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Use of noninvasive ventilation on internal wards for elderly patients with limitations to respiratory care: a cohort study
Article first published online: 24 SEP 2010
© 2010 The Authors. European Journal of Clinical Investigation © 2010 Stichting European Society for Clinical Investigation Journal Foundation
European Journal of Clinical Investigation
Volume 41, Issue 1, pages 59–69, January 2011
How to Cite
Corral-Gudino, L., Jorge-Sánchez, R. J., García-Aparicio, J., Herrero-Herrero, J. I., López-Bernús, A., Borao-Cengotita-Bengoa, M., Martín-González, J. I. and Moreiro-Barroso, M. T. (2011), Use of noninvasive ventilation on internal wards for elderly patients with limitations to respiratory care: a cohort study. European Journal of Clinical Investigation, 41: 59–69. doi: 10.1111/j.1365-2362.2010.02380.x
- Issue published online: 8 DEC 2010
- Article first published online: 24 SEP 2010
- Received 26 February 2010; accepted 19 August 2010
- general ward;
- positive-pressure respiration;
- respiratory insufficiency;
- treatment outcome
Eur J Clin Invest 2010; 41 (1): 59–69
Background The use of noninvasive positive pressure ventilation (NPPV) outside the intensive wards has been evaluated in patients with no limitation on life-sustaining support. Our aim was to evaluate its usefulness in general wards for patients with NPPV as the ceiling of ventilator care when admission to the intensive care unit (ICU) has been withheld.
Materials and methods Noninvasive positive pressure ventilation was used in 44 patients with acute respiratory failure (ARF) and limitations to respiratory care– 22 with chronic obstructive pulmonary disease (COPD) exacerbations and 22 with acute cardiogenic pulmonary oedema (CPE). Survival at hospital discharge, and survival and readmission rate at 12 months were assessed.
Results Sixty-three per cent of COPD and 55% of CPE patients survived hospital discharge; and 50% and 37% respectively, were alive after 1 year. The cause of the in-hospital mortality was related to the admission diagnosis in 88% of cases. Cancer in COPD patients [P = 0·040, odds ratio (OR) = 15, 95% CI = 1·14–198] and the completion of NPPV treatment in both diseases (P = 0·008, OR = 0·03, 95% CI = 0·00–0·39 for COPD and P = 0·010, OR = 0·04, 95% CI = 0·00–0·45 for CPE) were related to in-hospital mortality.
Fifty-six per cent of COPD and 33% of CPE patients that survived hospital admission were readmitted.
Conclusions Our study suggests that the use of NPPV in general wards could be a safe and effective option, as a last choice treatment, in patients with NPPV as the ceiling of ventilator care when admission to ICU has been withheld.