What is the role of noninvasive ventilation (NIV) in the treatment of patients with do-not-intubate status?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

For do-not-intubate status (advanced disease or terminal malignancy), [65]  note the following:

  • Numerous case series

  • COPD patients comprise most patients

  • Most with hypercapnic respiratory failure

  • Report of 60% success rate, but discharge home rate of 40-50%

  • Median survival following treatment 179 days in one series

  • One-year survival rate of 30%

  • Some with more distress from the mask and noninvasive ventilation than benefit

  • Issues with resource utilization and prolonging the inevitable

  • Better outcomes in CHF, awake patients, and those with strong cough (mobilized secretions)

  • Benefit in patients with malignancy if treating reversible condition

  • Benefit in dyspnea relief for patients with terminal malignancy [66]


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