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

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.