Non-invasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomised controlled trial

摘要: OBJECTIVE older patients usually receive less invasive and costly hospital care, even if they meet the criteria for Intensive Care Unit admission or have a 'do not intubate'(DNI) order. The aim of this randomised, controlled trial was to assess effectiveness non-invasive mechanical ventilation (NIV) versus standard medical therapy (SMT) in reducing need intubation, improving survival respiratory distress very old with acute hypercapnic failure (AHRF). PARTICIPANTS AND DESIGN eighty-two aged >75 years (mean age 81.3 ± 3.5 years) were randomised NIV SMT. SETTINGS three units. MEASUREMENTS primary outcome rate meeting endotracheal intubation (ETI) criteria. Secondary outcomes mortality rate, dyspnoea score, arterial blood gases. RESULTS ETI lower group compared SMT (7.3 63.4%, respectively; P < 0.001), as [(odds ratios) OR = 0.40; 95% CI: 0.19-0.83; 0.014]. Twenty-two 41 DNI orders received rescue therapy. subgroup comparable significantly receiving (OR 0.60, 0.18-1.92 4.03, 2.35-6.94, 0.009). Arterial gases, improved faster than CONCLUSIONS SMT, decreased AHRF. should be offered an alternative considered poor candidates those