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NIV to Improve Quality Of Life or Delay Death?

NIV to Improve Quality Of Life or Delay Death?

ICM JOURNAL: Article of the Month - FEB 2013 

One of the Intensive Care Medicine  "Articles of the Month" for February 2013, as selected by Chair of the Editorial and Publications Committee Salvatore Maggiore, is "Noninvasive mechanical ventilation in patients having declined tracheal intubation".  Lead author of this paper, Elie Azoulay, submitted this summary outlining the clinical implications of the article and associated study:

Studies have shown that noninvasive ventilation offers chances for survival in patients who declined tracheal intubation. However, no study has assessed whether survival gains were associated with acceptable quality of life or if noninvasive ventilation was only extending the dying process. 

In the oVNI study, we report five original findings that were not part of previous knowledge: 

  1. Noninvasive ventilation is delivered with a Do-Not-Intubate order in one fourth of the patients, 
  2. NIV in this setting is associated with substantial survival, more particularly in COPD patients; 
  3. Day-90 data indicates that noninvasive ventilation prolongs life without affecting patient's quality of life; 
  4. Post ICU burden (symptoms of stress, anxiety and depression) were not increased compared to full code patients;  
  5. Relatives of DNI patients did not present with a high post ICU burden compared to relatives of patients without decisions to forgo life sustaining therapies.

PHOTO: Author - Elie Azoulay

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