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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References
Morrison RS, Meier DE (2004) Clinical practice Palliative care. N Engl J Med 350:2582–2590
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
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 376:784–793
(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 152:478–480
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
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
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
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 37:1250–1257
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
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 33:350–354
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
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
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
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
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 183:1200–1206
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 356:469–478
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 270:2957–2963
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 22:707–710
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 102:904–911
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 364:1293–1304
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 154:1690–1695
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
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370
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 39:112–118
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 348:683–693
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
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
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
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
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
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 183:348–355
Acknowledgments
We are grateful to Vincent Gobert and Zoé Cohen Solal for conducting the interviews and to Anita Allemchahian for her steadfast. This work was supported by a grant from the French Ministry of Health, Assistance-Publique Hôpitaux de Paris (AOM 09006) and the French Society for Critical Care. We are indebted to A. Wolfe, MD, for helping with this manuscript.
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For the REVA and the FAMIREA study groups.
The collaborators are listed in the Appendix.
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Azoulay, É., Kouatchet, A., Jaber, S. et al. Noninvasive mechanical ventilation in patients having declined tracheal intubation. Intensive Care Med 39, 292–301 (2013). https://doi.org/10.1007/s00134-012-2746-2
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DOI: https://doi.org/10.1007/s00134-012-2746-2