1
|
Pasieka P, Surówka A, Fronczek J, Skwara E, Czuczwar M, Borys M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Żukowski M, Kotfis K, Cwyl K, Skowronek J, Solek-Pastuszka J, Biernawska J, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Sierakowska K, Mudyna W, Białka S, Studzińska D, Bernas S, Piechota M, Machała W, Sadowski Ł, Stefaniak J, Owczuk R, Szymkowiak M, Gawda R, Kozera N, Adamik B, Goździk W, Wieczorek A, Janc J, Kluzik A, Trzebicki J, Zatorski P, Gola W, Hymczak H, Krzych LJ, Czajka S, Kościuczuk U, Kudliński B, Flaatten H, Szczeklik W. Prevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies. J Crit Care 2024; 79:154439. [PMID: 37832351 DOI: 10.1016/j.jcrc.2023.154439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017. METHODS We analysed Polish cohorts from studies VIP1 (October 2016 - May 2017) and VIP2 (May 2018 - May 2019) that enrolled critical patients aged >80. We collected data on demographics, clinical features limitations of LST. Primary analysis assessed factors associated with prevalence of limitations of LST, A secondary analysis explored differences between patients with and without limitations of LST. RESULTS 601 patients were enrolled. Prevalence of LST limitations was 16.1% in 2016-2017 and 20.5% in 2018-2019. No difference was found in univariate analysis (p = 0.22), multivariable model showed higher propensity towards limiting LST in the 2018-2019 cohort compared to 2016-2017 cohort (OR 1.07;95%CI, 1.01-1.14). There was higher mortality and a longer length of stay of patients with limitations of LST compared to the patients without limitations of LST. (11 vs. 6 days, p = 0.001). CONCLUSIONS The clinicians in Poland have become more proactive in limiting LST in critically ill patients ≥80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low.
Collapse
Affiliation(s)
- Paweł Pasieka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Anna Surówka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Evan Skwara
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mirosław Czuczwar
- 2nd Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland
| | - Michał Borys
- 2nd Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland
| | - Paweł Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mirosław Ziętkiewicz
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kraków, Poland; 2nd Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Kraków, Poland
| | - Łukasz R Nowak
- Department of Intensive Care and Anaesthesiology, 5(th) Military Clinical Hospital in Kraków, Poland
| | - Maciej Żukowski
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Cwyl
- Anesthesia and Intensive Care Unit, Regional Health Center in Lubin, Poland
| | - Jacek Skowronek
- St. Raphael Hospital, Department of Anaesthesiology and Intensive Care, Kraków, Poland
| | - Joanna Solek-Pastuszka
- Department of Clinical Anesthesiology and Intensive Therapy PUM, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Jowita Biernawska
- Department of Clinical Anesthesiology and Intensive Therapy PUM, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Paweł Grudzień
- Department of Anaesthesiology and Intensive Therapy, E. Szczeklik Specialist Hospital in Tarnów, Poland
| | - Paweł Nasiłowski
- Department of Anaesthesiology and Intensive Therapy, G. Narutowicz Specialist Hospital in Kraków, Poland; Department of Anaesthesiology and Intensive Care, St Ann Hospital in Miechów, Poland
| | - Natalia Popek
- Department of Anaesthesiology and Intensive Therapy, S. Żeromski Specialist Hospital in Kraków, Poland
| | - Waldemar Cyrankiewicz
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland; Department of Anaesthesiology and Intensive Therapy, Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Wojciech Mudyna
- Department of Anaesthesiology and Intensive Therapy, Ludwik Rydygier Memorial Specialized Hospital in Kraków, Poland
| | - Szymon Białka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Dorota Studzińska
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Anaesthesiology and Intensive Care, St John Grande Hospital in Kraków, Poland
| | - Szymon Bernas
- Department of Anaesthesiology and Intensive Therapy - Centre for Artificial Extracorporeal Kidney and Liver Support, The Dr Wł. Biegański Regional Specialist Hospital in Lodz, Poland
| | - Mariusz Piechota
- Department of Anaesthesiology and Intensive Therapy - Centre for Artificial Extracorporeal Kidney and Liver Support, The Dr Wł. Biegański Regional Specialist Hospital in Lodz, Poland
| | - Waldemar Machała
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Łukasz Sadowski
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Jan Stefaniak
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Małgorzata Szymkowiak
- Department of Anaesthesiology and Intensive Care, Provincial Hospital in Poznań, Poland
| | - Ryszard Gawda
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Poland
| | - Natalia Kozera
- Department of Anaesthesiology and Intensive Therapy, Wroclaw University Hospital, Wrocław Medical University, Wrocław, Poland
| | - Barbara Adamik
- Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland
| | - Waldemar Goździk
- Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland
| | - Agnieszka Wieczorek
- Anaesthesia and Intensive Care Unit, 4(th) Military Hospital in Wrocław, Poland
| | - Jarosław Janc
- Anaesthesia and Intensive Care Unit, 4(th) Military Hospital in Wrocław, Poland
| | - Anna Kluzik
- Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, Poznan, Poland; Department of Teaching Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Janusz Trzebicki
- University Clinical Center of the Medical University of Warsaw - Infant Jesus Clinical Hospital, I Department of Anaesthesiology and Intensive Care, Warsaw, Poland
| | - Paweł Zatorski
- University Clinical Center of the Medical University of Warsaw - Infant Jesus Clinical Hospital, I Department of Anaesthesiology and Intensive Care, Warsaw, Poland
| | - Wojciech Gola
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Hubert Hymczak
- 1st Depratment of Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Kraków, Poland; Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Lukasz J Krzych
- Department of Anaesthesiology and Intensive Care, University Clinical Center, School of Medicine in Katowice - Medical University of Silesia, Poland
| | - Szymon Czajka
- Department of Anaesthesiology and Intensive Care, University Clinical Center, School of Medicine in Katowice - Medical University of Silesia, Poland
| | - Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Therapy, Medical Unibersity of Białystok, Poland
| | - Bartosz Kudliński
- Clinical Department of Anaesthesiology and Intensive Care, University Hospital in Zielona Góra, Poland
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Norway
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
2
|
Polok K, Fronczek J, Guidet B, Artigas A, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Pinto BB, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Flaatten H, Jung C, Szczeklik W. Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic. Ann Intensive Care 2023; 13:82. [PMID: 37698708 PMCID: PMC10497468 DOI: 10.1186/s13613-023-01173-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic. METHODS We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2-2018 to 2019) and admitted due to COVID-19 (COVIP-March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days). RESULTS The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80). CONCLUSION The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era.
Collapse
Affiliation(s)
- Kamil Polok
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland
- Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland
| | - Bertrand Guidet
- UMR_S 1136, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, UPMC Univ Paris 06, INSERMInstitut Pierre Louis d'Epidémiologie et de Santé PubliqueAssistance Publique - Hôpitaux de Paris, Sorbonne Universités, F-75012, Paris, France
| | - Antonio Artigas
- Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Jesper Fjølner
- Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Susannah Leaver
- Department of Critical Care, St George's Hospital, London, UK
| | - Michael Beil
- Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dorota Studzińska
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Rui Moreno
- Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy
- Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30-901, Kraków, Poland.
| |
Collapse
|
3
|
Falk Erhag H, Guðnadóttir G, Alfredsson J, Cederholm T, Ekerstad N, Religa D, Nellgård B, Wilhelmson K. The Association Between the Clinical Frailty Scale and Adverse Health Outcomes in Older Adults in Acute Clinical Settings - A Systematic Review of the Literature. Clin Interv Aging 2023; 18:249-261. [PMID: 36843633 PMCID: PMC9946013 DOI: 10.2147/cia.s388160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/14/2022] [Indexed: 02/19/2023] Open
Abstract
Background Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill. Purpose To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients >65 years in acute clinical settings. Design Systematic review with narrative synthesis. Methods Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020. Results Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review. Conclusion A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients' quality of life is warranted.
Collapse
Affiliation(s)
- Hanna Falk Erhag
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Centre for Ageing and Health (Agecap), University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden,Correspondence: Hanna Falk Erhag, Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Wallinsgatan 6, Gothenburg, SE 431 41, Sweden, Tel +46 760 476888, Fax +46 31 786 60 77, Email
| | - Gudny Guðnadóttir
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Ekerstad
- Department of Health, Medicine, and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden,The Research and Development Unit, NU Hospital Group, Trollhättan, Sweden
| | - Dorota Religa
- Department of Neurobiology, Care Sciences, and Society, Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden,Division for Clinical Geriatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Studies, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Wilhelmson
- Centre for Ageing and Health (Agecap), University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Department of Acute Medicine and Geriatrics, Gothenburg, Sweden,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
Polok K, Fronczek J, Artigas A, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Bollen Pinto B, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Jung C, Szczeklik W, Joannidis M, Mesotten D, Reper P, Oeyen S, Swinnen W, Brix H, Brushoej J, Villefrance M, Nedergaard HK, Bjerregaard AT, Balleby IR, Andersen K, Hansen MA, Uhrenholt S, Bundgaard H, Fjølner J, Hussein AARM, Salah R, Ali YKNM, Wassim K, Elgazzar YA, Tharwat S, Azzam AY, habib AA, Abosheaishaa HM, Azab MA, Leaver S, Galbois A, Guidet B, Charron C, Guerot E, Besch G, Rigaud JP, Maizel J, Djibré M, Burtin P, Garcon P, Nseir S, Valette X, Alexandru N, Marin N, Vaissiere M, Plantefeve G, Vanderlinden T, Jurcisin I, Megarbane B, Caillard A, Valent A, Garnier M, Besset S, Oziel J, RAPHALEN JH, Dauger S, Dumas G, Goncalves B, Piton G, Barth E, Goebel U, Barth E, Kunstein A, Schuster M, Welte M, Lutz M, Meybohm P, Steiner S, Poerner T, Haake H, Schaller S, Schaller S, Schaller S, Kindgen-Milles D, Meyer C, Kurt M, Kuhn KF, Randerath W, Wollborn J, Dindane Z, Kabitz HJ, Voigt I, Shala G, Faltlhauser A, Rovina N, Aidoni Z, Chrisanthopoulou E, Papadogoulas A, Gurjar M, Mahmoodpoor A, Ahmed AK, Marsh B, Elsaka A, Sviri S, Comellini V, Rabha A, Ahmed H, Namendys-Silva SA, Ghannam A, Groenendijk M, Zegers M, de Lange D, Cornet A, Evers M, Haas L, Dormans T, Dieperink W, Romundstad L, Sjøbø B, Andersen FH, Strietzel HF, Olasveengen T, Hahn M, Czuczwar M, Gawda R, Klimkiewicz J, de Lurdes Campos Santos M, Gordinho A, Santos H, Assis R, Oliveira AIP, Badawy MR, Perez-Torres D, Gomà G, Villamayor MI, Mira AP, Cubero PJ, Rivera SA, Tomasa T, Iglesias D, Vázquez EM, Aldecoa C, Ferreira AF, Zalba-Etayo B, Canas-Perez I, Tamayo-Lomas L, Diaz-Rodriguez C, Sancho S, Priego J, Abualqumboz EMY, Hilles MMY, Saleh M, Ben-HAmouda N, Roberti A, Dullenkopf A, Fleury Y, Bollen Pinto B, Schefold JC, Al-Sadawi M. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study. Crit Care 2022; 26:224. [PMID: 35869557 PMCID: PMC9305028 DOI: 10.1186/s13054-022-04082-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. METHODS This is a substudy of COVIP study-an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. RESULTS Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876). CONCLUSIONS Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .
Collapse
Affiliation(s)
- Kamil Polok
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland ,grid.5522.00000 0001 2162 9631Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland
| | - Antonio Artigas
- grid.7080.f0000 0001 2296 0625Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Hans Flaatten
- grid.412008.f0000 0000 9753 1393Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bertrand Guidet
- grid.462844.80000 0001 2308 1657INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Sorbonne Universités, UPMC Univ Paris 06, 75012 Paris, France ,grid.50550.350000 0001 2175 4109Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dylan W. De Lange
- grid.5477.10000000120346234Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Jesper Fjølner
- grid.416838.00000 0004 0646 9184Department of Anaesthesia and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Susannah Leaver
- grid.464688.00000 0001 2300 7844Department of Critical Care Medicine, St George’s Hospital, London, UK
| | - Michael Beil
- grid.17788.310000 0001 2221 2926Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Sigal Sviri
- grid.9619.70000 0004 1937 0538Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raphael Romano Bruno
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Bernhard Wernly
- grid.21604.310000 0004 0523 5263Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria ,grid.21604.310000 0004 0523 5263Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernardo Bollen Pinto
- grid.150338.c0000 0001 0721 9812Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C. Schefold
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dorota Studzińska
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- grid.410566.00000 0004 0626 3303Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- grid.411596.e0000 0004 0488 8430Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H. Andersen
- grid.459807.7Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway ,grid.5947.f0000 0001 1516 2393Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- grid.414551.00000 0000 9715 2430Faculdade de Ciências Médicas de Lisboa - Nova Médical School, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal ,grid.7427.60000 0001 2220 7094Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Maurizio Cecconi
- grid.417728.f0000 0004 1756 8807Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI Italy
| | - Christian Jung
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Wojciech Szczeklik
- grid.5522.00000 0001 2162 9631Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ul. Wrocławska 1-3, 30 – 901 Kraków, Poland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Fronczek J, Flaatten H, Guidet B, Polok K, Andersen FH, Andrew BY, Artigas A, Beil M, Cecconi M, Christensen S, de Lange DW, Fjølner J, Górka J, Joannidis M, Jung C, Kusza K, Leaver S, Marsh B, Morandi A, Moreno R, Oeyen S, Owczuk R, Agvald-Öhman C, Pinto BB, Rhodes A, Schefold JC, Soliman IW, Valentin A, Walther S, Watson X, Zafeiridis T, Szczeklik W. Short-term mortality of patients ≥80 years old admitted to European intensive care units: an international observational study. Br J Anaesth 2022; 129:58-66. [DOI: 10.1016/j.bja.2022.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 11/02/2022] Open
|
6
|
Pasin L, Boraso S, Golino G, Fakhr BS, Tiberio I, Trevisan C. The impact of frailty on mortality in older patients admitted to an Intensive Care Unit. Med Intensiva 2022; 46:23-30. [PMID: 34991871 DOI: 10.1016/j.medine.2020.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/24/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Frailty is a relatively new concept for intensivists, and is defined as a status of increased vulnerability to stressors associated with reduced reserve and function of different physiological systems. Supporting the hypothesis that frailty may be an important predictor of poor prognosis among older patients admitted to Intensive Care Unit (ICU), this study seeks to evaluate the association between frailty at ICU admission and short and long-term mortality. DESIGN An unmatched case-control study was carried out. SETTING Intensive Care Unit. PATIENTS OR PARTICIPANTS Patients≥80 years of age admitted to the ICU for medical reasons. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The primary outcome was 30-day mortality, while secondary outcomes were ICU mortality and mortality at one year. RESULTS Most of the patients were classified as frail at ICU admission (55.3%). The prevalence of frailty was higher among those who died than in those who were alive within 30 days from ICU admission (62.3% vs 48.3%, p=0.01). One-year mortality was higher in frail (84.4%) than in non-frail patients (65.2%, p<0.001). In the logistic regression analysis, after adjusting for potential confounders such as chronic diseases, clinical complexity, cause of ICU admission and use of advanced procedures, frailty was seen to be significantly associated to one-year mortality, but not with ICU mortality or 30-day mortality. DISCUSSION The admission of geriatric patients to the ICU is increasing. Frailty assessment may play an important role in the clinical evaluation of such individuals for triage, but should not be considered a priori as an exclusion criterion for admission.
Collapse
Affiliation(s)
- L Pasin
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy.
| | - S Boraso
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - G Golino
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - B S Fakhr
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - I Tiberio
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - C Trevisan
- Department of Medicine (DIMED), Geriatric Unit, University of Padova, Italy
| |
Collapse
|
7
|
Turcotte LA, Zalucky AA, Stall NM, Downar J, Rockwood K, Theou O, McArthur C, Heckman G. Baseline Frailty as a Predictor of Survival After Critical Care: A Retrospective Cohort Study of Older Adults Receiving Home Care in Ontario, Canada. Chest 2021; 160:2101-2111. [PMID: 34139208 DOI: 10.1016/j.chest.2021.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The extent to which the degree of baseline frailty, as measured using standardized multidimensional health assessments before hospital admission, predicts survival among older adults after admission to an ICU, remains unclear. RESEARCH QUESTION Is baseline frailty an independent predictor of survival among older adults receiving care in an ICU? STUDY DESIGN AND METHODS Retrospective cohort study of community-dwelling older adults (age, ≥ 65 years) receiving public home services who were admitted to any ICU in Ontario, Canada, between April 1, 2009, and March 31, 2015. All individuals underwent an inter-Resident Assessment Instrument-Home Care (RAI-HC) assessment completed within 180 days of ICU admission. These assessments were linked to hospital discharge abstract records. Patients were categorized using frailty measures each calculated from the RAI-HC: a classification tree version of the Clinical Frailty Scale; the Frailty Index-Acute Care; and the Changes in Health, End-Stage Disease, Signs, and Symptoms Scale. One-year survival models were used to compare their performance. Patients were stratified based on the receipt of mechanical ventilation in the ICU. RESULTS Of 24,499 individuals admitted to an ICU within 180 days of a RAI-HC assessment, 26.4% (n = 6,467) received mechanical ventilation. Overall, 43.0% (95% CI, 42.4%-43.6%) survived 365 days after ICU admission. In general, among the overall cohort and both mechanical ventilation subgroups, mortality hazards increased with the severity of baseline frailty. Models predicting survival 30, 90, and 365 days after admission to an ICU that adjusted for one of the frailty measures were more discriminant than reference models that adjusted only for age, sex, major clinical category, and area income quintile. INTERPRETATION Severity of baseline frailty is associated independently with survival after ICU admission and should be considered when determining goals of care and treatment plans for people with critical illness.
Collapse
Affiliation(s)
- Luke Andrew Turcotte
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON.
| | | | - Nathan M Stall
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON
| | - James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, NS, Canada
| | - Olga Theou
- Physiotherapy and Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - George Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| |
Collapse
|
8
|
Ding X, Lian H, Wang X. Management of Very Old Patients in Intensive Care Units. Aging Dis 2021; 12:614-624. [PMID: 33815886 PMCID: PMC7990356 DOI: 10.14336/ad.2020.0914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
The global population is aging and the demand for critical care wards increasing. Aging is associated not only with physiological and cognitive vulnerability, but also with a decline in organ function. A new topic in geriatric care is how to appropriately use critical care resources and provide the best treatment plan for very old patients (VOPs). Our special geriatric intensive care unit has admitted nearly 500 VOPs. In this review, we share our VOP treatment strategy and summarize the key points as “ABCCDEFGHI bundles.” The aim is to help intensivists to provide more comprehensive therapy for VOPs in intensive care units.
Collapse
Affiliation(s)
- Xin Ding
- 1Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Lian
- 2Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoting Wang
- 1Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,2Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | |
Collapse
|
9
|
Kokoszka-Bargieł I, Cyprys P, Rutkowska K, Madowicz J, Knapik P. Intensive Care Unit Admissions During the First 3 Months of the COVID-19 Pandemic in Poland: A Single-Center, Cross-Sectional Study. Med Sci Monit 2020; 26:e926974. [PMID: 32979262 PMCID: PMC7526339 DOI: 10.12659/msm.926974] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Data on the outcomes of patients with coronavirus disease 2019 (COVID-19) requiring Intensive Care Unit (ICU) care in Poland are limited. There are no data on critically ill patients with COVID-19 who did not meet criteria for ICU admission. Material/Methods We analyzed patients admitted to the ICU and those ineligible for ICU admission in a large COVID-19-dedicated hospital, during the first 3 months of the pandemic in Poland. Data from 67 patients considered for ICU admissions due to COVID-19 infection, treated between 10 March and 10 June 2020, were reviewed. Following exclusions, data on 32 patients admitted to the ICU and 21 patients ineligible for ICU admission were analyzed. Results In 38% of analyzed patients, symptoms of COVID-19 infection occurred during a hospital stay for an unrelated medical issue. The mean age of ICU patients was 62.4 (10.4) years, and the majority of patients were male (69%), with at least one comorbidity (88%). The mean admission APACHE II and SAPS II scores were 20.1 (8.1) points and 51.2 (15.3) points, respectively. The Charlson Comorbidity Index and Clinical Frailty Scale were lower in ICU patients compared with those disqualified: 5.9 (4.3) vs. 9.1 (3.5) points, P=0.01, and 4.7 (1.7) vs. 6.9 (1.2) points, P<0.01, respectively. All ICU patients required intubation and mechanical ventilation. ICU mortality was 67%. Hospital mortality among patients admitted to the ICU and those who were disqualified was 70% and 79%, respectively. Conclusions Patients with COVID-19 requiring ICU admission in our studied population were frail and had significant comorbidities. The outcomes in this group were poor and did not seem to be influenced by ICU admission.
Collapse
Affiliation(s)
- Izabela Kokoszka-Bargieł
- Department of Anesthesiology and Intensive Therapy, Provincial Specialist Hospital, Tychy, Poland
| | - Paweł Cyprys
- Students' Scientific Society, Department of Cardiac Anesthesia and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Rutkowska
- Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Jarosław Madowicz
- Provincial Specialist Hospital, Tychy, Poland.,Department of Health Sciences, Higher School of Strategic Planning, Dąbrowa Górnicza, Poland
| | - Piotr Knapik
- Department of Anesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, Zabrze, Poland
| |
Collapse
|
10
|
Michels G, Sieber CC, Marx G, Roller-Wirnsberger R, Joannidis M, Müller-Werdan U, Müllges W, Gahn G, Pfister R, Thürmann PA, Wirth R, Fresenborg J, Kuntz L, Simon ST, Janssens U, Heppner HJ. [Geriatric intensive care : Consensus paper of DGIIN, DIVI, DGAI, DGGG, ÖGGG, ÖGIAIN, DGP, DGEM, DGD, DGNI, DGIM, DGKliPha and DGG]. Med Klin Intensivmed Notfmed 2020; 115:393-411. [PMID: 31278437 DOI: 10.1007/s00063-019-0590-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The proportion of elderly, frail, and multimorbid people has increased dramatically in recent decades resulting from demographic changes and will further increase, which will impact acute medical care. Prospective, randomized studies on geriatric intensive care are still lacking. There are also no international or national recommendations regarding the management of critically ill elderly patients. Based on an expert opinion, this consensus paper provides 16 statements that should be considered when dealing with geriatric critical care patients.
Collapse
Affiliation(s)
- Guido Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Cornel C Sieber
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - Gernot Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | | | - Michael Joannidis
- Gemeinsame Einrichtung für Internistische Intensiv- und Notfallmedizin, Department Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Ursula Müller-Werdan
- Klinik für Geriatrie und Altersmedizin, Evangelisches Geriatriezentrum Berlin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Wolfgang Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Georg Gahn
- Neurologische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
| | - Roman Pfister
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Petra A Thürmann
- Lehrstuhl für Klinische Pharmakologie, Helios Universitätsklinkum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Jana Fresenborg
- Seminar für Allgemeine BWL und Management im Gesundheitswesen, Universität zu Köln, Köln, Deutschland
| | - Ludwig Kuntz
- Seminar für Allgemeine BWL und Management im Gesundheitswesen, Universität zu Köln, Köln, Deutschland
| | - Steffen T Simon
- Zentrum für Palliativmedizin, Uniklinik Köln, Köln, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital Eschweiler, Eschweiler, Deutschland
| | - Hans Jürgen Heppner
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
- Geriatrische Klinik und Tagesklinik, Lehrstuhl für Geriatrie, HELIOS Klinikum Schwelm, Universität Witten/Herdecke, Schwelm, Deutschland
| |
Collapse
|
11
|
Knapik P, Hirnle G, Kowalczuk-Wieteska A, O.Zembala M, Pawlak S, Hrapkowicz T, Przybyłowski P, Nadziakiewicz P, Cieśla D, Perek B, Kapelak B, Cisowski M, Rogowski J, Pietrzyk E, Tobota Z, Zembala M. Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry). PLoS One 2020; 15:e0238880. [PMID: 32913359 PMCID: PMC7482977 DOI: 10.1371/journal.pone.0238880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/25/2020] [Indexed: 12/04/2022] Open
Abstract
Background According to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians. Objectives The aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data. Methods All octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery. Results Octogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013). Conclusion On the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians.
Collapse
Affiliation(s)
- Piotr Knapik
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
- * E-mail:
| | - Grzegorz Hirnle
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Anetta Kowalczuk-Wieteska
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Michał O.Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Szymon Pawlak
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Hrapkowicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Piotr Przybyłowski
- Silesian Centre for Heart Diseases, Zabrze, Poland
- First Chair of General Surgery, Jagiellonian University, Medical College, Cracow, Poland
| | - Paweł Nadziakiewicz
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Daniel Cieśla
- Department of Science and New Technologies, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Marek Cisowski
- First Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biala, Poland
| | - Jan Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Edward Pietrzyk
- Department of Cardiac Surgery, Świętokrzyskie Centre of Cardiology, Kielce, Poland
| | - Zdzisław Tobota
- Department of Paediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | | |
Collapse
|
12
|
van Heerden PV, Sviri S, Beil M, Szczeklik W, de Lange D, Jung C, Guidet B, Leaver S, Rhodes A, Boumendil A, Flaatten H. The wave of very old people in the intensive care unit-A challenge in decision-making. J Crit Care 2020; 60:290-293. [PMID: 32949896 DOI: 10.1016/j.jcrc.2020.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/06/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022]
Abstract
In this paper the authors express the opinion that there is much to be learned about the 80+ year old age group as it relates to critical care and end-of-life matters. We need to learn how to better predict outcome, we need to learn our limitations and deal with uncertainties, we need to better communicate with our elderly patients and their caregivers and we need to engage with our colleagues in Geriatrics. There is a wave of very old people arriving in the intensive care unit and we have much to do to prepare for it and for the ethical, fair and appropriate care of these critically ill, but elderly, patients.
Collapse
Affiliation(s)
| | - Sigal Sviri
- Medical Intensive Care Unit, Hadassah-Hebrew University Hospital, Jerusalem, Israel
| | - Michael Beil
- Institute of Health Sciences at PTHV, Pallottistr. 3, 56179 Vallendar, Germany
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Dylan de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Christian Jung
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, Heinrich Heine University of Duesseldorf, Germany
| | - Bertrand Guidet
- Sorbonne Universite, INSERM, Institut Pierre Louis d'Epidemiomlogie et de Sante Publique Hopital Saint-Antoine, Service de Reanimation, Paris, France
| | - Susannah Leaver
- Department of Adult Critical Care, St George's Healthcare NHS Foundation Trust, London, UK
| | - Andrew Rhodes
- Department of Adult Critical Care, St George's Healthcare NHS Foundation Trust, London, UK
| | | | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
13
|
Pasin L, Boraso S, Golino G, Fakhr BS, Tiberio I, Trevisan C. The impact of frailty on mortality in older patients admitted to an Intensive Care Unit. Med Intensiva 2020; 46:S0210-5691(20)30191-1. [PMID: 32654922 DOI: 10.1016/j.medin.2020.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/27/2020] [Accepted: 05/24/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Frailty is a relatively new concept for intensivists, and is defined as a status of increased vulnerability to stressors associated with reduced reserve and function of different physiological systems. Supporting the hypothesis that frailty may be an important predictor of poor prognosis among older patients admitted to Intensive Care Unit (ICU), this study seeks to evaluate the association between frailty at ICU admission and short and long-term mortality. DESIGN An unmatched case-control study was carried out. SETTING Intensive Care Unit. PATIENTS OR PARTICIPANTS Patients≥80 years of age admitted to the ICU for medical reasons. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The primary outcome was 30-day mortality, while secondary outcomes were ICU mortality and mortality at one year. RESULTS Most of the patients were classified as frail at ICU admission (55.3%). The prevalence of frailty was higher among those who died than in those who were alive within 30 days from ICU admission (62.3% vs 48.3%, p=0.01). One-year mortality was higher in frail (84.4%) than in non-frail patients (65.2%, p<0.001). In the logistic regression analysis, after adjusting for potential confounders such as chronic diseases, clinical complexity, cause of ICU admission and use of advanced procedures, frailty was seen to be significantly associated to one-year mortality, but not with ICU mortality or 30-day mortality. DISCUSSION The admission of geriatric patients to the ICU is increasing. Frailty assessment may play an important role in the clinical evaluation of such individuals for triage, but should not be considered a priori as an exclusion criterion for admission.
Collapse
Affiliation(s)
- L Pasin
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy.
| | - S Boraso
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - G Golino
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - B S Fakhr
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - I Tiberio
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - C Trevisan
- Department of Medicine (DIMED), Geriatric Unit, University of Padova, Italy
| |
Collapse
|
14
|
De Biasio JC, Mittel AM, Mueller AL, Ferrante LE, Kim DH, Shaefi S. Frailty in Critical Care Medicine: A Review. Anesth Analg 2020; 130:1462-1473. [PMID: 32384336 DOI: 10.1213/ane.0000000000004665] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Traditional approaches to clinical risk assessment utilize age as a marker of increased vulnerability to stress. Relatively recent advancements in the study of aging have led to the concept of the frailty syndrome, which represents a multidimensional state of depleted physiologic and psychosocial reserve and clinical vulnerability that is related to but variably present with advancing age. The frailty syndrome is now a well-established clinical entity that serves as both a guide for clinical intervention and a predictor of poor outcomes in the primary and acute care settings. The biological aspects of the syndrome broadly represent a network of interrelated perturbations involving the age-related accumulation of molecular, cellular, and tissue damage that leads to multisystem dysregulation, functional decline, and disproportionately poor response to physiologic stress. Given the complexity of the underlying biologic processes, several well-validated approaches to define frailty clinically have been developed, each with distinct and reasonable considerations. Stemming from this background, the past several years have seen a number of observational studies conducted in intensive care units that have established that the determination of frailty is both feasible and prognostically useful in the critical care setting. Specifically, frailty as determined by several different frailty measurement tools appears associated with mortality, increased health care utilization, and disability, and has the potential to improve risk stratification of intensive care patients. While substantial variability in the implementation of frailty measurement likely limits the generalizability of specific findings, the overall prognostic trends may offer some assistance in guiding management decisions with patients and their families. Although no trials have assessed interventions to improve the outcomes of critically ill older people living with frailty, the particular vulnerability of this population offers a promising target for intervention in the future.
Collapse
Affiliation(s)
- Justin C De Biasio
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Aaron M Mittel
- Department of Anesthesiology, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ariel L Mueller
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dae H Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - Shahzad Shaefi
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
[Geriatric intensive care : Consensus paper of DGIIN, DIVI, DGAI, DGGG, ÖGGG, ÖGIAIN, DGP, DGEM, DGD, DGNI, DGIM, DGKliPha and DGG]. Z Gerontol Geriatr 2019; 52:440-456. [PMID: 31278486 DOI: 10.1007/s00391-019-01584-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The proportion of elderly, frail, and multimorbid people has increased dramatically in recent decades resulting from demographic changes and will further increase, which will impact acute medical care. Prospective, randomized studies on geriatric intensive care are still lacking. There are also no international or national recommendations regarding the management of critically ill elderly patients. Based on an expert opinion, this consensus paper provides 16 statements that should be considered when dealing with geriatric critical care patients.
Collapse
|
16
|
Oh DK, Na W, Park YR, Hong SB, Lim CM, Koh Y, Huh JW. Medical resource utilization patterns and mortality rates according to age among critically ill patients admitted to a medical intensive care unit. Medicine (Baltimore) 2019; 98:e15835. [PMID: 31145326 PMCID: PMC6709157 DOI: 10.1097/md.0000000000015835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
There is ongoing controversy about how to address the growing demand for intensive care for critically ill elderly patients. We investigated resource utilization patterns and mortality rates according to age among critically ill patients.We retrospectively analyzed the medical records of patients admitted to a medical intensive care unit (ICU) in a tertiary referral teaching hospital between July 2006 and June 2015. Patients were categorized into non-elderly (age <65 years, n = 4140), young-elderly (age 65-74 years, n = 2306), and old-elderly (age ≥75 years, n = 1508) groups.Among 7954 admissions, the mean age was 61.5 years, and 5061 (63.6%) were of male patients. The proportion of comorbidities increased with age (64.6% in the non-elderly vs 81.4% in the young-elderly vs 82.8% in the old-elderly, P < .001 and P for trend <.001), whereas the baseline Sequential Organ Failure Assessment (SOFA) score decreased with age (8.1 in the non-elderly vs 7.2 in the young-elderly vs 7.2 in the old-elderly, P < .001, R = -.092 and P for trend <.001). Utilization rates of mechanical ventilation (48.6% in the non-elderly vs 48.3% in the young-elderly vs 45.5% in the old-elderly, P = .11) and renal replacement therapy (27.5% in the non-elderly vs 25.5% in the young-elderly vs 24.8% in the old-elderly, P = .069) were comparable between the age groups. The 28-day ICU mortality rates were lower in the young-elderly and the old-elderly groups than in the non-elderly group (35.6% in the non-elderly vs 34.2% in the young-elderly, P = .011; and vs 32.6% in the old-elderly, P = .002).A substantial number of critically ill elderly patients used medical resources as non-elderly patients and showed favorable clinical outcomes. Our results support that underlying medical conditions rather than age per se need to be considered for determining intensive care.
Collapse
Affiliation(s)
- Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine
| | - Wonjun Na
- Department of Medical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine
| |
Collapse
|