Department of Anaesthesia, Royal Infirmary of Edinburgh, Scotland, United Kingdom.
Resuscitation. 2011 Jul;82(7):881-5. doi: 10.1016/j.resuscitation.2011.02.025. Epub 2011 Mar 26.
Our primary objective was to evaluate the characteristics and outcomes of elderly (≥ 80 years) patients undergoing rapid sequence induction of anaesthesia and intubation (RSI) in our emergency department (ED).
We retrospectively analysed data collected prospectively between January 1999 and December 2007. We retrieved age; gender; presenting diagnosis; indication and urgency for RSI; complications related to RSI; hospital destination; and outcome.
1686 patients underwent RSI in the ED during the study period; 107 (6%) were aged ≥ 80 years. The mean age (range) was 84 (80-91) years. 94 patients (88%) were living in a private residence before presentation to the ED. Intracerebral haemorrhage, ischaemic stroke and head injury were the commonest presenting diagnoses. Forty-one patients were admitted to intensive care, 55 were admitted to a ward (31 for palliative care) and 11 died in the ED. Seventy-two patients (67%) died; of the 35 survivors, 21 (60%) made a good recovery with no requirement for increased social care. Outcome was worse after neurological diagnoses, sepsis and trauma than after cardiac or respiratory failure, seizures or drug overdose. Presenting diagnosis predicted outcome on univariable analysis (p<0.001), but it was not possible to calculate risk for individual diagnoses. RSI-related complications, of which hypotension was commonest, occurred in 15% of patients.
A small number of patients who undergo RSI in our ED are aged ≥ 80 years. They generally have high mortality with only 20% surviving to hospital discharge with no increase in dependency; however 60% of survivors make a good recovery. In this highly selected elderly population age is not the main determinant of outcome which is influenced more by presenting diagnosis.
我们的主要目标是评估我们急诊科（ED）中接受快速序列诱导麻醉和插管（RSI）的老年（≥80 岁）患者的特征和结局。
我们回顾性分析了 1999 年 1 月至 2007 年 12 月期间前瞻性收集的数据。我们检索了年龄；性别；就诊诊断；RSI 的适应证和紧急程度；与 RSI 相关的并发症；住院去向；和结果。
在研究期间，1686 名患者在 ED 接受了 RSI；107 名（6%）年龄≥80 岁。平均年龄（范围）为 84（80-91）岁。94 名患者（88%）在就诊前居住在私人住所。脑出血、缺血性卒中和头部损伤是最常见的就诊诊断。41 名患者入住重症监护病房，55 名患者入住病房（31 名患者接受姑息治疗），11 名患者在 ED 死亡。72 名患者（67%）死亡；35 名幸存者中，21 名（60%）恢复良好，无需增加社会护理。神经诊断、脓毒症和创伤后的结局比心脏或呼吸衰竭、癫痫发作或药物过量后的结局更差。单变量分析显示就诊诊断预测结局（p<0.001），但无法计算个别诊断的风险。低血压最常见的 RSI 相关并发症发生在 15%的患者中。
在我们的 ED 中接受 RSI 的少数患者年龄≥80 岁。他们的死亡率通常较高，只有 20%的患者存活至出院且无依赖性增加；然而，60%的幸存者恢复良好。在这个高度选择的老年人群中，年龄不是结局的主要决定因素，而更多地受到就诊诊断的影响。
