Department of Intensive Care, Gelre Hospital, Apeldoorn.
Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht.
Chest. 2011 Dec;140(6):1473-1483. doi: 10.1378/chest.10-0803. Epub 2011 Sep 29.
Intensivists frequently are concerned about whether octogenarians actually will benefit from ICU admission. We studied changes in health-related quality of life (HRQOL) 6 months following ICU discharge in those patients.
We performed a long-term prospective study in a medical-surgical ICU. Patients aged ≥ 80 years (n = 129) and < 80 years (n = 620) admitted for > 48 h were included. We used the Medical Outcomes Study 36-item short form (SF-36) to evaluate HRQOL before ICU admission (using proxies), at ICU discharge, at hospital discharge, and at 3 and 6 months following ICU discharge, using a linear mixed model.
At 6 months after ICU discharge, 49 patients aged ≥ 80 years and 352 patients aged < 80 years could be evaluated. At ICU discharge, physical functioning was far lower than mental functioning (physical component score, 24.9; mental component score, 46.1) in the octogenerians. Most SF-36 dimensions showed significant improvement over time (all P < .01, except role-emotional [P = .038] and bodily pain [P = .77]). In the octogenarians, mean SF-36 scores 6 months after ICU discharge were comparable to baseline in all dimensions. Most dimensions of the SF-36 were not significantly lower in surviving octogenarians at 6 months after ICU discharge compared with the normal population.
We demonstrated a good recovery of HRQOL in octogenarians surviving critical illness. The findings suggest that denying admission to the ICU should not just rely on old age.
重症监护医师经常关注 80 岁以上的患者是否能从 ICU 住院中获益。我们研究了这些患者在 ICU 出院后 6 个月时与健康相关的生活质量（HRQOL）的变化。
我们在一个内科-外科 ICU 进行了一项长期前瞻性研究。纳入了年龄≥80 岁（n=129）和<80 岁（n=620）、住院时间>48 小时的患者。我们使用医疗结局研究 36 项简短表格（SF-36）在 ICU 入院前（使用代理人）、ICU 出院时、出院时以及 ICU 出院后 3 个月和 6 个月评估 HRQOL，使用线性混合模型。
在 ICU 出院后 6 个月时，可评估 49 名年龄≥80 岁的患者和 352 名年龄<80 岁的患者。在 80 岁以上的患者中，身体功能在 ICU 出院时远低于心理功能（身体成分评分 24.9；心理成分评分 46.1）。大多数 SF-36 维度随着时间的推移都有显著改善（所有 P<.01，除角色情感[P=0.038]和身体疼痛[P=0.77]）。在 80 岁以上的患者中，ICU 出院后 6 个月的 SF-36 平均得分在所有维度上均与基线相当。与普通人群相比，存活的 80 岁以上患者在 ICU 出院后 6 个月时，SF-36 的大多数维度并未明显降低。
我们证明了危重病幸存者的 HRQOL 有良好的恢复。这些发现表明，拒绝将患者收入 ICU 不应该仅仅依据年龄。
