Effect of noninvasive ventilation on 6-month mortality in patients with acute cardiogenic pulmonary oedema: a retrospective study dedicated to older persons.

Noninvasive ventilation (NIV) effectively treats acute cardiogenic pulmonary oedema (ACPE), leading to quicker clinical improvement and reduced intubation needs than medical treatment alone. However, the impact of NIV on mortality in patients with ACPE is unclear. The primary objective was to evaluate the impact of NIV on 6-month mortality in older patients with ACPE compared with medical treatment. Secondary objectives included assessing the effects of NIV on length of hospital stay and rehospitalisation. This retrospective study included patients aged ≥ 75 years with ACPE (acute respiratory distress and/or RR ≥ 25 cycles/min and/or paCO2 ≥ 45 mmHg and/or pH < 7.35 and/or uncorrected hypoxemia). Exclusion criteria: positive for SARS-CoV-2 and contraindication to NIV. Of the 186 patients admitted to emergency care with ACPE and eligible for NIV, 104 received NIV and 82 received medical treatment. Survival analyses were performed using a multivariate Cox model and adjusting for confounding factors. NIV was not significantly linked to reduced mortality risk (HR = 0.82, p = 0.51), except for in the acidosis subgroup (HR = 0.24, p = 0.01). No difference was observed in the length of hospital stay or in terms of rehospitalisation. NIV in older patients with ACPE did not significantly decrease 6-month mortality, except in the subgroup with respiratory acidosis, when the risk of death was reduced by 75%. The use of NIV in older patients with ACPE should be limited to patients with acidosis, to see their risk of death significantly reduced. Trial registration: The study protocol has been retrospectively registered on ClinicalTrials.gov (NCT06107257, 2023-10-30).