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Minerva Medica 2019 December;110(6):555-63

DOI: 10.23736/S0026-4806.19.06273-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Non-invasive ventilation in palliative care: a systematic review

Teresa DIAZ de TERAN 1, Elena BARBAGELATA 2, Catia CILLONIZ 3, 4, Antonello NICOLINI 5 , Tommaso PERAZZO 5, Andreas PERREN 6, Sibel OCAK SERIN 7, Martin SCHARFFENBERG 8, Giuseppe FIORENTINO 9, Marco ZACCAGNINI 10, Mohamad I. KHATIB 11, Peter PAPADAKOS 12, Habib M. REZAUL KARIM 13, Paolo SOLIDORO 14, Antonio ESQUINAS 15

1 Unit of Sleep and Non-Invasive Ventilation, Marqués de Valdecilla University Hospital, Santander, Spain; 2 Department of Internal Medicine, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy; 3 Department of Pneumology, Clinical Institute of Thoracic Surgery, August Pi i Sunyer Institute of Biomedical Research (IDIBAPS), Hospital Clínic, Barcelona, University of Barcelona (UB), Barcelona, Spain; 4 Unit SGR 911, Center for Biomedical Network Research for Respiratory Diseases (CIBERES), Barcelona, Spain; 5 Department of Respiratory Diseases, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy; 6 Department of Intensive Care, Regional Hospital of Bellinzona, Bellinzona, Switzerland; 7 University of Health Science, Umraniye Training and Research Hospital, Istanbul, Turkey; 8 Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus Faculty of Medicine, Technical University of Dresden, Dresden, Germany; 9 Unit of Respiratory Pathophysiology, Diseases, and Rehabilitation, Monaldi Hospital, Ospedali dei Colli, Naples, Italy; 10 Department of Anesthesia and Critical Care, McGill University Health Center, Montreal, QC, Canada; 11 Department of Anesthesiology, School of Medicine, American University of Beirut, Beirut, Lebanon; 12 Department of Anesthesiology, University of Rochester, Rochester, NY, USA; 13 Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India; 14 Unit of Pneumology U, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy; 15 Unit of Intensive Care, Morales Meseguer Hospital, Murcia, Spain



INTRODUCTION: An ageing population and steady increase in the rates of neoplasms and chronic degenerative diseases poses a challenge for societies and their healthcare systems. Because of the recent and continued advances in therapies, such as the development and widespread use of non-invasive ventilation (NIV), survival rates have increased for these pathologies. For patients with end-stage chronic respiratory diseases, the use of NIV following the onset of acute or severe chronic respiratory failure is a valid option when intubation has been excluded.
EVIDENCE ACQUISITION: The following electronic databases were searched from their inception to January 2000 to December 2017: MEDLINE, EMBASE, CINHAIL, CENTRAL (Cochrane Central register of Controlled Trials), DARE (Database of Abstracts of Reviews of Effectiveness), the Cochrane Database of Systematic Reviews, ACP Journal Club database.
EVIDENCE SYNTHESIS: The available evidence strongly supports the use of NIV in patients presenting with an exacerbation of chronic obstructive pulmonary disease, as well end-stage neuromuscular disease. Few studies support the use of NIV in end-stage interstitial lung disease and in morbid obesity patients. In patients with cancer has been recommend offering NIV as palliative care to improve dyspnea.
CONCLUSIONS: The decision regarding the treatment should be made by the patient, ideally before reaching the terminal stage and after having a frank dialogue with healthcare professionals and family members.


KEY WORDS: Aged; Terminal care; Noninvasive ventilation; Hypercapnia; Respiratory insufficiency; Palliative care

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