissen JJ, Fischer T, Hochhaus A, Hughes T, Lechner K, Nielsen JL, Rousselot P, Reiffers J, Saglio G, Shepherd J, Simonsson B, Gratwohl A, Goldman JM, Kantarjian H, Taylor K, Verhoef G, Bolton AE, Capdeville R, Druker BJ (2003) Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med 348:994–1004

    PubMed  Article  Google Scholar 

  4. Laver JH, Kraveka JM, Hutchison RE, Chang M, Kepner J, Schwenn M, Tarbell N, Desai S, Weitzman S, Weinstein HJ, Murphy SB (2005) Advanced-stage large-cell lymphoma in children and adolescents: results of a randomized trial incorporating intermediate-dose methotrexate and high-dose cytarabine in the maintenance phase of the APO regimen: a Pediatric Oncology Group phase III trial. J Clin Oncol 23:541–547

    PubMed  Article  CAS  Google Scholar 

  5. Azoulay E, Schlemmer B (2006) Diagnostic strategy in cancer patients with acute respiratory failure. Intensive Care Med 32:808–822

    PubMed  Article  Google Scholar 

  6. Azoulay E, Mokart D, Rabbat A, Pene F, Kouatchet A, Bruneel F, Vincent F, Hamidfar R, Moreau D, Mohammedi I, Epinette G, Beduneau G, Castelain V, de Lassence A, Gruson D, Lemiale V, Renard B, Chevret S, Schlemmer B (2008) Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data. Crit Care Med 36:100–107

    PubMed  Article  Google Scholar 

  7. Ewig S, Torres A, Riquelme R, El-Ebiary M, Rovira M, Carreras E, Rano A, Xaubet A (1998) Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU. Eur Respir J 12:116–122

    PubMed  Article  CAS  Google Scholar 

  8. Schuster DP, Marion JM (1983) Precedents for meaningful recovery during treatment in a medical intensive care unit. Outcome in patients with hematologic malignancy. Am J Med 75:402–408

    PubMed  Article  CAS  Google Scholar 

  9. Azoulay E, Thiery G, Chevret S, Moreau D, Darmon M, Bergeron A, Yang K, Meignin V, Ciroldi M, Le Gall JR, Tazi A, Schlemmer B (2004) The prognosis of acute respiratory failure in critically ill cancer patients. Medicine (Baltimore) 83:360–370

    Article  Google Scholar 

  10. Annane D, Aegerter P, Jars-Guincestre MC, Guidet B (2003) Current epidemiology of septic shock: the CUB-Rea network. Am J Respir Crit Care Med 168:165–172

    PubMed  Article  Google Scholar 

  11. Iapichino G, Corbella D, Minelli C, Mills GH, Artigas A, Edbooke DL, Pezzi A, Kesecioglu J, Patroniti N, Baras M, Sprung CL (2010) Reasons for refusal of admission to intensive care and impact on mortality. Intensive Care Med 36:1772–1779

    PubMed  Article  Google Scholar 

  12. Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinova K, Lafabrie A, Abizanda R, Svantesson M, Rubulotta F, Ricou B, Benoit D, Heyland D, Joynt G, Francais A, Azeivedo-Maia P, Owczuk R, Benbenishty J, de Vita M, Valentin A, Ksomos A, Cohen S, Kompan L, Ho K, Abroug F, Kaarlola A, Gerlach H, Kyprianou T, Michalsen A, Chevret S, Schlemmer B (2009) Prevalence and factors of intensive care unit conflicts: the Conflicus study. Am J Respir Crit Care Med 180:853–860

    PubMed  Article  Google Scholar 

  13. Nelson JE, Bassett R, Boss RD, Brasel KJ, Campbell ML, Cortez TB, Curtis JR, Lustbader DR, Mulkerin C, Puntillo KA, Ray DE, Weissman DE (2010) Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Crit Care Med 38:1765–1772

    PubMed  Article  Google Scholar 

  14. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742

    PubMed  Article  CAS  Google Scholar 

  15. Lightowler JV, Wedzicha JA, Elliott MW, Ram FS (2003) Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 326:185

    PubMed  Article  Google Scholar 

  16. 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 323:1523–1530

    PubMed  Article  CAS  Google Scholar 

  17. 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 333:817–822

    PubMed  Article  CAS  Google Scholar 

  18. Girou E, Schortgen F, Delclaux C, Brun-Buisson C, Blot F, Lefort Y, Lemaire F, Brochard L (2000) Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. Jama 284:2361–2367

    PubMed  Article  CAS  Google Scholar 

  19. Girou E, Brun-Buisson C, Taille S, Lemaire F, Brochard L (2003) Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema. Jama 290:2985–2991

    PubMed  Article  CAS  Google Scholar 

  20. Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, Raymondos K, Nin N, Hurtado J, Tomicic V, Gonzalez M, Elizalde J, Nightingale P, Abroug F, Pelosi P, Arabi Y, Moreno R, Jibaja M, D’Empaire G, Sandi F, Matamis D, Montanez AM, Anzueto A (2008) Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 177:170–177

    PubMed  Article  Google Scholar 

  21. 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

    PubMed  Article  Google Scholar 

  22. Nava S, Hill N (2009) Non-invasive ventilation in acute respiratory failure. Lancet 374:250–259

    PubMed  Article  Google Scholar 

  23. Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA (2005) Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. Jama 294:3124–3130

    PubMed  Article  CAS  Google Scholar 

  24. Jaber S, Chanques G, Jung B (2010) Postoperative noninvasive ventilation. Anesthesiology 112:453–461

    PubMed  Article  Google Scholar 

  25. Antonelli M, Conti G, Bufi M, Costa MG, Lappa A, Rocco M, Gasparetto A, Meduri GU (2000) Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. Jama 283:235–241

    PubMed  Article  CAS  Google Scholar 

  26. Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525

    PubMed  Article  CAS  Google Scholar 

  27. Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487

    PubMed  Article  CAS  Google Scholar 

  28. Antonelli M, Conti G, Rocco M, Bufi M, De Blasi RA, Vivino G, Gasparetto A, Meduri GU (1998) A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 339:429–435

    PubMed  Article  CAS  Google Scholar 

  29. 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 284:2352–2360

    PubMed  Article  CAS  Google Scholar 

  30. Garrouste-Orgeas M, Timsit JF, Montuclard L, Colvez A, Gattolliat O, Philippart F, Rigal G, Misset B, Carlet J (2006) Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission. Intensive Care Med 32:1045–1051

    PubMed  Article  Google Scholar 

  31. Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B (2007) Should elderly patients be admitted to the intensive care unit? Intensive Care Med 33:1252–1262

    PubMed  Article  Google Scholar 

  32. Pene F, Soares M (2008) Can we still refuse ICU admission of patients with hematological malignancies? Intensive Care Med 34:790–792

    PubMed  Article  Google Scholar 

  33. Eastman N, Philips B, Rhodes A (2010) Triaging for adult critical care in the event of overwhelming need. Intensive Care Med 36:1076–1082

    PubMed  Article  Google Scholar 

  34. Sprung CL, Zimmerman JL, Christian MD, Joynt GM, Hick JL, Taylor B, Richards GA, Sandrock C, Cohen R, Adini B (2010) Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine’s Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Intensive Care Med 36:428–443

    PubMed  Article  Google Scholar 

  35. 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 30:156–164

    PubMed  Article  CAS  Google Scholar 

  36. Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, Rushton CH, Kaufman DC (2008) Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine. Crit Care Med 36:953–963

    PubMed  Article  Google Scholar 

  37. 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 165:1722–1727

    PubMed  Article  Google Scholar 

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

    PubMed  Article  CAS  Google Scholar 

  39. Moryl N, Coyle N, Foley KM (2008) Managing an acute pain crisis in a patient with advanced cancer: “this is as much of a crisis as a code”. JAMA 299:1457–1467

    PubMed  Article  CAS  Google Scholar 

  40. Hirst A, Sloan R (2002) Benzodiazepines and related drugs for insomnia in palliative care. Cochrane Database Syst Rev 4:CD003346

    PubMed  Google Scholar 

  41. Simon ST, Higginson IJ, Booth S, Harding R, Bausewein C (2010) Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev 20:CD007354

    Google Scholar 

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

    PubMed  Article  CAS  Google Scholar 

  43. 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 22:1584–1590

    PubMed  CAS  Google Scholar 

  44. Clarke DE, Vaughan L, Raffin TA (1994) Noninvasive positive pressure ventilation for patients with terminal respiratory failure: the ethical and economic costs of delaying the inevitable are too great. Am J Crit Care 3:4–5

    PubMed  CAS  Google Scholar 

  45. Freichels TA (1994) Palliative ventilatory support: use of noninvasive positive pressure ventilation in terminal respiratory insufficiency. Am J Crit Care 3:6–10

    PubMed  CAS  Google Scholar 

  46. Kinali M, Manzur AY, Mercuri E, Gibson BE, Hartley L, Simonds AK, Muntoni F (2006) UK physicians’ attitudes and practices in long-term non-invasive ventilation of Duchenne muscular dystrophy. Pediatr Rehabil 9:351–364

    PubMed  CAS  Google Scholar 

  47. Sinuff T, Cook DJ, Keenan SP, Burns KE, Adhikari NK, Rocker GM, Mehta S, Kacmarek R, Eva K, Hill NS (2008) Noninvasive ventilation for acute respiratory failure near the end of life. Crit Care Med 36:789–794

    PubMed  Article  Google Scholar 

  48. Wright AA, Keating NL, Balboni TA, Matulonis UA, Block SD, Prigerson HG (2011) Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. J Clin Oncol 28:4457–4464

    Article  Google Scholar 

  49. Principi T, Pantanetti S, Catani F, Elisei D, Gabbanelli V, Pelaia P, Leoni P (2004) Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure. Intensive Care Med 30:147–150

    PubMed  Article  Google Scholar 

  50. Bourke SC, Bullock RE, Williams TL, Shaw PJ, Gibson GJ (2003) Noninvasive ventilation in ALS: indications and effect on quality of life. Neurology 61:171–177

    PubMed  CAS  Google Scholar 

  51. Shee CD, Green M (2003) Non-invasive ventilation and palliation: experience in a district general hospital and a review. Palliat Med 17:21–26

    PubMed  Article  Google Scholar 

  52. Eng D (2006) Management guidelines for motor neurone disease patients on non-invasive ventilation at home. Palliat Med 20:69–79

    PubMed  Article  Google Scholar 

  53. American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Société de Réanimation de Langue Française (2001) International consensus conferences in intensive care medicine: noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 163:283–291

    Google Scholar 

  54. Evans TW (2001) International consensus conferences in intensive care medicine: non-invasive positive pressure ventilation in acute respiratory failure. Organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Societe de Reanimation de Langue Francaise, and approved by the ATS Board of Directors, December 2000. Intensive Care Med 27:166–178

    Google Scholar 

  55. British Thoracic Society Standards of Care Committee (2002) Non-invasive ventilation in acute respiratory failure. Thorax 57:192–211

    Google Scholar 

  56. 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 35:932–939

    PubMed  Article  Google Scholar 

  57. 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 32:372–377

    PubMed  Article  Google Scholar 

  58. 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 32:2002–2007

    PubMed  Article  Google Scholar 

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

    PubMed  Article  Google Scholar 

  60. 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 18:602–610

    PubMed  Article  Google Scholar 

  61. Meert AP, Berghmans T, Hardy M, Markiewicz E, Sculier JP (2006) Non-invasive ventilation for cancer patients with life-support techniques limitation. Support Care Cancer 14:167–171

    PubMed  Article  Google Scholar 

  62. 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 53:1153–1157

    PubMed  Article  Google Scholar 

  63. Corral-Gudino L, Jorge-Sanchez RJ, Garcia-Aparicio J, Herrero-Herrero JI, Lopez-Bernus A, Borao-Cengotita-Bengoa M, Martin-Gonzalez JI, Moreiro-Barroso MT (2011) Use of noninvasive ventilation on internal wards for elderly patients with limitations to respiratory care: a cohort study. Eur J Clin Invest 41:59–69

    PubMed  Article  Google Scholar 

  64. Duchateau FX, Beaune S, Ricard-Hibon A, Mantz J, Juvin P (2010) Prehospital noninvasive ventilation can help in management of patients with limitations of life-sustaining treatments. Eur J Emerg Med 17:7–9

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de Réanimation Médicale, APHP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France

    Élie Azoulay, Alexandre Demoule, Samir Jaber, Achille Kouatchet, Anne-Pascale Meert, Laurent Papazian & Laurent Brochard

Authors
  1. Élie Azoulay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandre Demoule
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samir Jaber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Achille Kouatchet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne-Pascale Meert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Laurent Papazian
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Laurent Brochard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Élie Azoulay.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Azoulay, É., Demoule, A., Jaber, S. et al. Palliative noninvasive ventilation in patients with acute respiratory failure. Intensive Care Med 37, 1250–1257 (2011). https://doi.org/10.1007/s00134-011-2263-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-011-2263-8

Keywords

  • ARDS and ALI: clinical studies
  • Critical care organisation
  • Ethics
  • Hematologic–oncologic issues in the ICU
  • Non-invasive ventilation
  • Pain management