Effect of age on survival of critically ill patients with cancer*

Soares, Márcio; Carvalho, Marília Sá; Salluh, Jorge I.; Ferreira, Carlos Gil; Luiz, Ronir Raggio; Rocco, José Rodolfo; Spector, Nelson

doi:10.1097/01.ccm.0000201883.05900.3f

Cited by 59 publications

(22 citation statements)

References 33 publications

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“…33,34 In critical cancer subjects, greater age was associated with increased mortality, especially for subjects Ͼ 60 y of age. 35 The main predictors of mortality in elderly subjects with cancer admitted to an ICU were more severe organ failure and uncontrolled cancer. 35 Mortality rates were higher in subjects admitted from wards.…”

Section: Discussionmentioning

confidence: 99%

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

et al. 2014

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BACKGROUND:We evaluated the clinical characteristics and factors associated with mortality in very elderly patients > 90 y of age admitted to the ICU. METHODS: We evaluated age-specific rates of admission and mortality in 16,935 subjects > 18 y old and retrospectively analyzed the clinical data of 155 (0.92%) subjects > 90 y old admitted to the ICU from January 2003 to July 2012. The clinical mortality index was defined as the ICU mortality rate associated with clinical risk factors including poor nutrition, do not resuscitate (DNR) order, pneumonia, chronic renal failure, cancer, mechanical ventilation, use of a vasopressor, and admission from a ward. RESULTS: The mortality rate of ICU subjects > 90 y of age was 32.3%. A Cox's regression hazard model revealed that high glucose (P ‫؍‬ .006), poor nutrition (P ‫؍‬ .001), high Simplified Acute Physiology Scoring II scores (P < .001), DNR order (P ‫؍‬ .002), and vasopressor treatment (P ‫؍‬ .03) were independent predictive factors of mortality in subjects > 90 y of age admitted to the ICU. An increasing number of clinical risk factors was associated with progressively higher mortality rates. All subjects with more than 5 risk factors died. CONCLUSIONS: The very elderly subjects (> 90 y) admitted to the ICU had a higher mortality rate compared with subjects of other ages. High Simplified Acute Physiology Scoring II scores, poor nutritional status, high glucose, use of vasopressors, and DNR orders should be considered as important predictors of mortality in very elderly ICU patients. The level of ICU treatment should be carefully considered in very elderly patients presenting with 5 or more risk factors.

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Section: Discussionmentioning

confidence: 99%

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

et al. 2014

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“…On the other hand, other studies show that old age is in fact a reason for not admitting patients to 124 the ICU because of prognostic reasons 11,22 . However, there is consensus that functional status and 125 comorbidity are more important than age in determining the chance of ICU and hospital survival 126 23,24,25,26 . 127…”

Section: Old Versus Younger Patients 119mentioning

confidence: 99%

Factors influencing ICU referral at the end of life in the elderly

et al. 2010

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Remarks of the reviewers and answers of the authors: Could you please explain what a Belgian tertiary hospital is?We use the term 'tertiary' hospital as a synonym for a university hospital. This was adapted in the manuscript (in the abstract as well as in the method's section).Did the questionnaire you gave to the physicians also include questions why they decided to send the patients to the ICU or not?We agree that this would have been extremely valuable information. However, in order to have a maximum response rate, we used a very short questionnaire asking only objective data on the patient as well as on the DNR code and who participated in the decision to limit therapy.How was the decision made for a special DNR-Code? Was this decision mainly based on medical facts (prognosis underlying disease, comorbidity, functionality) or was this an overall decision with the participation of patient family, nurse and physician? Legal aspects in non-communicative patients -is there a legal representative who made the healthcare-decisions, or is that done by family members in Belgium?Legislation in Belgium demands that physicians inform and ask consent for every medical intervention/decision from the patient -or in case of incapacity from the surrogate decision-maker (this is in practice the nearest family).(this was added to the manuscript)The Order of Physicians in Belgium has added that it is also recommended to involve other members of the healthcare team (nurses!) in the DNR decision-making process.In this study, we see that 84% of competent patients were at least informed about the decision to limit therapy and that 100% of families of incompetent patients were informed. Only in 58%, nurses reported to be involved. (Table 1

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“…Absence of a significant age effect may be explained by the relatively low age range of our patients, which in turn may reflect the typical age range of patients admitted to a surgical ICU. 38,39 The patient's sex also was not predictive of the duration of action of NBDs. In contrast, Xue et al 18 reported a significantly longer dur 25 of rocuronium in women than in men.…”

Section: Discussionmentioning

confidence: 99%

Clinical Predictors of Duration of Action of Cisatracurium and Rocuronium Administered Long-Term

Faßbender

Geldner

Blobner

et al. 2009

American Journal of Critical Care

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BackgroundThe duration of action of neuromuscular blocking drugs (NBDs) varies between individuals and even within individuals in different settings. Objectives To define predictors of variance in duration of action of rocuronium and cisatracurium administered long-term. Methods A prospective, double-blind, multicenter trial that included 113 patients scheduled for major abdominal surgery and postoperative admission to the intensive care unit. Patients received repetitive (median, 7) equipotent doses of rocuronium or cisatracurium to maintain deep relaxation (twitch height of the adductor pollicis muscle <25% of baseline). Effects of weight, age, sex, American Society of Anesthesiologists risk score, lowest core temperature, duration of NBD administration, and tobacco smoking history on duration of action of cisatracurium and rocuronium were determined via multiple regression analysis. Results Only duration of NBD administration was predictive of the duration of action of rocuronium. The predicted increase in time to recovery of the train-of-4 ratio to 0.9 (duration TOF 0.9) per hour of continuous NBD treatment was 12.4 minutes. In contrast, only lowest core body temperature was predictive of cisatracurium's duration of action, and the predicted in crease in duration TOF 0.9 per degree Celsius decrease was 9.8 min. Conclusion Duration of NBD treatment is strongly predictive of the duration of action of rocuronium, and body temperature is predictive of the duration of action of cisatracurium. These data may help decrease the incidence of drug-induced muscle weakness in recovery rooms and surgical intensive care units, particularly if neuromuscular transmission monitoring is not available.

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Effect of age on survival of critically ill patients with cancer*

Cited by 59 publications

References 33 publications

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

Factors influencing ICU referral at the end of life in the elderly

Clinical Predictors of Duration of Action of Cisatracurium and Rocuronium Administered Long-Term

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