PURPOSE: To analyze prognostic factors in patients who received NPPV in our hospital.
METHODS: Eighty-six patients who had been admitted to our hospital between January and December 2009 and received NPPV were analyzed.The correlations were retrospectively analyzed between the survival rate and various factors (the age, gender, underlying diseases, performance status (PS) on admission, P/F ratio at NPPV initiation, type (I or II) of respiratory failure at NPPV initiation, duration of NPPV, outcome (weaning, death, intubation, or shifting to home NPPV), and the presence or absence of DNI orders.
RESULTS: The most common underlying diseases for which NPPV was provided were respiratory diseases in 92 patients, followed by heart failure in 7. Among the respiratory diseases, pneumonia was the most common, followed by acute COPD exacerbation.The survival rate tended to decrease with increasing age. The survival rate of patients with PS 2-3 was about half that of those with PS 1.survival rates were compared between the DIN group who refused invasive ventilation, such as intubation and tracheostomy, in the terminal phase or at the time of sudden change in the general condition, and the group who desired invasive ventilation. The DNI group accounted for 70% (60/86) of the total. The survival rate did not significantly differ between the two groups, but tended to be slightly higher when patients desired intubation at the time of a sudden change in the general condition.The survival rate did not significantly differ between the two groups, but tended to be slightly higher when patients desired intubation at the time of a sudden change in the general condition.The percentage of patients with a P/F ratio of lower than 200 was high, at 64%. A higher P/F ratio tended to be associated with a higher survival rate.Thirty-six patients (39%) were weaned from NPPV, four (4%) were shifted to home NPPV, such as placement on NPPV at night only, and eight (9%) were intubated, but later weaned, and survived. The survival rate of patients who were treated with NPPV was 52%.
CONCLUSIONS: In our hospital, many patients were elderly, and tended to have a poor PS and DNI orders. Patients who were elderly or had a PS of 2 or higher, DNI orders tended to have a poor prognosis.
CLINICAL IMPLICATIONS: The use of NPPV not for therapeutic but only for life-prolonging purposes in terminal patients should be avoided.
DISCLOSURE: The following authors have nothing to disclose: Hiroshi Igei, Yu Enomoto, Tadashi Takao
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