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患有脓毒症的老年重症患者:一篇叙述性综述

The critically ill older patient with sepsis: a narrative review.

作者信息

Ibarz Mercedes, Haas Lenneke E M, Ceccato Adrián, Artigas Antonio

机构信息

Department of Intensive Care Medicine, Hospital Universitari Sagrat Cor, Quirón Salud, Viladomat 288, 08029, Barcelona, Spain.

Department of Intensive Care Medicine, Diakonessenhuis Utrecht, Utrecht, the Netherlands.

出版信息

Ann Intensive Care. 2024 Jan 10;14(1):6. doi: 10.1186/s13613-023-01233-7.

Abstract

Sepsis is a significant public health concern, particularly affecting individuals above 70 years in developed countries. This is a crucial fact due to the increasing aging population, their heightened vulnerability to sepsis, and the associated high mortality rates. However, the morbidity and long-term outcomes are even more notable. While many patients respond well to timely and appropriate interventions, it is imperative to enhance efforts in identifying, documenting, preventing, and treating sepsis. Managing sepsis in older patients poses greater challenges and necessitates a comprehensive understanding of predisposing factors and a heightened suspicion for diagnosing infections and assessing the risk of sudden deterioration into sepsis. Despite age often being considered an independent risk factor for mortality and morbidity, recent research emphasizes the pivotal roles of frailty, disease severity, and comorbid conditions in influencing health outcomes. In addition, it is important to inquire about the patient's preferences and establish a personalized treatment plan that considers their potential for recovery with quality of life and functional outcomes. This review provides a summary of the most crucial aspects to consider when dealing with an old critically ill patient with sepsis.

摘要

脓毒症是一个重大的公共卫生问题,在发达国家尤其影响70岁以上的人群。鉴于人口老龄化加剧、他们对脓毒症的易感性增加以及相关的高死亡率,这是一个关键事实。然而,发病率和长期后果更为显著。虽然许多患者对及时和适当的干预反应良好,但必须加大在识别、记录、预防和治疗脓毒症方面的力度。在老年患者中管理脓毒症带来了更大的挑战,需要全面了解诱发因素,并提高对诊断感染和评估突然恶化为脓毒症风险的怀疑度。尽管年龄常被视为死亡率和发病率的独立危险因素,但最近的研究强调了虚弱、疾病严重程度和合并症在影响健康结果方面的关键作用。此外,询问患者的偏好并制定个性化的治疗计划很重要,该计划要考虑到他们恢复的潜力以及生活质量和功能结果。本综述总结了在处理老年脓毒症重症患者时需要考虑的最关键方面。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e450/10781658/962d079c25c5/13613_2023_1233_Fig1_HTML.jpg

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