Outcome of non-invasive domiciliary ventilation in elderly patients

Abstract

Study objectives: To analyze the short- and long-term effects of domiciliary non-invasive ventilation (NIV) in the elderly.

Methods: From 1990 to 2005 all patients who initiated NIV at age 75 or older were included in the study. The mean follow-up period was 36 (24) months. Data were obtained from a database record.

Results: Forty-three patients, mean age 77 (1.9) years and hypercapnic respiratory failure secondary to restrictive, neuromuscular or hypoventilatory disease were included. The short-term effects included a significant improvement in arterial blood gases and nocturnal desaturations during NIV compared to baseline: PaO(2) increased a mean of 19 mmHg (P<0.0001), PaCO(2) decreased a mean of 16 mmHg (P<0.0001) and nocturnal time with SaO(2)<90% decreased a mean of 72% (P<0.0001). Arterial blood gases while breathing room air also improved significantly at 6 months after NIV initiation. Five patients (11%) discontinued treatment; this group did not differ from patients who continued NIV. Mean compliance was 8.3 (3.1)h/day. In the long-term effects, we observed that the initial improvement of arterial blood gases breathing room air was maintained throughout the followup period. The number of hospital admissions and days of hospital stay decreased significantly (P<0.0001 and 0.001, respectively) after NIV initiation. The poorest survival was observed in ALS patients (median 10.9 (2.3) months) significantly lower than the survival for the other diagnostic groups (median 58.5 (4.8) months), P=0.0013.

Conclusions: NIV is an effective treatment in the elderly. It improves arterial blood gases and nocturnal desaturations, decreases hospital admissions and is associated with long survival. So advanced age should not be considered as an exclusion criteria to prescribe NIV.