Ventilator Support and Oxygen Therapy in Palliative and End-of-Life Care in the Elderly

Current treatment modalities, such as long-term oxygen therapy and home mechanical ventilation, may be very helpful in patients with chronic respiratory diseases with an aim to prolong survival in a very advanced age However, a prolonged life expectancy does not necessary mean a better quality of life due to unbearable symptoms that are characteristic for a severe impairment of lung function (i.e., dyspnea, weakness, depressive symptoms) Conversely, in patients with advanced chronic respiratory diseases, palliation of symptoms, "end-of-life" decisions, and good quality of death could be the main issue The scenario of end-stage pulmonary diseases may be much more difficult to deal with, considering the "nihilism" that characterizes physician's behavior concerning the estimated results of invasive mechanical ventilation (IMV) in chronic obstructive lung disease (COPD) and asthma Thus, the approach to "terminal stage" cardiac and pulmonary diseases with acute (on chronic) respiratory failure (ARF) may lead to ethical trouble regarding the preference of the stage of the "step-up treatment approach" starting from the medical and oxygen therapy ended with IMV [4]. The risk of developing ARF increases with age as elderly people are more likely to develop chronic respiratory disorders, including cardiac diseases, immune deficiency diseases, and also malignancies (i.e., solid and hematologic malignancies), together with many other diseases The main reasons of ARF in very elderly patients are acute heart failure, severe pneumonia and exacerbations of COPD, and acute lung injury, including drug-induced lung injury. Worsening of lung function may arise from without any symptoms of an overlying circumstance. This worsening could be thought advance of the underlying diseases course