Critical Care Fellowship Program, Gazi University Faculty of Medicine, Ankara, Turkey.
Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey.
Aging Clin Exp Res. 2018 Apr;30(4):359-366. doi: 10.1007/s40520-017-0774-z. Epub 2017 May 16.
Many factors affecting noninvasive ventilation (NIV) in critically ill patients have been reported in the literature, but there is no study about the effect of frailty. With this study, the frailty prevalence was evaluated with two different frailty scores among the NIV population of a medical intensive care unit (ICU). Besides, the impact of frailty on NIV success and mortality and its association with NIV application problems were evaluated.
A prospective observational cohort study was performed on patients who were over 50 years of age and assigned to NIV due to hypercapnic respiratory failure. For the assessment of frailty, Clinical Frailty Scale (CFS) and The Edmonton Frailty Scale (EFS) were used and the ones with CFS ≥5 and EFS ≥8 were considered as fragile. The study population was classified and compared according to NIV success, ICU outcome (discharge or exitus) and NIV application problems.
A total of 103 patients with the mean age of 73 ± 11 years were included. The incidence of frailty was 41% with CFS ≥5 and 36% with EFS ≥8. The NIV failure occurred in 30 (29%) patients. Among them frailty and SOFA score was higher; Glasgow Coma Scale (GCS) was lower. In multivariate analysis GCS (OR: 1.2, p: 0.042) and frailty with EFS (OR: 2.8, p: 0.027) were identified as independent risk factors of NIV failure. Sixty-five (63%) patients had NIV application problems and frailty was higher among them with both CFS and EFS (p < 0.05). Mortality occurred in 18 (17%) patients; NIV failure and frailty according to CFS were independent risk factors of mortality.
The frailty is associated with higher NIV application problems, failure and mortality risk in elderly ICU patients. The CFS and EFS frailty scores can be used to predict NIV success and outcomes in ICUs.
许多影响危重症患者无创通气（NIV）的因素已在文献中报道，但尚无关于脆弱性的研究。本研究通过两种不同的虚弱评分评估了医学重症监护病房（ICU）NIV 人群中的虚弱流行率。此外，还评估了虚弱对 NIV 成功和死亡率的影响及其与 NIV 应用问题的关系。
对因高碳酸血症性呼吸衰竭而接受 NIV 治疗的 50 岁以上患者进行前瞻性观察性队列研究。为评估虚弱程度，使用临床虚弱量表（CFS）和埃德蒙顿虚弱量表（EFS），CFS≥5 和 EFS≥8 的患者被认为是脆弱的。根据 NIV 成功、ICU 结局（出院或死亡）和 NIV 应用问题对研究人群进行分类和比较。
共纳入 103 例患者，平均年龄为 73±11 岁。CFS≥5 和 EFS≥8 的脆弱性发生率分别为 41%和 36%。30 例（29%）患者发生 NIV 失败。其中，虚弱和 SOFA 评分较高；格拉斯哥昏迷量表（GCS）较低。多变量分析显示，GCS（OR：1.2，p：0.042）和 EFS 伴虚弱（OR：2.8，p：0.027）是 NIV 失败的独立危险因素。65 例（63%）患者存在 NIV 应用问题，其中 CFS 和 EFS 均存在虚弱的患者比例较高（p<0.05）。18 例（17%）患者死亡；CFS 下的 NIV 失败和虚弱是死亡率的独立危险因素。
在老年 ICU 患者中，虚弱与更高的 NIV 应用问题、失败和死亡风险相关。CFS 和 EFS 虚弱评分可用于预测 ICU 中的 NIV 成功和结局。
