Effectiveness of non-invasive ventilation in critical patients with acute respiratory failure and do not intubate order

Abstract

Objective

The main purpose of this study was to analyze the prevalence of do-not-intubate (DNI) orders in patients admitted to an Intensive Care Unit (ICU) due to acute respiratory failure (ARF) and who were treated with non-invasive ventilation (NIV). The secondary objective was to correlate the presence of a DNI order with the patient’s prognosis.

Design

Retrospective observational study.

Setting

Polyvalent ICU.

Patients

All consecutively admitted ICU patients for ARF between January 1^st, 1997, and December 31^st, 2022, who were treated with NIV.

Main variables of interest

Initial clinical variables, NIV failure rate, complications, in-hospital and one-year mortality.

Results

5972 patients were analyzed, 1275 (21.3%) presenting a DNI order. The mean age was 68.2 ± 14.9; 60.2% were male. The most frequent cause of DNI order was chronic respiratory disease (452 patients; 35.5%). Patients with DNI order were older, had higher Charlson comorbidity index and higher frailty. NIV failure occurred in 536 (42.0%) patients in the DNI order group vs. 1118 (23.8%) in the non-DNI order group (p < 0.001). In-hospital mortality was higher in patients with DNI order (57.9% vs 16.4%; p < 0.001). The adjusted OR for inhospital mortality was 2.14 (95% CI 1.98 to 2.31).

Conclusions

DNI orders are common in patients with ARF treated with NIV and they related to worse short and long-term prognosis.