REVIEW   

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

DOI: 10.23736/S0026-4806.19.06273-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

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