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Akinosoglou K, Schinas G, Almyroudi MP, Gogos C, Dimopoulos G. The impact of age on intensive care. Ageing Res Rev 2023; 84:101832. [PMID: 36565961 PMCID: PMC9769029 DOI: 10.1016/j.arr.2022.101832] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Caring for the elderly has always been challenging for the intensive care unit (ICU) physician. Concerns like frailty, comorbidities, polypharmacy and advanced directives come up even before admission into the unit. The COVID-19 pandemic has put forward a variety of issues concerning elderly populations, making the topic more relevant than ever. Admittance to the ICU, an unequivocally multifactorial decision, requires special consideration from the side of the physician when caring for an elderly person. Patients' wishes are to be respected and thus given priority. Triage assessment must also account for age-related physiological alterations and functional status. Once in the ICU, special attention should be given to age-related specificities, such as therapeutic interventions' controversial role, infection susceptibility, and post-operative care, that could potentially alter the course of hospitalization and affect outcomes. Following ICU discharge, ensuring proper rehabilitation for both survivors and their caregivers can improve long-term outcomes and subsequent quality of life. The pandemic and its implications may limit the standard of care for the elderly requiring ICU support. Socioeconomic factors that further perplex the situation must be addressed. Elderly patients currently represent a vast expanding population in ICU. Tailoring safe treatment plans to match patients' wishes, and personalized needs will guide critical care for the elderly from this time forward.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, Medical School University of Patras, Greece.
| | - Georgios Schinas
- Department of Internal Medicine, Medical School University of Patras, Greece
| | - Maria Panagiota Almyroudi
- Department of Emergency Medicine, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Greece
| | - Charalambos Gogos
- Department of Internal Medicine and Infectious Diseases, Medical School University of Patras, Greece
| | - George Dimopoulos
- 3rd Department of Critical Care, EVGENIDIO Hospital, National and Kapodistrian University of Athens, Medical School, Greece
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2
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Cortes GM, Marcialis MA, Bardanzellu F, Corrias A, Fanos V, Mussap M. Inflammatory Bowel Disease and COVID-19: How Microbiomics and Metabolomics Depict Two Sides of the Same Coin. Front Microbiol 2022; 13:856165. [PMID: 35391730 PMCID: PMC8981987 DOI: 10.3389/fmicb.2022.856165] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/21/2022] [Indexed: 12/11/2022] Open
Abstract
The integrity of the gastrointestinal tract structure and function is seriously compromised by two pathological conditions sharing, at least in part, several pathogenetic mechanisms: inflammatory bowel diseases (IBD) and coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. IBD and COVID-19 are marked by gut inflammation, intestinal barrier breakdown, resulting in mucosal hyperpermeability, gut bacterial overgrowth, and dysbiosis together with perturbations in microbial and human metabolic pathways originating changes in the blood and fecal metabolome. This review compared the most relevant metabolic and microbial alterations reported from the literature in patients with IBD with those in patients with COVID-19. In both diseases, gut dysbiosis is marked by the prevalence of pro-inflammatory bacterial species and the shortfall of anti-inflammatory species; most studies reported the decrease in Firmicutes, with a specific decrease in obligately anaerobic producers short-chain fatty acids (SCFAs), such as Faecalibacterium prausnitzii. In addition, Escherichia coli overgrowth has been observed in IBD and COVID-19, while Akkermansia muciniphila is depleted in IBD and overexpressed in COVID-19. In patients with COVID-19, gut dysbiosis continues after the clearance of the viral RNA from the upper respiratory tract and the resolution of clinical symptoms. Finally, we presented and discussed the impact of gut dysbiosis, inflammation, oxidative stress, and increased energy demand on metabolic pathways involving key metabolites, such as tryptophan, phenylalanine, histidine, glutamine, succinate, citrate, and lipids.
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Affiliation(s)
- Gian Mario Cortes
- Neonatal Intensive Care Unit, Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Maria Antonietta Marcialis
- Neonatal Intensive Care Unit, Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Angelica Corrias
- Neonatal Intensive Care Unit, Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Michele Mussap
- Laboratory Medicine, Department of Surgical Sciences, School of Medicine, University of Cagliari, Monserrato, Italy
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3
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Thiolliere F, Falandry C, Allaouchiche B, Geoffray V, Bitker L, Reignier J, Abraham P, Malaquin S, Balança B, Boyer H, Seguin P, Guichon C, Simon M, Friggeri A, Vacheron CH. Intensive care-related loss of quality of life and autonomy at 6 months post-discharge: Does COVID-19 really make things worse? Crit Care 2022; 26:94. [PMID: 35379312 PMCID: PMC8978758 DOI: 10.1186/s13054-022-03958-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/22/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To compare old patients hospitalized in ICU for respiratory distress due to COVID-19 with old patients hospitalized in ICU for a non-COVID-19-related reason in terms of autonomy and quality of life.
Design Comparison of two prospective multi-centric studies. Setting This study was based on two prospective multi-centric studies, the Senior-COVID-Rea cohort (COVID-19-diagnosed ICU-admitted patients aged over 60) and the FRAGIREA cohort (ICU-admitted patients aged over 70). Patients We included herein the patients from both cohorts who had been evaluated at day 180 after admission (ADL score and quality of life). Interventions None. Measurements and main results A total of 93 COVID-19 patients and 185 control-ICU patients were included. Both groups were not balanced on age, body mass index, mechanical ventilation, length of ICU stay, and ADL and SAPS II scores. We modeled with ordered logistic regression the influence of COVID-19 on the quality of life and the ADL score. After adjustment on these factors, we observed COVID-19 patients were less likely to have a loss of usual activities (aOR [95% CI] 0.47 [0.23; 0.94]), a loss of mobility (aOR [95% CI] 0.30 [0.14; 0.63]), and a loss of ADL score (aOR [95% CI] 0.30 [0.14; 0.63]). On day 180, 52 (56%) COVID-19 patients presented signs of dyspnea, 37 (40%) still used analgesics, 17 (18%) used anxiolytics, and 14 (13%) used antidepressant. Conclusions COVID-19-related ICU stay was not associated with a lower quality of life or lower autonomy compared to non-COVID-19-related ICU stay. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03958-6.
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Affiliation(s)
- Fabrice Thiolliere
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Claire Falandry
- Hospices Civils de Lyon, Geriatrics Unit, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,University of Lyon, CarMeN Laboratory, Inserm U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Charles Mérieux Medical School, Pierre-Bénite, France
| | - Bernard Allaouchiche
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard, Lyon1, Villeurbanne, France.,Université de Lyon, VetAgro Sup, Campus Vétérinaire de Lyon, UPSP 2016.A101, Pulmonary and Cardiovascular Aggression in Sepsis, 69280, Marcy l'Étoile, France
| | - Victor Geoffray
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Laurent Bitker
- Service de Médecine Intensive - Réanimation, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard, Lyon 1, INSA-Lyon, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, U1206, Université de Lyon, 69621, Lyon, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France
| | - Paul Abraham
- Service d'Anesthésie-Réanimation, Hôpital Édouard Herriot, 69008, Hospices civils de LyonLyon, France
| | | | - Baptiste Balança
- Hospices Civils de Lyon, service d'anesthésie réanimation neurologique, Hôpital Pierre Wertheimer, département d'anesthésie reanimation, 59 Boulevard Pinel, 69500, Bron, France.,Centre de Recherche en Neurosciences de Lyon, U1028, Bron, France
| | - Hélène Boyer
- Direction de la Recherche en Santé, Hospices Civils de Lyon, Lyon, France
| | - Philippe Seguin
- Réanimation chirurgicale. CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Céline Guichon
- Département d'anesthésie et réanimation chirurgicale, hôpital Croix Rousse, Hospices Civils de Lyon, Lyon, France.,Laboratoire Inter universitaire de Biologie de la Motricité (LIBM), Lyon, France
| | - Marie Simon
- Médecine Intensive - Réanimation- Hôpital Edouard Herriot, 1 place d'Arsonval, 69003, Lyon, France
| | - Arnaud Friggeri
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud Hospices Civils de Lyon, Pierre-Bénite, France.,CIRI, Centre International de Recherche en Infectiologie (Equipe Laboratoire des Pathogènes Emergents), Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Lyon, France.,Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Charles-Hervé Vacheron
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France. .,CIRI, Centre International de Recherche en Infectiologie (Equipe Laboratoire des Pathogènes Emergents), Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Lyon, France. .,Pôle Santé Publique, Service de Biostatistique - Bioinformatique, 165, chemin du grand revoyet, 69495, Pierre-Bénite, Lyon, France.
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Falandry C, Bitker L, Abraham P, Subtil F, Collange V, Balança B, Haïne M, Guichon C, Leroy C, Simon M, Malapert A, Pialat JB, Jallades L, Lepape A, Friggeri A, Thiolliere F. Senior-COVID-Rea Cohort Study: A Geriatric Prediction Model of 30-day Mortality in Patients Aged over 60 Years in ICU for Severe COVID-19. Aging Dis 2022; 13:614-623. [PMID: 35371615 PMCID: PMC8947822 DOI: 10.14336/ad.2021.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
The SARS-COV2 pandemic induces tensions on health systems and ethical dilemmas. Practitioners need help tools to define patients not candidate for ICU admission. A multicentre observational study was performed to evaluate the impact of age and geriatric parameters on 30-day mortality in patients aged ≥60 years of age. Patients or next of kin were asked to answer a phone questionnaire assessing geriatric covariates 1 month before ICU admission. Among 290 screened patients, 231 were included between March 7 and May 7, 2020. In univariate, factors associated with lower 30-day survival were: age (per 10 years increase; OR 3.43, [95%CI: 2.13-5.53]), ≥3 CIRS-G grade ≥2 comorbidities (OR 2.49 [95%CI: 1.36-4.56]), impaired ADL, (OR 4.86 [95%CI: 2.44-9.72]), impaired IADL8 (OR 6.33 [95%CI: 3.31-12.10], p<0.001), frailty according to the Fried score (OR 4.33 [95%CI: 2.03-9.24]) or the CFS ≥5 (OR 3.79 [95%CI: 1.76-8.15]), 6-month fall history (OR 3.46 [95%CI: 1.58-7.63]). The final multivariate model included age (per 10 years increase; 2.94 [95%CI:1.78-5.04], p<0.001) and impaired IADL8 (OR 5.69 [95%CI: 2.90-11.47], p<0.001)). Considered as continuous variables, the model led to an AUC of 0.78 [95% CI: 0.72, 0.85]. Age and IADL8 provide independent prognostic factors for 30-day mortality in the considered population. Considering a risk of death exceeding 80% (82.6% [95%CI: 61.2% - 95.0%]), patients aged over 80 years with at least 1 IADL impairment appear as poor candidates for ICU admission.
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Affiliation(s)
- Claire Falandry
- Hospices Civils de Lyon, Service de Gériatrie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,Université de Lyon, Laboratoire CarMeN, Inserm U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Charles Mérieux Medical School, Pierre-Bénite, France.,Correspondence should be addressed to: Dr. Claire Falandry, Hospices Civils de Lyon, Service de Gériatrie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
| | - Laurent Bitker
- Hospices Civils de Lyon, Service de Réanimation Médicale, Hôpital de La Croix Rousse, Lyon, France.,Université de Lyon, CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France.
| | - Paul Abraham
- Hospices Civils de Lyon, Département d’anesthésie et reanimation médicale, Hôpital Edouard Herriot, Lyon, France.
| | - Fabien Subtil
- Université de Lyon, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Université Claude Bernard Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.
| | - Vincent Collange
- Medipole Lyon-Villeurbanne, Département anesthésie réanimation, Villeurbanne, France.
| | - Baptiste Balança
- Hospices Civils de Lyon, Département of d’Anesthésie Réanimation Neurologique, Hôpital Wertheimer, Bron, France.,Hôpital Pierre Wertheimer; Université de Lyon, Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team TIGER, Bron, France.
| | - Max Haïne
- Hôpital Nord-Ouest, Service de Gériatrie, Gleizé, France.
| | - Céline Guichon
- Hospices Civils de Lyon, Service de réanimation, Centre hospitalier universitaire de la Croix Rousse, Lyon, France.,Université de Lyon, Lyon, France.
| | - Christophe Leroy
- Centre Hospitalier Emile Roux, Service de réanimation, Le Puy-en-Velay, France.
| | - Marie Simon
- Hospices Civils de Lyon, Service de Médecine Intensive-Réanimation Médicale, Hôpital Edouard Herriot, Lyon, France.
| | - Amélie Malapert
- Hospices Civils de Lyon, Plateforme Transversale de Recherche de l'ICHCL, Pierre-Bénite, France.
| | - Jean-Baptiste Pialat
- Hospices Civils de Lyon, Service de radiologie, Groupement Hospitalier Sud; Pierre-Bénite, France.,Université de Lyon, CREATIS CNRS UMR 5220 INSERM U1206, Villeurbanne, France.
| | - Laurent Jallades
- Hospices Civils de Lyon, Service d'Hématologie biologique - Groupement Hospitalier Sud, Pierre-Bénite, France.
| | - Alain Lepape
- Hospices Civils de Lyon, Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,Université de Lyon, Centre International de Recherche en Infectiologie (CIRI), Lyon, France. On behalf of the Senior-COVID-Rea study group. ^Membership of the Senior-COVID-Rea study group is provided in the Acknowledgments section.;
| | - Arnaud Friggeri
- Hospices Civils de Lyon, Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
| | - Fabrice Thiolliere
- Hospices Civils de Lyon, Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
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Outcomes of COVID-19 Critically Ill Extremely Elderly Patients: Analysis of a Large, National, Observational Cohort. J Clin Med 2022; 11:jcm11061544. [PMID: 35329870 PMCID: PMC8951481 DOI: 10.3390/jcm11061544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
Background. During the COVID-19 pandemic, resource allocation became a major problem in globally overwhelmed ICUs. The main goal of this study was to describe the clinical characteristics of the very elderly patients (aged ≥ 80 years) with COVID-19 admitted in Romanian ICUs. The study objectives were to evaluate and determine the factors associated with ICU mortality. Methods. We designed a national, multicentric, observational platform with prospective enrolment. This study included patients aged ≥ 80 years admitted in Romanian ICUs with SARS-CoV-2 infection from March 2020 to December 2021. Results. We included 1666 patients with a median age of 83 years and 78% ICU mortality. Male sex, dyspnoea, lower Glasgow Coma Scale and lower SpO2 at ICU admission, the need for mechanical ventilation (MV), and corticosteroid use were independently associated with mortality. A total of 886/1666 (53%) elderly patients underwent invasive mechanical ventilation, with a mortality of 97%. The age impact on mortality was confirmed by a 1:1 propensity matching with less elderly ICU patients. Conclusion. In extremely elderly patients with COVID-19 admitted in the ICU, mortality is high, particularly when requiring MV. Therapy should be directed towards the optimization of less invasive ventilatory methods and the use of MV and corticosteroids only in highly selected patients.
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