Dept of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
Dept of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
Eur Respir Rev. 2020 Feb 19;29(155). doi: 10.1183/16000617.0126-2019. Print 2020 Mar 31.
Very old (aged ≥80 years) adults constitute an increasing proportion of the global population. Currently, this subgroup of patients represents an important percentage of patients admitted to the intensive care unit. Community-acquired pneumonia (CAP) frequently affects very old adults. However, there are no specific recommendations for the management of critically ill very old CAP patients. Multiple morbidities, polypharmacy, immunosenescence and frailty contribute to an increased risk of pneumonia in this population. CAP in critically ill very old patients is associated with higher short- and long-term mortality; however, because of its uncommon presentation, diagnosis can be very difficult. Management of critically ill very old CAP patients should be guided by their baseline characteristics, clinical presentation and risk factors for multidrug-resistant pathogens. Hospitalisation in intermediate care may be a good option for critical ill very old CAP patients who do not require invasive procedures and for whom intensive care is questionable in terms of benefit.
非常老的（年龄≥80 岁）成年人在全球人口中所占比例越来越大。目前，这一小部分患者代表了重症监护病房收治患者的重要比例。社区获得性肺炎（CAP）常影响非常老的成年人。然而，对于危重症 CAP 患者的管理尚无具体建议。多种合并症、多种药物治疗、免疫衰老和虚弱使该人群患肺炎的风险增加。危重症非常老的 CAP 患者的短期和长期死亡率较高；然而，由于其不常见的表现，诊断可能非常困难。危重症非常老的 CAP 患者的管理应根据其基线特征、临床表现和耐多药病原体的危险因素来指导。对于不需要侵入性操作且重症监护在获益方面存在疑问的危重症非常老的 CAP 患者，入住中级护理病房可能是一个不错的选择。
