Results of noninvasive ventilation in very old patients 英文参考文献.docVIP

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Results of noninvasive ventilation in very old patients 英文参考文献.doc

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Results of noninvasive ventilation in very old patients 英文参考文献

Schortgenetal.AnnalsofIntensiveCare2012,2:5 /content/2/1/5 RESEARCH OpenAccess Resultsofnoninvasiveventilationinveryold patients FrederiqueSchortgen1,2*,ArnaudFollin1,LucillaPiccari1,FerranRoche-Campo1,GuillaumeCarteaux1, ElodieTaillandier-Heriche3,SebastienKrypciak3,ArnaudWThille1,ElenaPaillaud3,4 andLaurentBrochard2,4,5 Abstract Background:Noninvasiveventilation(NIV)isfrequentlyusedforthemanagementofacuterespiratoryfailure(ARF) inveryoldpatients(≥80years),ofteninthecontextofado-not-intubateorder(DNI).Weaimedtodetermineits efficacyandlong-termoutcome. Methods:ProspectivecohortofallpatientsadmittedtothemedicalICUofatertiaryhospitalduringa2-year periodandmanagedusingNIV.Characteristicsofpatients,contextofNIV,andtreatmentintensitywerecompared forveryoldandyoungerpatients.Six-monthsurvivalandfunctionalstatuswereassessedinveryoldpatients. Results:Duringthestudyperiod,1,019patientsneededventilatorysupportand376(37%)receivedNIV.Among them,163(16%)veryoldpatientsreceivedventilatorysupportwith60%ofthemmanagedusingNIVcompared with32%ofyoungerpatients(p0.0001).VeryoldpatientsreceivedNIVmorefrequentlywithDNIthanin youngerpatients(40%vs.8%).Suchcaseswereassociatedwithhighmortalityforbothveryoldandyounger patients.HospitalmortalitywashigherinveryoldthaninyoungerpatientsbutdidnotdifferwhenNIVwasused forcardiogenicpulmonaryedemaoracute-on-chronicrespiratoryfailure(20%vs.15%)andinpostextubation(15% vs.17%)outofacontextofDNI.Six-monthmortalitywas51%inveryoldpatients,67%forDNIpatients,and77% incaseofNIVfailureandendotrachealintubation.Ofthe30hospitalsurvivors,22livedathomeand13remained independentforactivitiesofdailyliving. Conclusions:VeryoldpatientsmanagedusingNIVhaveanoverallsatisfactory6-monthsurvivalandfunctional status,exceptforendotrachealintubationafterNIVfailure. Introduction yearsorolder,alsoreferredtoas“veryoldpatients,”are The use of noninvasive ventilation (NIV) as first-line potentially “good candidates ” for a less invasive supportivetherapyforacuterespiratoryfai