The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting.
BACKGROUND:Noninvasive ventilation (NIV) is being used increasingly in patients who have a "do not intubate" (DNI) order. However, the impact of NIV on the clinical and health-related quality of life (HRQOL) in the emergency setting is not known, nor is its effectiveness for relieving symp...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2016-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC4763309?pdf=render |
| _version_ | 1811322838593830912 |
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| author | Marta Vilaça Irene Aragão Teresa Cardoso Cláudia Dias Glória Cabral-Campello |
| author_facet | Marta Vilaça Irene Aragão Teresa Cardoso Cláudia Dias Glória Cabral-Campello |
| author_sort | Marta Vilaça |
| collection | DOAJ |
| description | BACKGROUND:Noninvasive ventilation (NIV) is being used increasingly in patients who have a "do not intubate" (DNI) order. However, the impact of NIV on the clinical and health-related quality of life (HRQOL) in the emergency setting is not known, nor is its effectiveness for relieving symptoms in end-of-life care. OBJECTIVE:The aim of this prospective study was to determine the outcome and HRQOL impact of regular use of NIV outcomes on patients with a DNI order who were admitted to the emergency room department (ED). METHODS:Eligible for participation were DNI-status patients who receive NIV for acute or acute-on-chronic respiratory failure when admitted to the ED of a tertiary care, university-affiliated, 600-bed hospital between January 2014 and December 2014. Patients were divided into 2 groups: (1) those whose DNI order related to a decision to withhold therapy and (2) those for whom any treatment, including NIV, was provided for symptom relief only. HRQOL was evaluated only in group 1, using the 12-item Short Form Health Survey (SF-12). Long-term outcome was evaluated 90 days after hospital discharge by means of a telephone interview. RESULTS:During the study period 1727 patients were admitted to the ED, 243 were submitted to NIV and 70 (29%) were included in the study. Twenty-nine (41%) of the 70 enrollees received NIV for symptom relief only (group2). Active cancer [7% vs 35%, p = 0,004] and neuromuscular diseases [0% vs. 17%] were more prevalent in this group. NIV was stopped in 59% of the patients in group 2 due to lake of clinical benefit. The in-hospital mortality rate was 37% for group 1 and 86% for group 2 0,001). Among patients who were discharged from hospital, 23% of the group 1 and all patients in group 2 died within 90 days. Relative to baseline, no significant decline in HRQOL occurred in group 1 by 90 days postdischarge. CONCLUSION:The survival rate was 49% among DNI-status patients for whom NIV was used as a treatment in ED, and these patients did not experience a decline in HRQOL throughout the study. NIV did not provide significant relief of symptoms in more than half the patients who receive it for that purpose. |
| first_indexed | 2024-04-13T13:43:12Z |
| format | Article |
| id | doaj.art-551462a408824267ab1686bfbf24d018 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-13T13:43:12Z |
| publishDate | 2016-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-551462a408824267ab1686bfbf24d0182022-12-22T02:44:33ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01112e014964910.1371/journal.pone.0149649The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting.Marta VilaçaIrene AragãoTeresa CardosoCláudia DiasGlória Cabral-CampelloBACKGROUND:Noninvasive ventilation (NIV) is being used increasingly in patients who have a "do not intubate" (DNI) order. However, the impact of NIV on the clinical and health-related quality of life (HRQOL) in the emergency setting is not known, nor is its effectiveness for relieving symptoms in end-of-life care. OBJECTIVE:The aim of this prospective study was to determine the outcome and HRQOL impact of regular use of NIV outcomes on patients with a DNI order who were admitted to the emergency room department (ED). METHODS:Eligible for participation were DNI-status patients who receive NIV for acute or acute-on-chronic respiratory failure when admitted to the ED of a tertiary care, university-affiliated, 600-bed hospital between January 2014 and December 2014. Patients were divided into 2 groups: (1) those whose DNI order related to a decision to withhold therapy and (2) those for whom any treatment, including NIV, was provided for symptom relief only. HRQOL was evaluated only in group 1, using the 12-item Short Form Health Survey (SF-12). Long-term outcome was evaluated 90 days after hospital discharge by means of a telephone interview. RESULTS:During the study period 1727 patients were admitted to the ED, 243 were submitted to NIV and 70 (29%) were included in the study. Twenty-nine (41%) of the 70 enrollees received NIV for symptom relief only (group2). Active cancer [7% vs 35%, p = 0,004] and neuromuscular diseases [0% vs. 17%] were more prevalent in this group. NIV was stopped in 59% of the patients in group 2 due to lake of clinical benefit. The in-hospital mortality rate was 37% for group 1 and 86% for group 2 0,001). Among patients who were discharged from hospital, 23% of the group 1 and all patients in group 2 died within 90 days. Relative to baseline, no significant decline in HRQOL occurred in group 1 by 90 days postdischarge. CONCLUSION:The survival rate was 49% among DNI-status patients for whom NIV was used as a treatment in ED, and these patients did not experience a decline in HRQOL throughout the study. NIV did not provide significant relief of symptoms in more than half the patients who receive it for that purpose.http://europepmc.org/articles/PMC4763309?pdf=render |
| spellingShingle | Marta Vilaça Irene Aragão Teresa Cardoso Cláudia Dias Glória Cabral-Campello The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting. PLoS ONE |
| title | The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting. |
| title_full | The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting. |
| title_fullStr | The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting. |
| title_full_unstemmed | The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting. |
| title_short | The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting. |
| title_sort | role of noninvasive ventilation in patients with do not intubate order in the emergency setting |
| url | http://europepmc.org/articles/PMC4763309?pdf=render |
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