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Hernández-Tejedor A, Martín Delgado MC. An ethics crisis within the health crisis due to COVID-19. Med Intensiva 2021; 45:563-565. [PMID: 34776405 PMCID: PMC8542435 DOI: 10.1016/j.medine.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 11/01/2022]
Affiliation(s)
| | - M C Martín Delgado
- Junta Directiva de SEMICYUC, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
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Ruiz VR, Grande-Ratti MF, Martínez B, Midley A, Sylvestre V, Mayer GF. In-hospital mortality associated factors in elderly patients with invasive mechanical ventilation in the emergency department. ENFERMERIA INTENSIVA 2021; 32:145-152. [PMID: 34340950 DOI: 10.1016/j.enfie.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/04/2020] [Indexed: 10/20/2022]
Abstract
AIMS To identify factors associated with in-hospital mortality, to estimate the intubation rate and to describe in-hospital mortality in patients over 65 years old with invasive mechanical ventilation (IMV) in the emergency department (ED). METHODS Retrospective cohort study of patients over 65 years old, who were intubated in an ED of a high complexity hospital between 2016 and 2018. Demographic data, comorbidities, and severity scores on admission were described. Bivariate and multivariate analyses were performed with logistic regression according to mortality and possible confounders. RESULTS A total of 285 patients with a mean age of 80 years required IMV in the emergency department, for a median of 3 days, and with a mean APACHE II score of 20 points of severity. The IMV rate was .48% (95% CI .43-.54), and 55.44% (158) died. Mortality-associated factors after age and sex adjustment were stroke (OR 2.13; 95% CI 1.21-3.76), chronic kidney failure, (OR 4.,38; 95% CI 1.91-10.04), Charlson index (OR 1.19; 95% CI 1.02-1.38), APACHE II score (OR 1.07; 95% CI 1.02-1.12), and SOFA score (OR 1.14; 95% CI 1.03-1.27). DISCUSSION Our IMV rate was lower than that stated by Johnson et al. in the United States in 2018 (.59%). In-hospital mortality in our study exceeded that predicted by the APACHE II score (40%) and SOFA (33%). However it was consistent with that reported by Lieberman et al. in Israel and Esteban et al. in the United States. CONCLUSIONS Although the IMV rate was low in the ED, more than half the patients died during hospitalization. Pre-existing cerebrovascular and renal diseases and high results in the comorbidities index and severity scores on admission were independent factors associated with in-hospital mortality.
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Affiliation(s)
- V R Ruiz
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - M F Grande-Ratti
- Área de Investigación en Medicina Interna, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - B Martínez
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Midley
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - V Sylvestre
- Central de Emergencias del Adulto, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G F Mayer
- Sección de Rehabilitación y Cuidados Respiratorios del Paciente Crítico, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Factores asociados a mortalidad intrahospitalaria en pacientes adultos mayores con asistencia ventilatoria mecánica invasiva en el servicio de urgencias. ENFERMERIA INTENSIVA 2021. [DOI: 10.1016/j.enfi.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lee SI, Koh Y, Huh JW, Hong SB, Lim CM. Factors and Outcomes of Intensive Care Unit Readmission in Elderly Patients. Gerontology 2021; 68:280-288. [PMID: 34107481 DOI: 10.1159/000516297] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION An increase in age has been observed among patients admitted to the intensive care unit (ICU). Age is a well-known risk factor for ICU readmission and mortality. However, clinical characteristics and risk factors of ICU readmission of elderly patients (≥65 years) have not been studied. METHODS This retrospective single-center cohort study was conducted in a total of 122-bed ICU of a tertiary care hospital in Seoul, Korea. A total of 85,413 patients were enrolled in this hospital between January 1, 2007, and December 31, 2017. The odds ratio of readmission and in-hospital mortality was calculated by logistic regression analysis. RESULTS Totally, 29,503 patients were included in the study group, of which 2,711 (9.2%) had ICU readmissions. Of the 2,711 readmitted patients, 472 patients were readmitted more than once (readmitted 2 or more times to the ICU, 17.4%). In the readmitted patient group, there were more males, higher sequential organ failure assessment (SOFA) scores, and hospitalized for medical reasons. Length of stay (LOS) in ICU and in-hospital were longer, and 28-day and in-hospital mortality was higher in readmitted patients than in nonreadmitted patients. Risk factors of ICU readmission included the ICU admission due to medical reason, SOFA score, presence of chronic heart disease, diabetes mellitus, chronic kidney disease, transplantation, use of mechanical ventilation, and initial ICU LOS. ICU readmission and age (over 85 years) were independent predictors of in-hospital mortality on multivariable analysis. The delayed ICU readmission group (>72 h) had higher in-hospital mortality than the early readmission group (≤72 h) (20.6 vs. 16.2%, p = 0.005). CONCLUSIONS ICU readmissions occurred in 9.2% of elderly patients and were associated with poor prognosis and higher mortality.
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Affiliation(s)
- Song-I Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea, .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea,
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jin Won Huh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Chae-Man Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
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Ma JG, Zhu B, Jiang L, Jiang Q, Xi XM. Clinical characteristics and outcomes of mechanically ventilated elderly patients in intensive care units: a Chinese multicentre retrospective study. J Thorac Dis 2021; 13:2148-2159. [PMID: 34012565 PMCID: PMC8107518 DOI: 10.21037/jtd-20-2748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In recent years, the number of elderly patients receiving mechanical ventilation (MV) in intensive care units (ICUs) has increased. However, the evidence on the outcomes of elderly mechanically ventilated patients is scant in China. Our objective was to evaluate the characteristics and outcomes in elderly patients (≥65 years) receiving MV in the ICU. Methods We performed a multicentre retrospective study involving adult patients who were admitted to the ICU and received at least 24 hours of MV. Patients were divided into three age groups: under 65, 65-79, and ≥80 years. The primary outcome was hospital mortality. We performed univariate and multivariate logistic regression analysis to identify factors associated with hospital mortality. Results A total of 853 patients were analysed. Of those, 61.5% were ≥65 years of age, and 26.0% were ≥80 years of age. There were significant differences in the principal reason for MV among the three age groups (P<0.001). Advanced age was significantly associated with total duration of MV, ICU length of stay (LOS), and ICU costs (all P<0.001), but not with hospital LOS and hospital costs (P>0.05). In addition, mortality rates in the ICU, hospital, and at 60 days significantly increased with age (all P<0.001). In the age group of 80 years and older, the mortality rates were 47.7%, 49.5%, and 50.0%, respectively. Multivariate logistic regression analysis had found that age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2) ratio, total duration of MV, ICU LOS, and the decision to withhold/withdraw life-sustaining treatments were independent influence factors for mortality rates. Conclusions Mechanically ventilated elderly patients (≥65 years) have a higher ICU and hospital mortality, but the hospital LOS and hospital costs are similar to younger patients. Advanced age should be considered as a significant independent risk factor for hospital mortality of mechanically ventilated ICU patients.
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Affiliation(s)
- Jia-Gui Ma
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China.,Department of Critical Care Medicine, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Bo Zhu
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Li Jiang
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Qi Jiang
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Xiu-Ming Xi
- Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing, China
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Hernández-Tejedor A, Martín Delgado MC. An ethics crisis within the health crisis due to COVID-19. Med Intensiva 2021; 45:S0210-5691(21)00056-5. [PMID: 33867176 PMCID: PMC7997308 DOI: 10.1016/j.medin.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/22/2022]
Affiliation(s)
| | - M C Martín Delgado
- Junta Directiva de SEMICYUC, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
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Ouchi K, Lo Bello J, Moseley E, Lindvall C. Long-Term Prognosis of Older Adults Who Survive Emergency Mechanical Ventilation. J Pain Symptom Manage 2020; 60:1019-1026. [PMID: 32540468 PMCID: PMC8164382 DOI: 10.1016/j.jpainsymman.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Emergent mechanical ventilation represents an important inflection point in seriously ill older adults' illness trajectories. Data are lacking on the long-term prognosis after surviving mechanical ventilation to inform shared decision making in serious illness conversations. OBJECTIVES Describe the long-term prognosis of older adults who survive emergency mechanical ventilation to inform shared decision making. METHODS This is a retrospective cohort study from a single-center intensive care unit in an academic, urban, and tertiary care medical center. We included adults aged 75 years and older consecutively admitted with mechanical ventilation between 2008 and 2012 in the Multiparameter Intelligent Monitoring of Intensive Care III database. We excluded patients who were electively admitted. Our primary outcome was the long-term prognosis after leaving the hospital stratified by discharge location. Our secondary outcome was the frequency of documented serious illness conversations within 48 hours of hospitalization recommended by the National Quality Forum. RESULTS We identified 415 patients (454 hospital admissions) consecutively admitted to the intensive care unit. The median age was 82.6 years, 54.0% were female, 78.2% were white, non-Hispanic, and in-hospital mortality rate was 36.6%. Among the survivors, the median survival after hospital discharge was 163.5 days (interquartile range 37.5-476.8). Only 49.1% of patients had documented serious illness conversations within 48 hours of hospitalization. About 63.4% of patients (59 of 93) who were discharged to long-term acute care hospitals died by six months. CONCLUSION This study demonstrated the long-term prognosis of older adults who underwent emergent mechanical ventilation. These data could be used to inform shared decision making in serious illness conversations.
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Affiliation(s)
- Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA; Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA.
| | - Josephine Lo Bello
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Edward Moseley
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Aggarwal V, Singh R, Singh JB, Bawa J, Gaur N, Kumar S, Nagesh IV. Outcomes of Mechanically Ventilated Critically Ill Geriatric Patients in Intensive Care Unit. J Clin Diagn Res 2017; 11:OC01-OC03. [PMID: 28892951 DOI: 10.7860/jcdr/2017/23931.10126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 02/14/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Increase in life expectancy across the globe has led to rise in geriatric population. Geriatric population is now living longer and healthier. This rise in geriatric population has also led to increase in the geriatric ailments leading to increased number of geriatric patients requiring intensive care including mechanical ventilation. Data on outcomes of geriatric patients requiring mechanical ventilation from India is scarce. AIM To study the profile and outcome of geriatric patients more than equal to 60 years requiring mechanical ventilation in Intensive Care Unit (ICU). MATERIALS AND METHODS The data of all the geriatric patients, more than 60 years of age, admitted to ICU between January 2008 to August 2014 requiring mechanical ventilation for various reasons were extracted from the hospital records. Various reasons for ventilation, duration of ventilation/hospital stay, mortality and associated comorbidities were recorded and analysed. RESULTS Total 140 geriatric patients were mechanically ventilated in the study period, out of which 43.5% (61/140) were above 70 years of age and 67.8% (95/140) were above 65 years of age. Chronic Obstructive Pulmonary Disease (COPD) was the most common cause for mechanical ventilation constituting 20% of patients followed by severe sepsis (17.8%), cerebro-vascular accident (12.8%), post-surgical patients (12.8%) and Coronary Artery Disease (CAD) in 10%. In our study, 44.28% of the geriatric patients requiring mechanical ventilation in the ICU were successfully weaned off the ventilator. Early tracheostomy helped in weaning off from ventilator as 83.33% (5/6) of patients requiring tracheostomy could be weaned off the ventilator suggesting that tracheostomy may help in improving the outcome. Reintubation carried a very poor prognosis and increased mortality, as 80% (4/5) of the patients who were reintubated in our study could not survive. CONCLUSION Our study revealed that in appropriate intensive care setting and with standard protocol based therapy for primary ailments, outcomes with mechanical ventilation in geriatric population can be comparable to outcomes in younger population.
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Affiliation(s)
- Vivek Aggarwal
- Assistant Professor, Department of Medicine, AFMC, Pune, Maharashtra, India
| | - Rajeshwar Singh
- Associate Professor, Department of Medicine, AFMC, Pune, Maharashtra, India
| | - Jung Bahadur Singh
- Senior Advisor, Department of Anaesthesiology and Critical Care, Military Hospital, Pathankot, Punjab, India
| | - Jps Bawa
- Classified Specialist, Department of Anaesthesiology and Critical Care, Military Hospital, Pathankot, Punjab, India
| | - Nimish Gaur
- Graded Specialist, Department of Anaesthesiology and Critical Care, Military Hospital, Pathankot, Punjab, India
| | - Sandeep Kumar
- Assistant Professor, Department of Medicine, AFMC, Pune, Maharashtra, India
| | - I V Nagesh
- Assistant Professor, Department of Medicine, AFMC, Pune, Maharashtra, India
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Badia M, Montserrat N, Serviá L, Baeza I, Bello G, Vilanova J, Rodríguez-Ruiz S, Trujillano J. Complicaciones graves en la intubación orotraqueal en cuidados intensivos: estudio observacional y análisis de factores de riesgo. Med Intensiva 2015; 39:26-33. [DOI: 10.1016/j.medin.2014.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/12/2013] [Accepted: 01/02/2014] [Indexed: 11/28/2022]
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