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10.03.2017 | original article | Ausgabe 19-20/2017

Wiener klinische Wochenschrift 19-20/2017

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

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 19-20/2017
Autoren:
MD Fatma Çiftci, MD Aydın Çiledağ, MD Serhat Erol, MD Prof. Akın Kaya
Wichtige Hinweise
Fatma Çiftci designed the study, performed the literature search and data collection, and reviewed and submitted the manuscript. Aydın Çiledağ designed the study, performed data collection, and prepared and reviewed the manuscript. Serhat Erol performed data collection and prepared and reviewed the manuscript. Akın Kaya designed the study and prepared and reviewed the manuscript.

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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