Noninvasive mechanical ventilation in patients having declined tracheal intubation

被引：105

作者：

Azoulay, Elie ^{[1
]}

Kouatchet, Achille ^{[2
]}

Jaber, Samir ^{[3
]}

Lambert, Jerome ^{[4
,5
]}

Meziani, Ferhat ^{[6
]}

Schmidt, Matthieu ^{[7
]}

Schnell, David ^{[1
]}

Mortaza, Satar ^{[2
]}

Conseil, Matthieu ^{[3
]}

Tchenio, Xavier ^{[8
]}

Herbecq, Patrick ^{[9
]}

Andrivet, Pierre ^{[10
]}

Guerot, Emmanuel ^{[11
]}

Lafabrie, Ariane ^{[1
]}

Perbet, Sebastien ^{[12
]}

Camous, Laurent ^{[13
]}

Janssen-Langenstein, Ralf ^{[6
]}

Collet, Francois ^{[14
]}

Messika, Jonathan ^{[15
]}

Legriel, Stephane ^{[16
]}

Fabre, Xavier ^{[17
]}

Guisset, Olivier ^{[18
]}

Touati, Samia ^{[19
]}

Kilani, Sarah ^{[20
]}

Alves, Michael ^{[21
]}

Mercat, Alain ^{[2
]}

Similowski, Thomas ^{[7
]}

Papazian, Laurent ^{[22
]}

Meert, Anne-Pascale ^{[23
]}

Chevret, Sylvie ^{[4
,5
]}

Schlemmer, Benoit ^{[1
]}

Brochard, Laurent ^{[24
]}

Demoule, Alexandre ^{[7
]}

机构：

[1] Univ Paris Diderot, Med ICU, Fac Med, St Louis Hosp,AP HP, F-75010 Paris, France

[2] Angers Hosp, Med ICU, Angers, France

[3] St Eloi Univ Hosp, Surg ICU, Montpellier, France

[4] St Louis Hosp, Dept Biostat, Paris, France

[5] Univ Paris 07, Paris, France

[6] Cent Univ Hosp, Med ICU, Strasbourg, France

[7] La Pitie Salpetriere Univ Hosp, Pulm & Crit Care Dept, Paris, France

[8] Bourg En Bresse Hosp, Bourg En Bresse ICU, Bourg En Bresse, France

[9] Roubaix Hosp, Roubaix ICU, Roubaix, France

[10] Bligny Med Ctr, Bligny ICU, Briis Sous Forges, France

[11] Pompidou Hosp, Med ICU, Paris, France

[12] Hotel Dieu Univ Hosp, Surg ICU, Clermont Ferrand, France

[13] Bicetre Univ Hosp, Med ICU, Le Kremlin Bicetre, France

[14] St Malo Hosp, St Malo ICU, St Malo, France

[15] Tenon Univ Hosp, Tenon ICU, Paris, France

[16] Versailles Hosp, Versailles ICU, Versailles, France

[17] Roanne Hosp, Roanne ICU, Roanne, France

[18] St Andre Hosp, Bordeaux ICU, Bordeaux, France

[19] St Joseph Hosp, Paris, France

[20] Bretagne Sud Hosp, Quimper ICU, Lorient, France

[21] St Antoine Univ Hosp, St Antoine ICU, Paris, France

[22] N Univ Hosp, Marseille Nord ICU, Marseille, France

[23] Inst Jules Bordet, Brussels ICU, B-1000 Brussels, Belgium

[24] Hop Cantonal Univ Geneva, Geneva ICU, Geneva, Switzerland

来源：

INTENSIVE CARE MEDICINE | 2013年 / 39卷 / 02期

关键词：

Mechanical ventilation; Intubation; Palliative care; Quality of dying and death; Family members; End-of-life; Dyspnea; Breathlessness; ACUTE RESPIRATORY-FAILURE; REFUSED ENDOTRACHEAL INTUBATION; OBSTRUCTIVE PULMONARY-DISEASE; POSITIVE-PRESSURE VENTILATION; RANDOMIZED CONTROLLED-TRIAL; INTENSIVE-CARE-UNIT; QUALITY-OF-LIFE; FACE MASK; ACUTE EXACERBATIONS; DISTRESS-SYNDROME;

D O I：

10.1007/s00134-012-2746-2

中图分类号：

R4 [临床医学];

学科分类号：

100218 [急诊医学];

摘要：

Noninvasive ventilation (NIV) is a treatment option in patients with acute respiratory failure who are good candidates for intensive care but have declined tracheal intubation. The aim of our study was to report outcomes after NIV in patients with a do-not-intubate (DNI) order. Prospective observational cohort study in all patients who received NIV for acute respiratory failure in 54 ICUs in France and Belgium, in 2010/2011. Goals of care, comfort, and vital status were assessed daily. On day 90, a telephone interview with patients and relatives recorded health-related quality of life (HRQOL), posttraumatic stress disorder-related symptoms, and symptoms of anxiety and depression. Post-ICU burden was compared between DNI patients and patients receiving NIV with no treatment-limitation decisions (TLD). Of 780 NIV patients, 574 received NIV with no TLD, and 134 had DNI orders. Hospital mortality was 44 % in DNI patients and 12 % in the no-TLD group. Mortality in the DNI group was lowest in COPD patients compared to other patients in the DNI group (34 vs. 51 %, P = 0.01). In the DNI group, HRQOL showed no significant decline on day 90 compared to baseline; day-90 data of patients and relatives did not differ from those in the no-TLD group. Do-not-intubate status was present among one-fifth of ICU patients who received NIV. DNI patients who were alive on day 90 experienced no decrease in HRQOL compared to baseline. The prevalences of anxiety, depression, and PTSD-related symptoms in these patients and their relatives were similar to those seen after NIV was used as part of full-code management (clinicaltrial.govNCT01449331).

引用

页码：292 / 301

页数：10

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