超高龄患者入住 ICU：能否有一个好的结局？

The Very Elderly Admitted to ICU: A Quality Finish?

机构信息

1Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. 2Department of Medicine, McMaster University, Hamilton, ON, Canada. 3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 4Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. 5Department of Medicine, University of Manitoba, Winnipeg, MB, Canada. 6Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. 7Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Calgary, AB, Canada. 8Alberta Health Services-Calgary Zone, Calgary, AB, Canada. 9Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada. 10Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. 11Interdepartmental Division of Critical Care, St Michael's Hospital, University of Toronto, Toronto, ON, Canada. 12Department of Critical Care Medicine, Queens University, Kingston, ON, Canada. 13Department of Anesthesiology and Critical Care Medicine and Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Université Laval, Québec City, QC, Canada. 14Interdepartmental Division of Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada.

出版信息

Crit Care Med. 2015 Jul;43(7):1352-60. doi: 10.1097/CCM.0000000000001024.

DOI:10.1097/CCM.0000000000001024

PMID:25901550

Abstract

OBJECTIVE

Very elderly persons admitted to ICUs are at high risk of death. To document life-sustaining interventions (mechanical ventilation, vasopressors, renal replacement therapy) provided in the ICU and outcomes of care.

DESIGN

Multicenter, prospective cohort study.

SETTING

ICUs of 24 Canadian hospitals.

PARTICIPANTS/SETTING: Patients 80 years old or older admitted to the ICU.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

One thousand six hundred seventy-one patients were included. The average age of the cohort was 85 years (range, 80-100 yr). Median total length of stay in ICU was 4 days (interquartile range, 2-8 d) and in hospital was 17 days (interquartile range, 8-33 d). Of all patients included, 502 (30%) stayed in ICU for 7 days or more and 344 (21%) received some form of life-sustaining treatment for at least 7 days. ICU and hospital mortality were 22% and 35%, respectively. For nonsurvivors, the median time from ICU admission to death was 10 days (interquartile range, 3-20 d). Of those who died (n = 5 85), 289 (49%) died while receiving mechanical ventilation, vasopressors, or dialysis. The presence of frailty or advance directives had little impact on limiting use of life-sustaining treatments or shortening the time from admission to death.

CONCLUSIONS

In this multicenter study, one third of very elderly ICU patients died in hospital, many after a prolonged ICU stay while continuing to receive aggressive life-sustaining interventions. These findings raise questions about the use of critical care at the end of life for the very elderly.

摘要

目的

入住 ICU 的超高龄患者死亡风险很高。本研究旨在记录 ICU 中提供的生命支持干预措施（机械通气、血管加压药、肾脏替代治疗）以及治疗结局。

设计

多中心前瞻性队列研究。

地点

加拿大 24 家医院的 ICU。

参与者/地点：入住 ICU 的 80 岁及以上患者。

干预措施

无。

测量和主要结果

共纳入 1671 例患者。队列的平均年龄为 85 岁（范围，80-100 岁）。ICU 总住院时间中位数为 4 天（四分位间距，2-8 天），住院时间中位数为 17 天（四分位间距，8-33 天）。所有纳入患者中，502 例（30%）在 ICU 住院 7 天或以上，344 例（21%）至少接受了 7 天的某种形式的生命支持治疗。ICU 死亡率和住院死亡率分别为 22%和 35%。对于非幸存者，从 ICU 入院到死亡的中位时间为 10 天（四分位间距，3-20 天）。在死亡患者中（n=585），289 例（49%）在接受机械通气、血管加压药或透析治疗时死亡。衰弱或预立医疗指示的存在对限制生命支持治疗的使用或缩短从入院到死亡的时间几乎没有影响。