Publication
The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting
| dc.contributor.author | Vilaça, M. | |
| dc.contributor.author | Aragão, I. | |
| dc.contributor.author | Cardoso, T. | |
| dc.contributor.author | Dias, C. | |
| dc.contributor.author | Cabral-Campello, G. | |
| dc.date.accessioned | 2017-07-11T14:51:08Z | |
| dc.date.available | 2017-07-11T14:51:08Z | |
| dc.date.issued | 2016 | |
| dc.description.abstract | 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. | pt_PT |
| dc.description.sponsorship | Supported, in part, by grants from the Discipline of Initiation to Clinical Investigation (Disciplina de Iniciação à Investigação Clínica) of Instituto de Ciências Biomédicas Abel Salazar and in part by ASSUCIP (Associação dos Amigos da Unidade de Cuidados Intensivos Polivalente, Hospital de Santo António, Porto, Portugal). | pt_PT |
| dc.description.version | info:eu-repo/semantics/publishedVersion | pt_PT |
| dc.identifier.citation | PLoS One. 2016 Feb 22;11(2):e0149649 | pt_PT |
| dc.identifier.doi | 10.1371/journal.pone.0149649 | pt_PT |
| dc.identifier.issn | 1932-6203 | |
| dc.identifier.uri | http://hdl.handle.net/10400.16/2153 | |
| dc.language.iso | eng | pt_PT |
| dc.peerreviewed | yes | pt_PT |
| dc.publisher | Public Library of Science | pt_PT |
| dc.relation.publisherversion | http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0149649 | pt_PT |
| dc.title | The Role of Noninvasive Ventilation in Patients with "Do Not Intubate" Order in the Emergency Setting | pt_PT |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| oaire.citation.conferencePlace | United States of America | pt_PT |
| oaire.citation.issue | 2 | pt_PT |
| oaire.citation.startPage | e0149649 | pt_PT |
| oaire.citation.title | PLoS ONE | pt_PT |
| oaire.citation.volume | 11 | pt_PT |
| rcaap.rights | openAccess | pt_PT |
| rcaap.type | article | pt_PT |