Non-invasive ventilation for acute respiratory failure in the elderly

Background: The use of NIV is spreading for acute respiratory failure (ARF) in the geriatric population. Aims: To identify NIV characteristics and predictors for success or failure for ARF in the elderly. Methods: Observational study including unselected patient consecutively treated with NIV in the Emergency Department (ED) in 5 months. We compared different subgroups according to age, ventilation mode, ARF cause; we furthermore focused on NIV as ceiling treatment (CT). Results: 245 patientsincluded; mean age 81,8 years. ARF was mainly due to ACPE (44,5%), AECOPD (29,0%) and pneumonia (16,3%). Overall failure rate was 21.2% (6.3% ETI, 19.6% mortality). In logistic regression, CT (O.R.: 50,592, p >0,001) and low SaO2 (O.R.: 0.95, p = 0.005) resulted as negative predictors, much more strongly than age (O.R.: 0,077, p = 0,782). In the > 80 years subgroup, failure cases showed lower systolic blood pressure (median 120 mmHg vs 135, p = 0.005), higher creatininemia (mean 1.37 mg/dl vs 1.13, p = 0.031), higher CRP (median 5.04 mg/dl vs 2.28, p = 0.009), lower SaO2 (median 84.1% vs. 89.1%, p = 0.034), lower HCO3- (21.7 mmol/L vs. 35,6, p = 0.020) and higher lactates (3.1 mmol/L vs. 1.4, p = 0.001). Conclusions: The efficacy of NIV for the treatment of ARF in the ED is confirmed, even in the elderly. Aging "per se" does not affect the outcome. We identified different factors (to be in CT subgroup, severe metabolic acidosis, and lower SaO2 values) increasing NIV failure rate in elderly patients aged > 80.