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BMC Anesthesiology

, 14:126

Critical care

Abstract

BackgroundOlder age is associated with chronic illnesses and disability, which contribute to increased admission to the intensive care unit ICU. Our primary objective was to compare the characteristics, ICU management and outcomes of critically ill patients ≥ 80 year-old with those of younger patients.

MethodsThis was a retrospective cohort study of patients admitted to a tertiary-care ICU from 1999 to 2011. The characteristics, ICU management and outcomes of patients ≥ 80 year-old were compared with those 50–64.9 and 65–79.9 year-old. Multivariate analysis was performed to determine the adjusted risk of Do-Not-Resuscitate orders and hospital mortality in patients ≥ 80 year-old compared with the younger groups.

ResultsDuring the study period, patients aged ≥ 80 years N = 748 represented 7.9% of all ICU admissions and 12.8% of patients aged ≥ 50 years. Chronic cardiac 32.2% and respiratory 21.8% diseases were more prevalent in them than the younger groups p < 0.0001. The most common reasons for their ICU admission were cardiovascular 30.9% and respiratory 40.4% conditions. Sepsis was commonly present in them on admission 32.9%. Mechanical ventilation and renal replacement therapy were commonly provided 76.9% and 16.0%, respectively. During ICU stay, Do-Not-Resuscitate orders were more frequently written for patients aged ≥ 80 years 35.0% compared with 21.9% for 50–64.9 year-old group, p < 0.0001, and 25.4% for the 60–79.9 year-old group, p < 0.0001. On multivariate analysis, patients aged ≥ 80 years were more likely to receive these order compared with the 50–64.9 year-old patients adjusted OR, 1.83; 95% CI, 1.45-2.31 and the 65–80 year-old patients adjusted OR, 1.64; 95% CI, 1.32-2.04. The hospital mortality increased gradually with age and was highest 54.6% in patients ≥ 80 year-old p < 0.0001. Patients ≥ 80 year-old had higher risk of hospital mortality compared with patients aged 50–64.9 years adjusted OR, 2.16; 95% CI, 1.73-2.69 and with those aged 65–79.9 years adjusted OR, 1.51; 95% CI, 1.23-1.86.

ConclusionsPatients ≥ 80 year-old represented a significant proportion of ICU admissions. Although they received life sustaining measures similar to younger groups, they had higher adjusted mortality risk compared with the younger groups.

KeywordsAged 80 and over Critical illness Health outcome Mortality AbbreviationsAPACHEAcute Physiology and Chronic Health Evaluation

CIConfidence interval

ICUIntensive care unit

INRInternational Normalized Ratio

MPMMortality Probability Model

OROdds ratio.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2253-14-126 contains supplementary material, which is available to authorized users.

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Autor: Hasan M Al-Dorzi - Hani M Tamim - Shihab Mundekkadan - Muhammad R Sohail - Yaseen M Arabi

Fuente: https://link.springer.com/



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