Effect of noninvasive mechanical ventilation in elderly patients with hypercapnic acute-on-chronic respiratory failure and a do-not-intubate order

Int J Chron Obstruct Pulmon Dis. 2008;3(4):797-801. doi: 10.2147/copd.s3976.


Noninvasive mechanical ventilation (NIMV) is effective in the treatment of patients with acute respiratory failure (ARF). It proved to reduce the need of endotracheal intubation (ETI), the incidence of ETI-associated pneumonia, and mortality compared to nonventilated patients. A particular aspect concerns the outcome of NIMV in patients referring to an emergency room (ER) for ARF, and with a do-not-intubate (DNI) status due to advanced age or critical conditions. The aim of our study is to assess the outcome of NIMV in a group of elderly patients with acute hypercapnic ARF who had a DNI status. An overall number of 62 subjects (30 males, 32 females, mean age 81 +/- 4.8 years, range 79-91 years) referred to our semi-intensive respiratory department were enrolled in the study. The underlying diseases were severe chronic obstructive pulmonary disease (COPD) in 50/62 subjects, restrictive thoracic disorders in 7/62 subjects, and multiorgan failure in 5/62 subjects. Fifty-four/62 patients were successfully treated with NIMV while 2/62 did not respond to NIMV and were therefore submitted to ETI (one survived). Among NIMV-treated patients, death occurred in 6 patients after a mean of 9.9 days; the overall rate of NIMV failure was 12.9%. Negative prognostic factors for NIMV response proved to be: an older age, a low Glasgow Coma Score, a high APACHE score at admission, a high PaCO2 after 12 hours and a low pH both after 1 and 12 hours of NIMV. We conclude that elderly patients with acute hypercapnic ARF with a DNI status can be successfully treated by NIMV.

MeSH terms

  • Acute Disease
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Carbon Dioxide / blood
  • Chronic Disease
  • Female
  • Glasgow Coma Scale
  • Humans
  • Hydrogen-Ion Concentration
  • Hypercapnia / blood
  • Hypercapnia / etiology
  • Hypercapnia / mortality
  • Hypercapnia / therapy*
  • Intubation, Intratracheal*
  • Male
  • Respiration, Artificial* / mortality
  • Respiratory Insufficiency / blood
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / therapy*
  • Resuscitation Orders*
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Failure


  • Carbon Dioxide