Morbimortality and Six-Month Survival Among Elderly Patients Treated With Noninvasive Mechanical Ventilation in an Intermediate Care Unit: A Retrospective Evaluation.

Abstract

Noninvasive mechanical ventilation (NIMV) has been established as a successful therapeutic option for patients with acute respiratory failure (ARF) with a specific etiology. 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. This retrospective cohort study included elderly patients admitted for ARF and treated with NIMV in the UCINTbetween 2015 and 2019. In the sample of 102 patients, the median age was84.2(±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 IIwas 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%. 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. NIMV can be used successfully in elderly patients and less studied ARF etiologies, such as pneumonia.