Non-invasive ventilation in the elderly

Review of a recent paper in Age & Ageing by one of the consultants at Truro for the eldercare lunchtime meeting.

The older person did better than anticipated on non-invasive ventilation (NIV) during acute exacerbations of COPD. [1] The authors concluded "NIV should be offered as an alternative to patients considered poor candidates for intubation and those with a [Do Not Intubate] order."

This has been shown in younger patients over 10 years ago [2] and we are aware that physician predictions of prognosis on ventilation can be unreliable. [3]

The challenge is how and where to manage such elderly NIV patients in the hospital. It needs specialist expertise and sophisticated equipment but clearly has a survival benefit for older patients with acute respiratory failure.

1.

Nava S, Grassi M, Fanfulla F, Domenighetti G, Carlucci A, Perren A, Dell’Orso D, Vitacca M, Ceriana P, Karakurt Z, Clini E. Non-invasive ventilation in elderly patients with acute hypercapnic respiratory failure: a randomised controlled trial. Age and Ageing 2011 Jul;40(4):444 -450. Available from: http://ageing.oxfordjournals.org/content/40/4/444.abstract

2.

Plant PK, Owen JL, Elliott MW. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial. Lancet 2000 Jun;355(9219):1931-1935. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10859037

3.

Wildman MJ, Sanderson C, Groves J, Reeves BC, Ayres J, Harrison D, Young D, Rowan K. Implications of prognostic pessimism in patients with chronic obstructive pulmonary disease (COPD) or asthma admitted to intensive care in the UK within the COPD and asthma outcome study (CAOS): multicentre observational cohort study. BMJ 2007 Dec;335(7630):1132. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17975254