Orsini Jose, Butala Ashvin, Salomon Say, Studer Sean, Gadhia Shardul, Shamian Ben, Prajapati Ramesh, Blaak Christa
Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, New York, New York, USA.
Geriatr Gerontol Int. 2015 Jul;15(7):889-94. doi: 10.1111/ggi.12363. Epub 2014 Sep 26.
Despite concerns over the appropriateness and quality of care provided in the intensive care unit (ICU) at the end of life, the number of elderly patients who receive critical care is increasing. Despite this, many physicians have doubts as to whether elderly patients are good candidates for ICU care because of the apparently poor outcome during and after critical care in this population. The objective of the present study was to describe the clinical characteristics and outcome of a geriatric population admitted to the ICU.
A single-center, prospective, observational study was carried out among geriatric patients, aged 75 years or older, admitted to ICU.
A total of 71 patients were admitted to ICU during the study period. Their mean age was 83 years (range 75-98 years), with a mean Acute Physiology and Chronic Health Evaluation-II score of 21.8 (range 8-39) on admission to ICU. A total of 48 patients (68%) required mechanical ventilation, and 39 (55%) received at least one vasoactive drug. The mean ICU length of stay was 4.6 days (range 1-18 days), and it was similar for ICU survivors and non-survivors (4.7 vs 4.5). A total of 14 patients (19.7%) were admitted after cardiac arrest, and eight (57.1%) of them died in ICU. A total of 28 patients (39.4%) died in the hospital, and 18 (25.4%) died in ICU.
Advanced age, critical illness, cardiopulmonary resuscitation, and needs for mechanical ventilation and/or vasopressor therapy are independent risk factors associated with adverse outcome in elderly patients admitted to ICU. Alternatives for ICU admission should be considered in geriatric patients with severe critical illnesses.
尽管人们对重症监护病房（ICU）在生命末期所提供护理的适宜性和质量存在担忧，但接受重症监护的老年患者数量仍在增加。尽管如此，许多医生怀疑老年患者是否适合接受ICU护理，因为该人群在重症监护期间及之后的预后明显较差。本研究的目的是描述入住ICU的老年人群的临床特征和预后。
对年龄在75岁及以上入住ICU的老年患者进行了一项单中心、前瞻性观察性研究。
在研究期间，共有71例患者入住ICU。他们的平均年龄为83岁（范围75 - 98岁），入住ICU时急性生理与慢性健康状况评分系统II（APACHE-II）的平均评分为21.8（范围8 - 39）。共有48例患者（68%）需要机械通气，39例（55%）接受了至少一种血管活性药物治疗。ICU平均住院时间为4.6天（范围1 - 18天），ICU幸存者和非幸存者相似（4.7天对4.5天）。共有14例患者（19.7%）在心搏骤停后入院，其中8例（57.1%）在ICU死亡。共有28例患者（39.4%）在医院死亡，18例（25.4%）在ICU死亡。
高龄、危重病、心肺复苏以及机械通气和/或血管升压药治疗需求是入住ICU老年患者不良预后的独立危险因素。对于患有严重危重病的老年患者，应考虑替代ICU入院的方案。
