Management of Very Old Patients in Intensive Care Units

Ding, Xin; Lian, Hui; Wang, Xiaoting

doi:10.14336/ad.2020.0914

Cited by 5 publications

(4 citation statements)

References 114 publications

(121 reference statements)

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“…At present, older patients with a critical illness are frequently admitted in the ICU. However, data on older patients with pneumonia are relatively rare, and there have been few evidence-based medical reports ( 23 ). This study was a retrospective analysis based on data from a previous nurse-led GDLPT study.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Nurse-Led, Goal-Directed Lung Physiotherapy for Older Patients With Sepsis and Pneumonia in the ICU

et al. 2021

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Objectives: This study aimed to investigate the effect of nurse-led, goal-directed lung physiotherapy (GDLPT) on the prognosis of older patients with sepsis caused by pneumonia in the intensive care unit.Methods: We conducted a prospective, two-phase (before-and-after) study over 3 years called the GDLPT study. All patients received standard lung therapy for sepsis caused by pneumonia and patients in phase 2 also received GDLPT. In this study, 253 older patients (age ≥ 65 years) with sepsis and pneumonia were retrospectively analyzed. The main outcome was 28 day mortality.Results: Among 742 patients with sepsis, 253 older patients with pneumonia were divided into the control group and the treatment group. Patients in the treatment group had a significantly shorter duration of mechanical ventilation [5 (4, 6) vs. 5 (4, 8) days; P = 0.045], and a lower risk of intensive care unit (ICU) mortality [14.5% (24/166) vs. 28.7% (25/87); P = 0.008] and 28 day mortality [15.1% (25/166) vs. 31% (27/87); P = 0.005] compared with those in the control group. GDLPT was an independent risk factor for 28 day mortality [odds ratio (OR), 0.379; 95% confidence interval (CI), 0.187–0.766; P = 0.007].Conclusions: Nurse-led GDLPT shortens the duration of mechanical ventilation, decreases ICU and 28-day mortality, and improves the prognosis of older patients with sepsis and pneumonia in the ICU.

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Section: Discussionmentioning

confidence: 99%

Implementation of Nurse-Led, Goal-Directed Lung Physiotherapy for Older Patients With Sepsis and Pneumonia in the ICU

et al. 2021

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“…40 Worldwide, institutions in China have implemented the "ABCCDEFGHI bundles", treatment strategies for the elderly admitted to their geriatric ICUs, which have proven positive results in patient outcomes, and in Germany many institutions have been certified as geriatric trauma centers. 39,41 This study, however, is subject to some limitations. Data were retrieved in a retrospective manner, and since the 20-y study period was evaluated in a time-series analysis, trends presented may not take into consideration changes over time including database patient classification and data recollection changes, population changes, hospital bed capacity, and implementation of new and advanced technology.…”

Section: Discussionmentioning

confidence: 91%

Elderly Admission Trends at the Puerto Rico Trauma Hospital: A Time-Series Analysis

Rivera-Delgado¹,

Ramos-Meléndez²,

Ramírez-Martínez³

et al. 2022

Journal of Surgical Research

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“…[1][2][3] Among geriatric patients, those over the age of 80 and referred to as very elderly patients need increasingly more follow-up in the intensive care unit (ICU), and in addition to multiple comorbidities associated with systemic diseases, dementia, frailty, difficulty in swallowing or in maintaining the airway contribute to the increase in AP. [4,5] AP is a clinical condition difficult to be diagnosed. It is defined as the history of witnessed aspiration, the presence of infiltration in the zones consistent with aspiration in lung imaging, and laboratory results consistent with infection in the elderly with oral dysphagia due to comorbid conditions.…”

Section: Introductionmentioning

confidence: 99%

Aspirasyon Pnömonisi ile Yoğun Bakım Ünitesine Yatan Geriatrik Hastalarda Erken Mortalite Belirteçleri

Çiyiltepe

Özgültekin

2022

Journal of Contemporary Medicine

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Aim In the geriatric group, aspiration pneumonia is one of the most common causes of Intensive Care Unit admission. Multiple comorbidities related with systemic diseases, as well as dementia, fraility and difficulty in swallowing or protecting the airway may all contribute the development of the AP in the geriatric age. Furthermore, many other variables may influence the outcome of this patient group. In this study, it is aimed to determine the parameters that may have an effect on the intensive care mortality. Materials and Methods 221 patients aged ≥ 80 years who were admitted to the third level ICU with the diagnosis of aspiration pneumonia were retrospectively analyzed. They were divided into two groups according to the 28-day outcome (survived-nonsurvived). The admission levels of arterial blood Ph and pCO2 and lactate , blood urea, creatinine, potassium (K) and sodium (Na) levels, APACHE II, Glaskow Coma Scale (GCS), modified shock index (MSI) and the aspiration pneumonia's source ( community-acquired aspiration pneumonia (CA-AP) or healthcare-associated aspiration pneumonia (HCA-AP) )were recorded.The effects of these variables on 28-day mortality were analyzed. Results The presence of HCA-AP, GCS and APACHEII scores were found to be significantly correlated between the two groups. ROC analysis were done for those variables and cutoff points werecalculated. Logistic regression analysis indicated that APACHEII (>22.5,AUC:0.812,P=0.00) and GCS (<9, AUC:0.730, P=0.00) as the most prominentin dependent predictors of mortality (p<0,05, odds ratio 7.68, 3.23 respectively) with the presence of HCA-AP. Conclusion Although many variables are significant in predicting the first 28 days of mortality in ICU admission of geriatric patients with aspiration pneumonia, the presence of HCA-AP, high hospitalization APACHE II score and low GCS score were significant independent variables.

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Management of Very Old Patients in Intensive Care Units

Cited by 5 publications

References 114 publications

Implementation of Nurse-Led, Goal-Directed Lung Physiotherapy for Older Patients With Sepsis and Pneumonia in the ICU

Implementation of Nurse-Led, Goal-Directed Lung Physiotherapy for Older Patients With Sepsis and Pneumonia in the ICU

Elderly Admission Trends at the Puerto Rico Trauma Hospital: A Time-Series Analysis

Aspirasyon Pnömonisi ile Yoğun Bakım Ünitesine Yatan Geriatrik Hastalarda Erken Mortalite Belirteçleri

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