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Invited Commentary
October 19, 2020

Noninvasive Ventilation in Seriously Ill Older Adults at the End of Life—The Evidence Remains Elusive

Author Affiliations
  • 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham
  • 2Lung Health Center, Department of Medicine, University of Alabama at Birmingham, Birmingham
  • 3Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham
JAMA Intern Med. 2021;181(1):102-103. doi:10.1001/jamainternmed.2020.5648

Acute respiratory failure is a frequent cause of hospitalizations among seriously ill older adults at or near the end of life. These terminal hospitalizations are often complicated by distressful respiratory symptoms and chaotic transitions that result in high-intensity, high-risk interventions such as invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV), which delivers positive pressure ventilation through a mask. In this issue of JAMA Internal Medicine, Sullivan and colleagues1 studied trends in IMV and NIV use among older decedents hospitalized at the end of life. The authors found a substantial increase in NIV use and a slight increase in IMV use in the past 2 decades, potentially signifying a major shift in the way that clinicians provide ventilatory support at the end of life. Although use of NIV in older adults with terminal respiratory failure may seem appealing, high-quality evidence supporting its use across serious illnesses remains elusive.

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