Prognosis of respiratory failure: Impact for life-sustaining treatment limitation in intensive care

Acute respiratory failure requiring mechanical ventilation has age-dependent features in respiratory physiology, increased susceptibility to respiratory failure, longer Intensive care unit (ICU) stay, increased cost and health care after ICU discharge. Advanced age is associated with more frequent ICU admission refusal, less aggressive ICU treatment, and more frequent withholding of mechanical ventilation. Acute exacerbations of chronic obstructive pulmonary disease (COPD) are frequent and associated with a high risk of death and a significant financial burden. Noninvasive respiratory support is very effective in the context of COPD exacerbations preventing intubation and facilitating early liberation from invasive ventilation. The rate of do-not-intubate orders has increased over time, and the use of noninvasive ventilation can be helpful preventing intubation. Withdrawal of ventilator support decision should be individualized considering the patient and family wishes and the involvement of all care team. & COPY; 2023 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.