The use of non-invasive ventilation to treat acute respiratory failure in long term care setting: clinical experience in elderly patient

Marta Clerici 1, Antonella Ferrari 2, Giorgio Gallimbeni 2, Luigi Cesare Bergamaschini 3

1 Geriatric School, University of Milan, Italy; 2 Long term facility, A.S.P. Pio Albergo Trivulzio, Milan, Italy; 3 Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, A.S.P. Pio Albergo Trivulzio, Milan, Italy

Background. Nowadays older patients with acute respiratory failure (ARF) leading to a severe respiratory acidosis are frequently ventilated using a non-invasive approach in intensive care unit (ICU). Current guidelines suggest that patients with more severe acidosis should be managed in a higher dependency area. However, the use of non-invasive ventilation (NIV) is effective and safe in treating ARF in general wards in elderly.

Case report. a 82 years old male patient was admitted to a long term care facility due to a severe chronic obstructive pulmonary disease (COPD). Three days after the admission, he suffered of severe acute exacerbation of COPD leading to hypercapnic coma. NIV in Bi-PAP mode and standard medical therapy was started, taking into consideration the do-not-intubate order of the patient. His state of consciousness improved after 48 hours of NIV with decreasing of PaCO2 values and the patient was progressively weaned from the ventilator.

Conclusions. NIV should be considered a successful approach even in unusual setting of long term facility. The choice of use NIV should be taken by multidisciplinary medical staff in a setting where nurses and medical team are trained in NIV protocol, in order to reduce ICU admission, intubation rates and mortality.

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