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Coppola S, Radovanovic D, Pozzi T, Danzo F, Rocco C, Lazzaroni G, Santus P, Chiumello D. Non-invasive respiratory support in elderly hospitalized patients. Expert Rev Respir Med 2024:1-16. [PMID: 39267448 DOI: 10.1080/17476348.2024.2404696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 09/01/2024] [Accepted: 09/11/2024] [Indexed: 09/17/2024]
Abstract
INTRODUCTION The proportion of elderly people among hospitalized patients is rapidly growing. Between 7% to 25% of ICU patients are aged 85 and over and noninvasive respiratory support is often offered to avoid the risks of invasive mechanical ventilation or in patients with a 'do-not-intubate' order. However, while noninvasive respiratory support has been extensively studied in the general population, there is limited data available on its efficacy in elderly patients with ARF. AREAS COVERED PubMed/Medline, Web of Science, Scopus and Embase online databases were searched for studies that assessed clinical efficacy of high flow nasal cannula, continuous positive airway pressure and noninvasive ventilation in patients ≥ 65 years old with acute de novo ARF, showing that short to mid-term benefits provided by noninvasive respiratory support in elderly patients in terms of reduction of mechanical ventilation risk and mortality are similar to younger patients, if adjusted for the severity of comorbidities and respiratory failure. EXPERT OPINION Noninvasive support strategies can represent an effective opportunity in elderly patients with ARF, especially in patients too frail to undergo endotracheal intubation and in whom received or decided for a 'do not intubate' order. Indeed, noninvasive support has a different impact, depending on the setting.
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Affiliation(s)
- Silvia Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Milan, Italy
| | - Tommaso Pozzi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Fiammetta Danzo
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Cosmo Rocco
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Giada Lazzaroni
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Milan, Italy
| | - Davide Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
- Coordinated Research Center on Respiratory Failure, University of Milan, Milan, Italy
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Vianello A, De Vita N, Scotti L, Guarnieri G, Confalonieri M, Bonato V, Molena B, Maestrone C, Airoldi G, Olivieri C, Sainaghi PP, Lionello F, Arcaro G, Della Corte F, Navalesi P, Vaschetto R. Clinical Outcomes in Patients Aged 80 Years or Older Receiving Non-Invasive Respiratory Support for Hypoxemic Acute Respiratory Failure Consequent to COVID-19. J Clin Med 2022; 11:jcm11051372. [PMID: 35268463 PMCID: PMC8911338 DOI: 10.3390/jcm11051372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 12/10/2022] Open
Abstract
As the clinical outcome of octogenarian patients hospitalised for COVID-19 is very poor, here we assessed the clinical characteristics and outcomes of patients aged 80 year or older hospitalised for COVID-19 receiving non-invasive respiratory support (NIRS). A multicentre, retrospective, observational study was conducted in seven hospitals in Northern Italy. All patients aged ≥80 years with COVID-19 associated hypoxemic acute respiratory failure (hARF) undergoing NIRS between 24 February 2020, and 31 March 2021, were included. Out of 252 study participants, 156 (61.9%) and 163 (64.6%) died during hospital stay and within 90 days from hospital admission, respectively. In this case, 228 (90.5%) patients only received NIRS (NIRS group), while 24 (9.5%) were treated with invasive mechanical ventilation (IMV) after NIRS failure (NIRS+IMV group). In-hospital mortality did not significantly differ between NIRS and NIRS+IMV group (61.0% vs. 70.8%, respectively; p = 0.507), while survival probability at 90 days was significantly higher for NIRS compared to NIRS+IMV patients (0.379 vs. 0.147; p = 0.0025). The outcome of octogenarian patients with COVID-19 receiving NIRS is quite poor. Caution should be used when considering transition from NIRS to IMV after NIRS failure.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
- Correspondence: ; Tel.: +39-049-821-8587; Fax: +39-049-821-7791
| | - Nello De Vita
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Lorenza Scotti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Marco Confalonieri
- Pneumologia, Azienda Sanitaria Universitaria Giuliano Isontina, Via Giacomo Puccini, 50, 34148 Trieste, Italy;
| | - Valeria Bonato
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia, 16, 15121 Alessandria, Italy;
| | - Beatrice Molena
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Carlo Maestrone
- Anestesia Rianimazione ASL VCO, Dipartimento Chirurgico, Presidio Ospedaliero Domodossola e Verbania, Largo Caduti Lager Nazisti, 1, 28845 Domodossola, Italy;
| | - Gianluca Airoldi
- Medicina Interna, Ospedale Ss. Trinità, Viale Zoppis, 10, 28021 Borgomanero, Italy;
| | - Carlo Olivieri
- Department of Anesthesia and Critical Care, Azienda Ospedaliera Sant’Andrea, Corso M. Abbiate, 21, 13100 Vercelli, Italy;
| | - Pier Paolo Sainaghi
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Federico Lionello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Giovanna Arcaro
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Francesco Della Corte
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Paolo Navalesi
- Istituto di Anestesia e Rianimazione, Dipartimento di Medicina-DIMED-Università di Padova, Azienda Ospedale-Università di Padova, Via Gallucci, 13, 35121 Padova, Italy;
| | - Rosanna Vaschetto
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
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Mendonça Almeida L, Jacob M, Van Zeller M, Pinto T, Gonçalves M, Drummond M. Non-invasive ventilation in the elderly - never too late! Monaldi Arch Chest Dis 2021; 91. [PMID: 33794594 DOI: 10.4081/monaldi.2021.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
Dear Editor, Practising evidence-based medicine in an ageing population is challenging. Nevertheless, using age as a diagnostic or therapeutic procedure contraindication is less and less common. Domiciliary non-invasive ventilation (NIV) in chronic respiratory failure patients has been largely used; however, data from older people is scarce...
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Affiliation(s)
| | - Maria Jacob
- Pulmonology Department, Centro Hospitalar Universitário São João.
| | - Mafalda Van Zeller
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar Universitário São João.
| | - Tiago Pinto
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar Universitário São João.
| | - Miguel Gonçalves
- Pulmonology Department, Centro Hospitalar Universitário São João.
| | - Marta Drummond
- Sleep and Non-invasive Ventilation Unit, Centro Hospitalar Universitário São João.
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Trovato FM, Montoneri G, Noto P, Mangano G, Carpinteri G, Malatino L. In reply: Outcomes difference in non-invasive ventilation in ’very old' patients with acute respiratory failure: occult gender effect? Arch Emerg Med 2019; 36:514-515. [DOI: 10.1136/emermed-2019-208696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 11/03/2022]
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