Shiotsuka Junji, Masuyama Tomoyuki, Uchino Shigehiko, Sasabuchi Yusuke, Suzuki Reina, Ono Shohei, Yoshinaga Koichi, Iizuka Yusuke, Sanui Masamitsu
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Tochigi, Japan.
Department of Emergency and Critical Care Medicine, Dokkyo Medical University, Tochigi, Japan.
Intensive Care Med. 2025 Jan;51(1):115-124. doi: 10.1007/s00134-024-07759-z. Epub 2025 Jan 7.
The purpose of this study is to describe the implementation of life-supporting interventions and the short-term outcomes of older patients in ICUs in Japan.
All adult patients admitted to ICUs participating in the Japanese Intensive Care Patient Database (JIPAD) from April 1, 2015, to March 31, 2022, were eligible for inclusion. Information, including life-supporting interventions, was retrieved from the database. Patients were divided into six age groups. The primary outcome of interest was the proportion of receiving a composite of the following interventions: mechanical ventilation, continuous renal replacement therapy, and veno-venous or veno-arterial extracorporeal membrane oxygenation.
Data of a total of 233,093 patients were analyzed. The median age was 71 years, with 18.2% of the patients in their 80s, 5303 patients in their 90s (2.3%), and 67 patients in their 100s. Many life-supporting interventions were provided to older patients. The proportion of patients older than 90 years who received the composite interventions decreased from 40.4% in 18-59 to 27.6% in 90-99. Non-invasive ventilation (NIV) use increased with age, resulting in a consistent proportion of patients receiving either NIV or mechanical ventilation until their 90s. ICU mortality for patients aged 80 years or older was 5.6%, and hospital mortality for this age group was 12.9%. Approximately half of the patients in their 80s and 60% of those older than 90 years did not return home.
Although life-supporting interventions tended to decrease with age, a considerable number of patients of advanced age still received these interventions.
本研究旨在描述日本重症监护病房（ICU）中维持生命干预措施的实施情况以及老年患者的短期预后。
2015年4月1日至2022年3月31日期间入住参与日本重症监护患者数据库（JIPAD）的ICU的所有成年患者均符合纳入标准。从数据库中检索包括维持生命干预措施在内的信息。患者被分为六个年龄组。主要关注的结局是接受以下综合干预措施的比例：机械通气、持续肾脏替代治疗以及静脉-静脉或静脉-动脉体外膜肺氧合。
共分析了233,093例患者的数据。中位年龄为71岁，其中18.2%的患者为80多岁，5303例患者为90多岁（2.3%），67例患者为100多岁。老年患者接受了许多维持生命的干预措施。接受综合干预措施的90岁以上患者的比例从18 - 59岁年龄段的40.4%降至90 - 99岁年龄段的27.6%。无创通气（NIV）的使用随年龄增加，导致90多岁之前接受NIV或机械通气的患者比例保持一致。80岁及以上患者的ICU死亡率为5.6%，该年龄组的医院死亡率为12.9%。80多岁的患者中约一半以及90岁以上的患者中60%没有回家。
尽管维持生命的干预措施往往随年龄减少，但仍有相当数量高龄患者接受了这些干预措施。
