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Erschienen in: Wiener klinische Wochenschrift 19-20/2017

10.03.2017 | original article

Non-invasive ventilation for acute hypercapnic respiratory failure in older patients

verfasst von: Fatma Çiftci, MD, Aydın Çiledağ, MD, Serhat Erol, MD, Prof. Akın Kaya, MD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 19-20/2017

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Summary

Background

This trial was conducted to carry out an age and etiology-based analysis of the clinical efficacy of non-invasive ventilation (NIV) in acute hypercapnic respiratory failure (AHRF).

Methods

This single center, prospective, cohort study included patients aged ≥65 years with chronic obstructive pulmonary disease (COPD), acute cardiogenic pulmonary edema (ACPE), community-acquired pneumonia (CAP), bronchiectasis, and kyphoscoliosis, who were treated with NIV for AHRF in the intensive care unit within a 4-year period.

Results

From 496 patients aged 65 years or older treated with NIV for AHRF, 162 patients were included. Of the patients 71 were aged 65–74 years, 70 were 75–84 years, and 21 were aged ≥85 years. Of the patients 90 had COPD, 31 had ACPE, 19 had CAP, 15 had bronchiectasis exacerbation and 7 had kyphoscoliosis as the AHRF etiology. The treatment with NIV was successful in 119 patients. No significant difference was found between the age groups regarding NIV success rates (p = 0.803). An etiology-based analysis revealed that NIV was significantly more successful in the COPD and ACPE groups (p = 0.029, p = 0.035). A multivariate analysis revealed that Glasgow coma scale (GCS) (hazard ratio HR 0.215, 95% confidence interval CI: 0.104 to 0.442; p < 0.001), COPD assessment test (CAT) (HR 1.563, 95%CI: 1.229 to 1.987; p < 0.001), and acute physiology and chronic health evaluation (APACHE) ΙΙ (HR 1.009, 95%CI: 1.001 to 1.018; p = 0.031) as significant independent predictors of NIV failure in patients with COPD and AHRF.

Conclusions

The efficacy of NIV was independent of age in patients aged ≥65 years with AHRF and NIV was most successful when the etiology of AHRF was COPD or ACPE. Dyspnea level, GCS, and APACHE-ΙΙ scores were independent predictors of NIV failure in COPD.
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Metadaten
Titel
Non-invasive ventilation for acute hypercapnic respiratory failure in older patients
verfasst von
Fatma Çiftci, MD
Aydın Çiledağ, MD
Serhat Erol, MD
Prof. Akın Kaya, MD
Publikationsdatum
10.03.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 19-20/2017
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-017-1182-2

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