Critically Ill Patients with Visceral Nocardia Infection, France and Belgium, 2004-2023.

We studied 50 patients with invasive nocardiosis treated during 2004-2023 in intensive care centers in France and Belgium. Most (65%) died in the intensive care unit or in the year after admission. Nocardia infections should be included in the differential diagnoses for patients in the intensive care setting.

An exposed/unexposed cohort study assessing the effectiveness, the safety and the survival of patients established on home non-invasive ventilation after 80 years old.

BACKGROUND: Little is known about the use of long-term non-invasive ventilation (NIV) in the elderly. We aimed to assess if the effectiveness of long-term NIV of patients ≥ 80 years (older) was not greatly inferior to that of patients < 75 years (younger). METHODS: This retrospective exposed/unexposed cohort study included all patients established on long-term NIV treated at Rouen University Hospital between 2017 and 2019. Follow-up data were collected at the first visit following NIV initiation. The primary outcome was daytime PaCO2 with a non-inferiority margin of 50% of the improvement of PaCO2 for older patients compared to younger patients. RESULTS: We included 55 older patients and 88 younger patients. After adjustment on the baseline PaCO2, the mean daytime PaCO2 was reduced by 0.95 (95% CI: 0.67; 1.23) kPa in older patients compared to1.03 (95% CI: 0.81; 1.24) kPa in younger patients for a ratio of improvements estimated at 0.95/1.03 = 0.93 (95% CI: 0.59; 1.27, one-sided p = 0.007 for non-inferiority to 0.50). Median (interquartile range) daily use was 6 (4; 8.1) hours in older versus 7.3 (5; 8.4) hours in younger patients. No significant differences were seen in the quality of sleep and NIV safety. The 24-months survival was 63.6% in older and 87.2% in younger patients. CONCLUSIONS: effectiveness and safety seemed acceptable in older patients, with a life expectancy long enough to expect a mid-term benefit, suggesting that initiation of long-term NIV should not be refused only based on age. Prospective studies are needed.

Defining successful non-invasive ventilation initiation: Data from a real-life cohort.

BACKGROUND AND OBJECTIVE: When home non-invasive ventilation (NIV) is initiated, five goals need to be achieved: a daily use >4 h/day, an improvement in gas exchange, health-related quality of life (HRQL) and sleep quality without side effects. Our aim was to assess how frequently these five goals were reached and the factors predictive of achievement. METHODS: We conducted a monocentric cohort study that included patients electively established on home NIV over 2 years. HRQL was assessed at baseline and follow-up by the Severe Respiratory Insufficiency questionnaire. Adequate initiation was defined as the achievement of at least three of five goals and successful initiation as the achievement of all. RESULTS: Two-hundred and fifty patients were included at baseline. NIV was initiated for: obesity hypoventilation syndrome (n = 95; 38%), neuromuscular disease (n = 70; 28%), chronic obstructive pulmonary disease (n = 66; 26%) and chest wall disease (n = 19; 8%). At follow-up, measures of all five goals were available in 141 (56%) patients. NIV initiation was adequate for 96 (68%) patients and successful for 12 (9%) patients. In multivariate analysis, a tidal volume ≥ 7.8 ml/kg of ideal body weight was associated with an increased likelihood of adequate NIV initiation (hazard ratio: 5.765 [95% CI:1.824-18.223], p = 0.006]. Improvement in daytime partial arterial carbon dioxide pressure (PaCO2 ) was not correlated to improvement in HRQL or sleep quality. Severe to very severe NIV-related side effects occurred in 114 (47%) patients and were associated with higher daytime PaCO2 (6.35 ± 1.08 vs. 5.92 ± 0.79 kPa, p < 0.001). CONCLUSION: Successful home NIV initiation is rarely achieved in real life. HRQL and NIV tolerance should be assessed to improve patient-centred outcomes.