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Báo cáo y học: "Elderly patients undergoing mechanical ventilation in and out of intensive care units: a comparative, prospective study of 579 ventilations"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Elderly patients undergoing mechanical ventilation in and out of intensive care units: a comparative, prospective study of 579 ventilations. | Lieberman et al. Critical Care 2010 14 R48 http ccforum.eom content 14 2 R48 c CRITICAL CARE RESEARCH Open Access Elderly patients undergoing mechanical ventilation in and out of intensive care units a comparative prospective study of 579 ventilations David Lieberman 1 2 3 Liat Nachshon2 3 Oleg Miloslavsky2 3 Valery Dvorkin2 3 Avi Shimon 2 3 Julian Zelinger3 4 Michael Friger5 and Devora Lieberman2 3 6 Abstract Introduction Many mechanically ventilated elderly patients in Israel are treated outside of intensive care units ICUs . The decision as to whether these patients should be treated in ICUs is reached without clear guidelines. We therefore conducted a study with the aim of identifying triage criteria and factors associated with in-hospital mortality in this population. Methods All mechanically invasive ventilated elderly 65 medical patients in the hospital were included in a prospective non-interventional observational study. Results Of the 579 ventilations 283 48.9 were done in ICUs compared with 296 51.1 in non-ICU wards. The percentage of ICU ventilations in the 65 to 74 75 to 84 and 85 age groups was 62 45 and 23 respectively. The decision to ventilate in ICUs was significantly and independently influenced by age Odds Ratio OR 0.945 P 0.001 and pre-hospitalization functional status by functional independence measure FIM scale OR 1.054 P 0.001 . Inhospital mortality was 53.0 in ICUs compared with 68.2 in non-ICU wards P 0.001 but the rate was not independently and significantly affected by hospitalization in ICUs. Conclusions In Israel most elderly patients are ventilated outside ICUs and the percentage of ICU ventilations decreases as age increases. In our study groups the lower mortality among elderly patients ventilated in ICUs is related to patient characteristics and not to their treatment in ICUs perse. Although the milieu in which this study was conducted is uncommon today in the western world its findings point to possible means of managing future .