Factor for Predicting Non-Invasive Ventilation Failure in Very Old Patients with Hypoxemic Respiratory Failure in Intensive Care Unit

Year 2024, , 264 - 271, 01.07.2024

Korhan Kollu , Mahmut Sami İnce , Dursun Elmas

https://doi.org/10.18663/tjcl.1490768

Abstract

Aims: This study aimed to investigate the efficacy of NIV in patients with pneumonia-associated acute hypoxemic respiratory failure (AHRF) and to identify factors that predict NIV failure.
Methods: A total of 50 very elderly patients (aged 85 and older) with pneumonia-associated AHRF were retrospectively evaluated from January 2021 to August 2022. Failure of NIV was defined was characterized by a transition to mechanical ventilation (either through tracheal intubation or tracheostomy), discharge under "hopeless" conditions while still on NIV, or death during NIV.
Results: The mean age of the patients was 87.4±2.4 years, median SOFA score was 5, median duration of NIV was 4 days, and median length of stay in the ICU for the patients was 7 days. It was determined that 48% of the patients experienced NIV failure due to worsening clinical conditions. The SOFA score, levels of procalcitonin, CRP, heart rate, and respiratory rate were higher in the NIV failure group compared to the NIV successful group. An increased SOFA score (OR= 1.51, 95% CI= 1.11-2.06, p= 0.009), elevated CRP levels (OR= 1.03, 95% CI= 1.01-1.05, p= 0.003), and increased respiratory rate (OR= 1.18, 95% CI= 1.01-1.38, p= 0.039) were identified as independent predictors of NIV failure.
Conclusion: In very elderly patients with AHRF due to pneumonia, the use of NIV may offer a significant survival benefit if patients are closely monitored and potential risk factors such as systemic inflammation parameters, SOFA score, and respiratory rate are considered.

Keywords

Critical illness, elderly, noninvasive ventilation, pneumonia, respiratory failure

Ethical Statement

Ethics Committee of the Medical Faculty of the KTO Karatay University (Date: 21.09.2022, Decision No: 2022/042)

Project Number

2022/042

References

• Bello G, De Pascale G, and Antonelli M. Noninvasive Ventilation. Clin Chest Med. 2016;37(4):711-21. DOI: 10.1016/j.ccm.2016.07.011.
• Popowicz P and Leonard K. Noninvasive Ventilation and Oxygenation Strategies. Surg Clin North Am. 2022;102(1):149-57. DOI: 10.1016/j.suc.2021.09.012.
• Mas A and Masip J. Noninvasive ventilation in acute respiratory failure. Int J Chron Obstruct Pulmon Dis. 2014;9:837-52. DOI: 10.2147/COPD.S42664.
• Aswanetmanee P, Limsuwat C, Maneechotesuwan K, and Wongsurakiat P. Noninvasive ventilation in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2023;13(1):8283. DOI: 10.1038/s41598-023-35323-0.
• Group ST. Hypoxemia in the ICU: prevalence, treatment, and outcome. Ann Intensive Care. 2018;8(1):82. DOI: 10.1186/s13613-018-0424-4.
• Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2) DOI: 10.1183/13993003.02426-2016.
• Xu XP, Zhang XC, Hu SL, et al. Noninvasive Ventilation in Acute Hypoxemic Nonhypercapnic Respiratory Failure: A Systematic Review and Meta-Analysis. Crit Care Med. 2017;45(7):e727-e33. DOI: 10.1097/CCM.0000000000002361.
• Piroddi IMG, Barlascini C, Esquinas A, Braido F, Banfi P, and Nicolini A. Non-invasive mechanical ventilation in elderly patients: A narrative review. Geriatr Gerontol Int. 2017;17(5):689-96. DOI: 10.1111/ggi.12810.
• Brochard L, Lefebvre JC, Cordioli RL, Akoumianaki E, and Richard JC. Noninvasive ventilation for patients with hypoxemic acute respiratory failure. Semin Respir Crit Care Med. 2014;35(4):492-500. DOI: 10.1055/s-0034-1383863.
• Levy M, Tanios MA, Nelson D, et al. Outcomes of patients with do-not-intubate orders treated with noninvasive ventilation. Crit Care Med. 2004;32(10):2002-7. DOI: 10.1097/01.ccm.0000142729.07050.c9.
• Schettino G, Altobelli N, and Kacmarek RM. Noninvasive positive pressure ventilation reverses acute respiratory failure in select "do-not-intubate" patients. Crit Care Med. 2005;33(9):1976-82. DOI: 10.1097/01.ccm.0000178176.51024.82.
• Park MJ, Cho JH, Chang Y, et al. Factors for Predicting Noninvasive Ventilation Failure in Elderly Patients with Respiratory Failure. J Clin Med. 2020;9(7) DOI: 10.3390/jcm9072116.
• Schortgen F, Follin A, Piccari L, et al. Results of noninvasive ventilation in very old patients. Ann Intensive Care. 2012;2(1):5. DOI: 10.1186/2110-5820-2-5.
• Force ADT, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-33. DOI: 10.1001/jama.2012.5669.
• Muir JF, Lamia B, Molano C, and Cuvelier A. Respiratory failure in the elderly patient. Semin Respir Crit Care Med. 2010;31(5):634-46. DOI: 10.1055/s-0030-1265903.
• Valley TS, Sjoding MW, Ryan AM, Iwashyna TJ, and Cooke CR. Association of Intensive Care Unit Admission With Mortality Among Older Patients With Pneumonia. JAMA. 2015;314(12):1272-9. DOI: 10.1001/jama.2015.11068.
• Farfel JM, Franca SA, Sitta Mdo C, Filho WJ, and Carvalho CR. Age, invasive ventilatory support and outcomes in elderly patients admitted to intensive care units. Age Ageing. 2009;38(5):515-20. DOI: 10.1093/ageing/afp119.
• Ma JG, Zhu B, Jiang L, Jiang Q, and Xi XM. Gender- and age-based differences in outcomes of mechanically ventilated ICU patients: a Chinese multicentre retrospective study. BMC Anesthesiol. 2022;22(1):18. DOI: 10.1186/s12871-021-01555-8.
• Esteban A, Anzueto A, Frutos-Vivar F, et al. Outcome of older patients receiving mechanical ventilation. Intensive Care Med. 2004;30(4):639-46. DOI: 10.1007/s00134-004-2160-5.
• Scala R. Challenges on non-invasive ventilation to treat acute respiratory failure in the elderly. BMC Pulm Med. 2016;16(1):150. DOI: 10.1186/s12890-016-0310-5.
• Ferrer M, Cosentini R, and Nava S. The use of non-invasive ventilation during acute respiratory failure due to pneumonia. Eur J Intern Med. 2012;23(5):420-8. DOI: 10.1016/j.ejim.2012.02.011.
• Ozyilmaz E, Ugurlu A O, and Nava S. Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC Pulm Med. 2014;14:19. DOI: 10.1186/1471-2466-14-19.
• Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, and Torres A. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med. 2003;168(12):1438-44. DOI: 10.1164/rccm.200301-072OC.
• Antonelli M, Conti G, Esquinas A, et al. A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med. 2007;35(1):18-25. DOI: 10.1097/01.CCM.0000251821.44259.F3.
• Antonelli M, Conti G, Rocco M, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med. 1998;339(7):429-35. DOI: 10.1056/NEJM199808133390703.
• Valley TS, Walkey AJ, Lindenauer PK, Wiener R S, and Cooke CR. Association Between Noninvasive Ventilation and Mortality Among Older Patients With Pneumonia. Crit Care Med. 2017;45(3):e246-e54. DOI: 10.1097/CCM.0000000000002076.
• Carron M, Freo U, BaHammam AS, et al. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. Br J Anaesth. 2013;110(6):896-914. DOI: 10.1093/bja/aet070.
• Besen B, Park M, and Ranzani OT. Noninvasive ventilation in critically ill very old patients with pneumonia: A multicenter retrospective cohort study. PLoS One. 2021;16(1):e0246072. DOI: 10.1371/journal.pone.0246072.
• Antonelli M, Conti G, Moro ML, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med. 2001;27(11):1718-28. DOI: 10.1007/s00134-001-1114-4.
• Nava S and Ceriana P. Causes of failure of noninvasive mechanical ventilation. Respir Care. 2004;49(3):295-303.
• Nava S and Hill N. Non-invasive ventilation in acute respiratory failure. Lancet. 2009;374(9685):250-9. DOI: 10.1016/S0140-6736(09)60496-7.
• Confalonieri M, Garuti G, Cattaruzza MS, et al. A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation. Eur Respir J. 2005;25(2):348-55. DOI: 10.1183/09031936.05.00085304.
• Demoule A, Girou E, Richard JC, Taille S, and Brochard L. Benefits and risks of success or failure of noninvasive ventilation. Intensive Care Med. 2006;32(11):1756-65. DOI: 10.1007/s00134-006-0324-1.
• Sevransky JE and Haponik EF. Respiratory failure in elderly patients. Clin Geriatr Med. 2003;19(1):205-24. DOI: 10.1016/s0749-0690(02)00065-4.
• Vanoni NM, Carugati M, Borsa N, et al. Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review. Med Sci (Basel). 2019;7(1) DOI: 10.3390/medsci7010010.
• Watson A, Yadollahi S, Fahmy A, et al. Non-Invasive Ventilation for Community-Acquired Pneumonia: Outcomes and Predictors of Failure from an ICU Cohort. Medicina (Kaunas). 2023;60(1) DOI: 10.3390/medicina60010081.
• Chen Q, Liu M, Liu B, et al. Predictive Factors for Failure of Noninvasive Ventilation in Adult Intensive Care Unit: A Retrospective Clinical Study. Can Respir J. 2020;2020:1324348. DOI: 10.1155/2020/1324348.
• Carteaux G, Millan-Guilarte T, De Prost N, et al. Failure of Noninvasive Ventilation for De Novo Acute Hypoxemic Respiratory Failure: Role of Tidal Volume. Crit Care Med. 2016;44(2):282-90. DOI: 10.1097/CCM.0000000000001379.
• Duan J, Chen L, Liu X, et al. An updated HACOR score for predicting the failure of noninvasive ventilation: a multicenter prospective observational study. Crit Care. 2022;26(1):196. DOI: 10.1186/s13054-022-04060-7.
• Al-Rajhi A, Murad A, Li PZ, and Shahin J. Outcomes and predictors of failure of non-invasive ventilation in patients with community acquired pneumonia in the ED. Am J Emerg Med. 2018;36(3):347-51. DOI: 10.1016/j.ajem.2017.08.016.
• Hong Y, Duan J, Bai L, Han X, Huang S, and Guo S. Noninvasive ventilation failure in pneumonia patients >/=65years old: The role of cough strength. J Crit Care. 2018;44:149-53. DOI: 10.1016/j.jcrc.2017.11.008.
• Scala R and Pisani L. Noninvasive ventilation in acute respiratory failure: which recipe for success? Eur Respir Rev. 2018;27(149) DOI: 10.1183/16000617.0029-2018.
• Duan J, Chen L, Liang G, et al. Noninvasive ventilation failure in patients with hypoxemic respiratory failure: the role of sepsis and septic shock. Ther Adv Respir Dis. 2019;13:1753466619888124. DOI: 10.1177/1753466619888124.
• Nicolini A, Piroddi IM, Barlascini C, and Senarega R. Predictors of non-invasive ventilation failure in severe respiratory failure due to community acquired pneumonia. Tanaffos. 2014;13(4):20-8.
• Rittayamai N, Pravarnpat C, Srilam W, Bunyarid S, and Chierakul N. Safety and efficacy of noninvasive ventilation for acute respiratory failure in general medical ward: a prospective cohort study. J Thorac Dis. 2023;15(10):5466-74. DOI: 10.21037/jtd-23-732.
• Sun W, Luo Z, Cao Z, Wang J, Zhang L, and Ma Y. A combination of the APACHE II score, neutrophil/lymphocyte ratio, and expired tidal volume could predict non-invasive ventilation failure in pneumonia-induced mild to moderate acute respiratory distress syndrome patients. Ann Transl Med. 2022;10(7):407. DOI: 10.21037/atm-22-536.
• Abraham E, Carmody A, Shenkar R, and Arcaroli J. Neutrophils as early immunologic effectors in hemorrhage- or endotoxemia-induced acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2000;279(6):L1137-45. DOI: 10.1152/ajplung.2000.279.6.L1137.