Prognostic nomogram for elderly patients with acute respiratory failure receiving invasive mechanical ventilation: a nationwide population-based cohort study in Taiwan

Hsu, Ching Yi; Hung, Yao-Min; Chu, Kuo-An; Chen, Chiu-Fan; Yin, Chun-Hao; Lee, Ching‐Chih

doi:10.1038/s41598-020-70130-x

Cited by 13 publications

(9 citation statements)

References 33 publications

(41 reference statements)

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“…The outcome of AHRF in our study was similar to what was reported in the same period in several cohorts of mechanically ventilated hypoxaemic patients [10,17,18]. However, the observed mortality was almost 10% higher compared to cohorts in Italy and in Canada with similar demographics and similar degrees of hypoxaemia [19,20].…”

Section: Discussionsupporting

confidence: 89%

Prevalence and Outcomes of Acute Hypoxaemic Respiratory Failure in Wales: The PANDORA-WALES Study

Kopczynska

Sharif

Pugh

et al. 2020

JCM

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Background: We aimed to identify the prevalence of acute hypoxaemic respiratory failure (AHRF) in the intensive care unit (ICU) and its associated mortality. The secondary aim was to describe ventilatory management as well as the use of rescue therapies. Methods: Multi-centre prospective study in nine hospitals in Wales, UK, over 2-month periods. All patients admitted to an ICU were screened for AHRF and followed-up until discharge from the ICU. Data were collected from patient charts on patient demographics, clinical characteristics, management and outcomes. Results: Out of 2215 critical care admissions, 886 patients received mechanical ventilation. A total of 197 patients met inclusion criteria and were recruited. Seventy (35.5%) were non-survivors. Non-survivors were significantly older, had higher SOFA scores and received more vasopressor support than survivors. Twenty-five (12.7%) patients who fulfilled the Berlin definition of acute respiratory distress syndrome (ARDS) during the ICU stay without impact on overall survival. Rescue therapies were rarely used. Analysis of ventilation showed that median Vt was 7.1 mL/kg PBW (IQR 5.9–9.1) and 21.3% of patients had optimal ventilation during their ICU stay. Conclusions: One in four mechanically ventilated patients have AHRF. Despite advances of care and better, but not optimal, utilisation of low tidal volume ventilation, mortality remains high.

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Section: Discussionsupporting

confidence: 89%

Prevalence and Outcomes of Acute Hypoxaemic Respiratory Failure in Wales: The PANDORA-WALES Study

Kopczynska

Sharif

Pugh

et al. 2020

JCM

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“…Intracranial haemorrhages are associated with very high rates of mortality or severe impairment in this age group 31 . Respiratory failure, the most common medical cause for unconsciousness in older individuals, often marks the final stage of morbidity and is thus associated with high mortality rates 32 . This shift seems to be relevant with regards to the decision-making processes and the suspected cause of unconsciousness.…”

Section: Discussionmentioning

confidence: 99%

A retrospective cohort study on association of age and physician decision making for or against rapid sequence intubation in unconscious patients

Eichlseder

Eichinger

Hallmann

et al. 2022

Sci Rep

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In unconscious individuals, rapid sequence intubation (RSI) may be necessary for cardiopulmonary stabilisation and avoidance of secondary damage. Opinions on such invasive procedures in people of older age vary. We thus sought to evaluate a possible association between the probability of receiving prehospital RSI in unconsciousness and increasing age. We conducted a retrospective study in all missions (traumatic and non-traumatic) of the prehospital emergency physician response unit in Graz between January 1st, 2010 and December 31st, 2019, which we searched for Glasgow Coma Scale (GCS) below 9. Cardiac arrests were excluded. We performed multivariable regression analysis for RSI with age, GCS, independent living, and suspected cause as independent variables. Of the 769 finally included patients, 256 (33%) received RSI, whereas 513 (67%) did not. Unadjusted rates of RSI were significantly lower in older patients (aged 85 years and older) compared to the reference group aged 50–64 years (13% vs. 51%, p < 0.001). In multivariable regression analysis, patients aged 85 years and older were also significantly less likely to receive RSI [OR (95% CI) 0.76 (0.69–0.84)]. We conclude that advanced age, especially 85 years or older, is associated with significantly lower odds of receiving prehospital RSI in cases of unconsciousness.

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“…Only 3 out of 10 elderly patients admitted to the ICU, both with acute respiratory failure and using mechanical ventilation, survived in one-year observation. 15 The mechanism causing this is diffuse alveolar damage. Several aetiologies such as cytokine-laden pneumonia, aspiration, direct injury by ventilation pressure may cause profound uid and cellular exudation.…”

Section: Discussionmentioning

confidence: 99%

Comorbidities and COVID-19 Status Influence the Survival Rate of Geriatric Patients in Intensive Care Units: a Prospective Cohort Study From the Indonesian Society of Anaesthesiology and Intensive Therapy

Rehatta

Chandra

Sari

et al. 2021

Preprint

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Background: With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting.Methods: We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis.Results: We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson's Comorbidity Index Score >5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival rates than subjects without those conditions (p < 0.005).Conclusion: Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.

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Prognostic nomogram for elderly patients with acute respiratory failure receiving invasive mechanical ventilation: a nationwide population-based cohort study in Taiwan

Cited by 13 publications

References 33 publications

Prevalence and Outcomes of Acute Hypoxaemic Respiratory Failure in Wales: The PANDORA-WALES Study

Prevalence and Outcomes of Acute Hypoxaemic Respiratory Failure in Wales: The PANDORA-WALES Study

A retrospective cohort study on association of age and physician decision making for or against rapid sequence intubation in unconscious patients

Comorbidities and COVID-19 Status Influence the Survival Rate of Geriatric Patients in Intensive Care Units: a Prospective Cohort Study From the Indonesian Society of Anaesthesiology and Intensive Therapy

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