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Morbimortality and Six-Month Survival Among Elderly Patients Treated With Noninvasive Mechanical Ventilation in an
Mafalda F Teixeira1, Mónica Lopes1, Frederico Batista1
1Department of Internal Medicine IV, Hospital Professor Doutor Fernando Fonseca, Lisboa, PRT.
Background:
Noninvasive mechanical ventilation (NIMV) has been established as a successful therapeutic option for patients with acute respiratory failure (ARF) with a specific etiology.
Objectives:
This study evaluated the morbimortality of patients with ARF treated with NIMV in a medical intermediate care unit (UCINT) to identify factors associated with higher in-hospital mortality, six-month mortality, and three- and six-month hospital readmission rates.
Methods:
This retrospective cohort study included elderly patients admitted for ARF and treated with NIMV in the UCINT between 2015 and 2019.
Results:
In the sample of 102 patients, the median age was 84.2 (±5.5) years, and 57% were women. In total, 28% were on long-term oxygen therapy, and 68% had a do-not-resuscitate order. At admission, the median Charlson comorbidity index and Barthel index of activities of daily living were 7 [6; 8] and 30 [20; 57,5], respectively. The simplified acute physiology score II was 39.1±10.7, and 92% of patients had type 2 ARF. Median days on NIMV and days in UCINT were 10 [6; 16] and 6 [3; 10], respectively. The main conditions requiring UCINT admission for NIMV were heart failure, pneumonia, and exacerbation of the chronic obstructive pulmonary disease. The NIMV failure rate was 7%. At discharge, the average Barthel index was 35 [10; 55]. The in-hospital mortality rate was 23%.
Discussion:
Older age, higher simplified acute physiology score II, higher Charlson comorbidity index, and higher number of days on NIMV were associated with higher in-hospital mortality. Long-term oxygen therapy was associated with higher three-month mortality. A higher Barthel index at the time of hospital discharge was associated with a higher six-month readmission rate.
Conclusion:
NIMV can be used successfully in elderly patients and less studied ARF etiologies, such as pneumonia.
Insights
Noninvasive mechanical ventilation (NIMV) is effective for acute respiratory failure (ARF) in elderly patients. Factors like older age and comorbidities increase in-hospital mortality risk.
Area of Science:
- Geriatric Medicine
- Critical Care Medicine
- Pulmonology
Background:
- Noninvasive mechanical ventilation (NIMV) is a recognized treatment for acute respiratory failure (ARF).
- Limited data exists on NIMV outcomes in elderly patients with diverse ARF etiologies.
Purpose of the Study:
- Evaluate morbimortality in elderly ARF patients treated with NIMV in a medical intermediate care unit (UCINT).
- Identify factors predicting in-hospital mortality, 6-month mortality, and 3- and 6-month readmission rates.
Main Methods:
- Retrospective cohort study of elderly ARF patients treated with NIMV in UCINT (2015-2019).
- Data collected included demographics, comorbidities (Charlson index), functional status (Barthel index), physiological scores (SAPS II), and ventilation parameters.
Main Results:
- 102 elderly patients (median age 84.2 years) with predominantly Type 2 ARF (92%) were included.
- In-hospital mortality was 23%. Factors associated with increased mortality included older age, higher SAPS II, higher Charlson index, and longer NIMV duration.
- Long-term oxygen therapy correlated with higher 3-month mortality; higher discharge Barthel index predicted higher 6-month readmission.
Conclusions:
- NIMV is a viable treatment for ARF in the elderly, including less common causes like pneumonia.
- Prognostic factors for mortality and readmission in this population can guide clinical management.
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