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Duncan CF, Lonsdale DO, Farrah H, Farnell-Ward S, Ryan C, Watson X, Cecconi M, Fjølner J, Szczeklik W, Moreno R, Artigas A, Joannidis M, de Lange DW, Guidet B, Flaatten H, Jung C, Leaver SK. 30-Day Mortality among Very Old Patients Admitted to European Intensive Care Units for Major Trauma. Gerontology 2024; 70:715-723. [PMID: 38387455 DOI: 10.1159/000537718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION Cases of major trauma in the very old (over 80 years) are increasingly common in the intensive care unit (ICU). Predicting outcome is challenging in this group of patients as chronological age is a poor marker of health and poor predictor of outcome. Increasingly, decisions are guided by the use of organ dysfunction scores of both acute conditions (e.g., sequential organ failure assessment [SOFA] score) and chronic health issues (e.g., clinical frailty scale [CFS]). Recent work suggests that increased CFS is associated with a worse outcome in elderly major trauma patients. We aimed to test whether this association held true in the very old (over 80) or whether SOFA had a stronger association with 30-day outcome. METHODS Data from the very elderly intensive care patient (VIP)-1 and VIP-2 studies for patients over 80 years old with major trauma admissions were merged. These participants were recruited from 20 countries across Europe. Baseline characteristics, level of care provided, and outcome (ICU and 30-day mortality) were summarised. Uni- and multivariable regression analyses were undertaken to determine associations between CFS and SOFA score in the first 24 h, type of major trauma, and outcomes. RESULTS Of the 8,062 acute patients recruited to the two VIP studies, 498 patients were admitted to intensive care because of major trauma. Median age was 84 years, median SOFA score was 6 (IQR 3, 9), and median CFS was 3 (IQR 2, 5). Survival for 30 days was 54%. Median and interquartile range of CFS were the same for survivors and non-survivors. In the logistic regression analysis, CFS was not associated with increased mortality. SOFA score (p < 0.001) and trauma with head injury (p < 0.01) were associated with increased mortality. CONCLUSIONS Major trauma admissions in the very old are not uncommon, and 30-day mortality is high. We found that CFS was not a helpful predictor of mortality. SOFA and trauma with head injury were associated with worse outcomes in this patient group.
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Affiliation(s)
- Chris F Duncan
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dagan O Lonsdale
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Clinical Pharmacology, University of London, London, UK
| | - Helen Farrah
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Farnell-Ward
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christine Ryan
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ximena Watson
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Jesper Fjølner
- Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Vyborg, Denmark
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Krakow, Poland
| | - Rui Moreno
- Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Antonio Artigas
- Department of Intensive Care Medicine, Parc Tauli University Hospital, Institut d'Investigació I innovació Parc tauli (I3PT), Autonomous University of Barcelona, Sabadell, Spain
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Dylan W de Lange
- Department of Intensive Care Medicine, Dutch Poisons Information Center (DPIC), University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis D'Epidémiologie Et de Santé Publique, Saint Antoine Hospital, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, Paris, France
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Department of Clinical Medicine, Haukeland University Hospital Bergen, Department of Anaesthesia and Intensive Care and University of Bergen, Bergen, Norway
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Susannah K Leaver
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
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2
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Pasieka P, Surówka A, Fronczek J, Skwara E, Czuczwar M, Borys M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Żukowski M, Kotfis K, Cwyl K, Skowronek J, Solek-Pastuszka J, Biernawska J, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Sierakowska K, Mudyna W, Białka S, Studzińska D, Bernas S, Piechota M, Machała W, Sadowski Ł, Stefaniak J, Owczuk R, Szymkowiak M, Gawda R, Kozera N, Adamik B, Goździk W, Wieczorek A, Janc J, Kluzik A, Trzebicki J, Zatorski P, Gola W, Hymczak H, Krzych LJ, Czajka S, Kościuczuk U, Kudliński B, Flaatten H, Szczeklik W. Prevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies. J Crit Care 2024; 79:154439. [PMID: 37832351 DOI: 10.1016/j.jcrc.2023.154439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017. METHODS We analysed Polish cohorts from studies VIP1 (October 2016 - May 2017) and VIP2 (May 2018 - May 2019) that enrolled critical patients aged >80. We collected data on demographics, clinical features limitations of LST. Primary analysis assessed factors associated with prevalence of limitations of LST, A secondary analysis explored differences between patients with and without limitations of LST. RESULTS 601 patients were enrolled. Prevalence of LST limitations was 16.1% in 2016-2017 and 20.5% in 2018-2019. No difference was found in univariate analysis (p = 0.22), multivariable model showed higher propensity towards limiting LST in the 2018-2019 cohort compared to 2016-2017 cohort (OR 1.07;95%CI, 1.01-1.14). There was higher mortality and a longer length of stay of patients with limitations of LST compared to the patients without limitations of LST. (11 vs. 6 days, p = 0.001). CONCLUSIONS The clinicians in Poland have become more proactive in limiting LST in critically ill patients ≥80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low.
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Affiliation(s)
- Paweł Pasieka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Anna Surówka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Evan Skwara
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mirosław Czuczwar
- 2nd Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland
| | - Michał Borys
- 2nd Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland
| | - Paweł Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mirosław Ziętkiewicz
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kraków, Poland; 2nd Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Kraków, Poland
| | - Łukasz R Nowak
- Department of Intensive Care and Anaesthesiology, 5(th) Military Clinical Hospital in Kraków, Poland
| | - Maciej Żukowski
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Cwyl
- Anesthesia and Intensive Care Unit, Regional Health Center in Lubin, Poland
| | - Jacek Skowronek
- St. Raphael Hospital, Department of Anaesthesiology and Intensive Care, Kraków, Poland
| | - Joanna Solek-Pastuszka
- Department of Clinical Anesthesiology and Intensive Therapy PUM, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Jowita Biernawska
- Department of Clinical Anesthesiology and Intensive Therapy PUM, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Paweł Grudzień
- Department of Anaesthesiology and Intensive Therapy, E. Szczeklik Specialist Hospital in Tarnów, Poland
| | - Paweł Nasiłowski
- Department of Anaesthesiology and Intensive Therapy, G. Narutowicz Specialist Hospital in Kraków, Poland; Department of Anaesthesiology and Intensive Care, St Ann Hospital in Miechów, Poland
| | - Natalia Popek
- Department of Anaesthesiology and Intensive Therapy, S. Żeromski Specialist Hospital in Kraków, Poland
| | - Waldemar Cyrankiewicz
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland; Department of Anaesthesiology and Intensive Therapy, Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Wojciech Mudyna
- Department of Anaesthesiology and Intensive Therapy, Ludwik Rydygier Memorial Specialized Hospital in Kraków, Poland
| | - Szymon Białka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Dorota Studzińska
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Anaesthesiology and Intensive Care, St John Grande Hospital in Kraków, Poland
| | - Szymon Bernas
- Department of Anaesthesiology and Intensive Therapy - Centre for Artificial Extracorporeal Kidney and Liver Support, The Dr Wł. Biegański Regional Specialist Hospital in Lodz, Poland
| | - Mariusz Piechota
- Department of Anaesthesiology and Intensive Therapy - Centre for Artificial Extracorporeal Kidney and Liver Support, The Dr Wł. Biegański Regional Specialist Hospital in Lodz, Poland
| | - Waldemar Machała
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Łukasz Sadowski
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Jan Stefaniak
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Małgorzata Szymkowiak
- Department of Anaesthesiology and Intensive Care, Provincial Hospital in Poznań, Poland
| | - Ryszard Gawda
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Poland
| | - Natalia Kozera
- Department of Anaesthesiology and Intensive Therapy, Wroclaw University Hospital, Wrocław Medical University, Wrocław, Poland
| | - Barbara Adamik
- Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland
| | - Waldemar Goździk
- Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland
| | - Agnieszka Wieczorek
- Anaesthesia and Intensive Care Unit, 4(th) Military Hospital in Wrocław, Poland
| | - Jarosław Janc
- Anaesthesia and Intensive Care Unit, 4(th) Military Hospital in Wrocław, Poland
| | - Anna Kluzik
- Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, Poznan, Poland; Department of Teaching Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Janusz Trzebicki
- University Clinical Center of the Medical University of Warsaw - Infant Jesus Clinical Hospital, I Department of Anaesthesiology and Intensive Care, Warsaw, Poland
| | - Paweł Zatorski
- University Clinical Center of the Medical University of Warsaw - Infant Jesus Clinical Hospital, I Department of Anaesthesiology and Intensive Care, Warsaw, Poland
| | - Wojciech Gola
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Hubert Hymczak
- 1st Depratment of Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Kraków, Poland; Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Lukasz J Krzych
- Department of Anaesthesiology and Intensive Care, University Clinical Center, School of Medicine in Katowice - Medical University of Silesia, Poland
| | - Szymon Czajka
- Department of Anaesthesiology and Intensive Care, University Clinical Center, School of Medicine in Katowice - Medical University of Silesia, Poland
| | - Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Therapy, Medical Unibersity of Białystok, Poland
| | - Bartosz Kudliński
- Clinical Department of Anaesthesiology and Intensive Care, University Hospital in Zielona Góra, Poland
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Norway
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
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Pasieka PM, Kurek M, Skupnik W, Skwara E, Bezshapkin V, Fronczek J, Kluzik A, Kudliński B, Białka S, Studzińska D, Krzych ŁJ, Czajka S, Stefaniak J, Owczuk R, Sołek-Pastuszka J, Biernawska J, Zorska J, Krawczyk P, Cwyl K, Żukowski M, Kotfis K, Zegan-Barańska M, Wieczorek A, Mudyna W, Piechota M, Bernas S, Machała W, Sadowski Ł, Serwa M, Czuczwar M, Borys M, Ziętkiewicz M, Kozera N, Adamik B, Goździk W, Nasiłowski P, Zatorski P, Trzebicki J, Gałkin P, Gawda R, Kościuczuk U, Cyrankiewicz W, Sierakowska K, Gola W, Hymczak H, Flaatten H, Szczeklik W. Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study. Anaesthesiol Intensive Ther 2024; 56:61-69. [PMID: 38741445 PMCID: PMC11022638 DOI: 10.5114/ait.2024.138192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/24/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes. MATERIAL AND METHODS The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed. RESULTS A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities. CONCLUSIONS We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.
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Affiliation(s)
- Paweł Melchior Pasieka
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Kurek
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Skupnik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Evan Skwara
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Valentyn Bezshapkin
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Kluzik
- Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, Poznan, Poland
- Department of Teaching Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartosz Kudliński
- Clinical Department of Anaesthesiology and Intensive Care, University Hospital in Zielona Gora, Poland
| | - Szymon Białka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Dorota Studzińska
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
- Department of Anaesthesiology and Intensive Care, St. John Grande Hospital in Krakow, Poland
| | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, University Clinical Centre, School of Medicine in Katowice – Medical University of Silesia, Katowice, Poland
| | - Szymon Czajka
- Department of Anaesthesiology and Intensive Care, University Clinical Centre, School of Medicine in Katowice – Medical University of Silesia, Katowice, Poland
| | - Jan Stefaniak
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdansk, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdansk, Poland
| | - Joanna Sołek-Pastuszka
- Department of Clinical Anaesthesiology and Intensive Therapy, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Jowita Biernawska
- Department of Clinical Anaesthesiology and Intensive Therapy, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Joanna Zorska
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Cwyl
- Anesthesia and Intensive Care Unit, Regional Health Centre in Lublin, Poland
| | - Maciej Żukowski
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Małgorzata Zegan-Barańska
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | | | - Wojciech Mudyna
- Department of Anaesthesiology and Intensive Therapy, Ludwik Rydygier Memorial Specialist Hospital in Krakow, Poland
| | - Mariusz Piechota
- Department of Anaesthesiology and Intensive Therapy – Centre for Artificial Extracorporeal Kidney and Liver Support, Lodz, Poland
| | - Szymon Bernas
- Department of Anaesthesiology and Intensive Therapy – Centre for Artificial Extracorporeal Kidney and Liver Support, Lodz, Poland
| | - Waldemar Machała
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Łukasz Sadowski
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Marta Serwa
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Mirosław Czuczwar
- 2 Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Michał Borys
- 2 Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Mirosław Ziętkiewicz
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland
- 2 Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Krakow, Poland
| | - Natalia Kozera
- Department of Anaesthesiology and Intensive Therapy, Wroclaw University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Adamik
- Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Goździk
- Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Nasiłowski
- Department of Anaesthesiology and Intensive Therapy, G. Narutowicz Specialist Hospital in Krakow, Poland
- Department of Anaesthesiology and Intensive Care, St. Ann Hospital in Miechow, Poland
| | - Paweł Zatorski
- I Department of Anaesthesiology and Intensive Care, University Clinical Center of the Medical University of Warsaw – Infant Jesus Clinical Hospital, Warsaw, Poland
| | - Janusz Trzebicki
- I Department of Anaesthesiology and Intensive Care, University Clinical Center of the Medical University of Warsaw – Infant Jesus Clinical Hospital, Warsaw, Poland
| | - Piotr Gałkin
- Department of Anaesthesiology and Intensive Care, Regional Hospital in Bialystok, Poland
| | - Ryszard Gawda
- Department of Anaesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Poland
| | - Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Care, Medical University of Bialystok, Poland
| | - Waldemar Cyrankiewicz
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
- Department of Anaesthesiology and Intensive Therapy, Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Wojciech Gola
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Hubert Hymczak
- 1 Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Krakow, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
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4
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Polok K, Fronczek J, Guidet B, Artigas A, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Pinto BB, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Flaatten H, Jung C, Szczeklik W. Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic. Ann Intensive Care 2023; 13:82. [PMID: 37698708 PMCID: PMC10497468 DOI: 10.1186/s13613-023-01173-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic. METHODS We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2-2018 to 2019) and admitted due to COVID-19 (COVIP-March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days). RESULTS The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80). CONCLUSION The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.
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Affiliation(s)
- Kamil Polok
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland
- Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland
| | - Bertrand Guidet
- UMR_S 1136, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, UPMC Univ Paris 06, INSERMInstitut Pierre Louis d'Epidémiologie et de Santé PubliqueAssistance Publique - Hôpitaux de Paris, Sorbonne Universités, F-75012, Paris, France
| | - Antonio Artigas
- Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Jesper Fjølner
- Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Susannah Leaver
- Department of Critical Care, St George's Hospital, London, UK
| | - Michael Beil
- Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dorota Studzińska
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Rui Moreno
- Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy
- Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland.
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Fronczek J, Flaatten H, Guidet B, Polok K, Andersen FH, Andrew BY, Artigas A, Beil M, Cecconi M, Christensen S, de Lange DW, Fjølner J, Górka J, Joannidis M, Jung C, Kusza K, Leaver S, Marsh B, Morandi A, Moreno R, Oeyen S, Owczuk R, Agvald-Öhman C, Pinto BB, Rhodes A, Schefold JC, Soliman IW, Valentin A, Walther S, Watson X, Zafeiridis T, Szczeklik W. Short-term mortality of patients ≥80 years old admitted to European intensive care units: an international observational study. Br J Anaesth 2022; 129:58-66. [DOI: 10.1016/j.bja.2022.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 11/02/2022] Open
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Guidet B, Jung C, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Beil M, Sigal S, van Heerden PV, Szczeklik W, Joannidis M, Oeyen S, Kondili E, Marsh B, Andersen FH, Moreno R, Cecconi M, Leaver S, De Lange DW, Boumendil A. Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19. Intensive Care Med 2022; 48:435-447. [PMID: 35218366 PMCID: PMC8881896 DOI: 10.1007/s00134-022-06642-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/05/2022] [Indexed: 12/26/2022]
Abstract
Purpose The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06642-z.
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Affiliation(s)
- Bertrand Guidet
- UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Medical Intensive Care, Sorbonne Universités, 184 rue du Faubourg Saint Antoine, 75012, Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France.
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Michael Beil
- Medical Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sviri Sigal
- Medical Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Eumorfia Kondili
- Intensive Care Unit, University Hospital of Heraklion, Medical School University of Crete, Giofirakia, Greece
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Alesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Lisbon, Portugal
| | - Maurizio Cecconi
- Department of Anaesthesia IRCCS, Instituto Clínico Humanitas, Humanitas University, Milan, Italy
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands
| | - Ariane Boumendil
- UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, Medical Intensive Care, Sorbonne Universités, 184 rue du Faubourg Saint Antoine, 75012, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
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