Araştırma Makalesi
Yıl 2021,
Cilt: 8 Sayı: 3, 189 - 194, 28.12.2021
Öz
Klinisyenler arasında yaşlı hastaların yoğun bakım ünitesine(YBÜ) kabulüne ilişkin kriterler konusunda fikir birliği bulunmamaktadır. Bu çalışmada, Acil servisten(AS) YBÜ’ye yatırılan yaşlı hastalarda AS’ye kabul sırasında değerlendirilen risk faktörlerinin mortaliteye etkisini belirlemeyi amaçladık. 1 Ocak 2019-31 Aralık 2019 tarihleri arasında YBÜ’ye kabul edilen 65 yaş ve üzeri hastalar retrospektif olarak alındı. Hastalar yaşlarına göre iki gruba ayrıldı: 65-74 yaş, 75 yaş ve üzeri. Klinik ve demografik verileri değerlendirilmiştir; hastalar yaş gruplarına göre analiz edildi. Risk faktörlerinin YBÜ’deki mortalitesine etkisi lojistik regresyon analizi kullanılarak belirlendi. Çalışmaya dahil edilen 839 hastanın %66.3'ü 65-74 yaş grubu, %33.7'si ≥75 yaş grubu idi. Hastaların %24.7’si (n=207) öldü. Mortaliteyi etkileyen risk faktörlerinin düşük ortalama arteriyel basınç (OR=0.98, 95%CI:0.97-0.99), düşük Glasgow Koma Skoru (OR=0.73, 95% CI:0.66-0.80), entübasyon ihtiyacı (OR=12.58, 95%CI:6.02–26.30), altta yatan bir kanser tanısı (OR = 7.23, 95% CI: 2.60-20.16), ve AS’de uzun kalış süresi (OR=1.65, 95% CI:1.46–1.87) olduğunu saptadık. Yaşın tek başına yoğun bakımda mortalite ile ilişkili olmadığını tespit ettik (p=0.122). Mortaliteyi etkileyen risk faktörleri göz önünde bulundurularak AS’den YBÜ’ye kabulü düşünülmelidir.
Anahtar Kelimeler
Acil Servis Mortalite Yaşlı Erişkin Hastalar Yoğun Bakım Ünitesi
Kaynakça
- 1. Ross MA, Compton S, Richardson D, et al. The use and effectiveness of an emergency department observation unit for elderly patients. Ann Emerg Med. 2003;41(5):668-77.
- 2. Guidet B, Leblanc G, Simon T, et al. Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France: A Randomized Clinical Trial. JAMA. 2017;318(15):1450-9.
- 3. Boumendil A, Somme D, Garrouste-Orgeas M, et al. Should elderly patients be admitted to the intensive care unit? Intensive Care Med. 2007;33(7):1252.
- 4. Demoule A, Cracco C, Lefort Y, et al. Patients aged 90 years or older in the intensive care unit. J Gerontol A Biol Sci Med Sci. 2005;60(1):129-32.
- 5. Ely WE. Optimizing outcomes for older patients treated in the intensive care unit. Intensive Care Med. 2003;29(12):2112-5.
- 6. Nguyen YL, Angus DC, Boumendil A, et al. The challenge of admitting the very elderly to intensive care. Ann Intensive Care. 2011;1(1):29.
- 7. Yu W, ASh AS, Levinsky NG, Moskowitz MA. Intensive care unit and mortality in the elderly. J Gen Intern Med. 2000;15(2): 97–102.
- 8. Garrouste-Orgeas M, Boumendil A, Pateron D, et al. Selection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: An observational, multicenter, prospective study. Crit Care Med. 2009;37(11):2919-28.
- 9. Guidelines for intensive care unit admission, discharge, and triage. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med. 1999: 27(3):633-8.
- 10. Kramer AA, Higgins TL, Zimmerman JE. The association between ICU readmission rate and patient outcomes. Crit Care Med. 2013; 41:24–33.
- 11. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.
- 12. Vosylius S, Sipylaite J, Ivaskevicius J. Determinents of outcome in elderly patients admitted to the intensive care unit. Age and Aging. 2005; 34:157–162.
- 13. Fuchs L, Chronaki CE, Park S, et al. ICU admission characteristics and mortality rates among elderly and very elderly patients. Intensive Care Med. 2012;38(10):1654–61.
- 14. Somme D, Maillet JM, Gisselbrecht M, et al. Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med. 2003;29(12):2137-43.
- 15. Andersen FH, Kvåle R. Do elderly intensive care unit patients receive less intensive care treatment and have higher mortality? Acta Anaesthesiol Scand. 2012;56(10):1298-305.
- 16. Ducos G, Mathe O, Balardy L, et al. Influence of age on decision-making process to limit or withdraw life-sustaining treatment in the intensive care unit—a single center prospective observational study. J Frailty Aging. 2017;6(3):148-53.
- 17. Flaatten H, De Lange DW, Morandi A, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (⩾80 years). Intensive Care Med. 2017; 43(12):1820–8.
- 18. Heyland DK, Stelfox HT, Garland A, et al. Canadian Critical Care Trials Group and the Canadian Researchers at the End of Life Network. Predicting performance status 1 year after critical illness in patients 80 years or older: development of a multivariable clinical prediction model. Crit Care Med. 2016; 44(9): 1718–26.
- 19. Hwang LC, Hsu CP, Tjung JJ, et al. Predictors of in-hospital mortality in oldest-old patients in Taiwan. Int J Gerontol. 2013;7(1):22–6.
- 20. Bo M, Massaia M, Raspo S, et al. Predictive factors of in-hospital mortality in older patients admitted to a medical intensive care unit. J Am Geriatr Soc. 2003; 51(4):529-33.
- 21. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: A severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
- 22. Le Gall JR, Lemeshow S, Saulnier F. A new Simplifed Acute Physiology Score (SAPS-II) based on a European/North American multicenter study. JAMA. 1993; 270(24):2957-63.
- 23. Norena M, Wong H, Thompson WD, et al. Adjustment of intensive care unit outcomes for severity of illness and comorbidity scores. J Crit Care. 2006; 21(2):142-50.
- 24. Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP; DELAY-ED study group. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007;35(6):1477-83.
- 25. Cardoso LT, Grion CM, Matsuo Tet al. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care. 2011;15(1): R28.
- 26. Beynon T, Gomes B, Murtagh FE, et al. How common are palliative care needs among older people who die in the emergency department? Emerg Med J. 2011;28(6):491-5.
Determinants of Outcomes in Older Adult Patients Admitted to The Intensive Care Unit from The Emergency Department
Öz
There is no consensus among clinicians on the criteria for admission of older adult patients to the intensive care unit (ICU). In this study, we aimed to determine the impact of risk factors assessed during admission to the emergency department (ED) in older adult patients admitted to the ICU from the ED on ICU mortality. Patients aged 65 years or older, who were admitted to the ICU between January 1, 2019, and December 31, 2019, were retrospectively evaluated. Patients were divided into two groups according to their age: 65–74 years old and 75 years and older. Clinical and demographic data were evaluated and patients were analyzed according to the age groups. The association of risk factors on ICU mortality was determined using logistic regression analysis. Of the 839 patients included in the study, 66.3% were in the 65–74 age group and 33.7% were in the ≥75 age group. A proportion of 24.7% of the patients (n=207) died. The risk factors associated with ICU mortality were low mean arterial pressure (OR=0.98, 95% CI:0.97-0.99), low Glasgow Coma Scale score (OR=0.73, 95% CI:0.66-0.80), intubation requirement (OR=12.58, 95% CI:6.02–26.30), underlying cancer diagnosis (OR = 7.23, 95% CI: 2.60-20.16), and long stay in the ED (OR=1.65, 95% CI:1.46–1.87).Age alone was not associated with ICU mortality (p=0.122). Admission to the ICU from the ED should consider the risk factors associated with ICU mortality.
Anahtar Kelimeler
Emergency Department Intensive Care Unit Older Adult Patients Mortality
Kaynakça
- 1. Ross MA, Compton S, Richardson D, et al. The use and effectiveness of an emergency department observation unit for elderly patients. Ann Emerg Med. 2003;41(5):668-77.
- 2. Guidet B, Leblanc G, Simon T, et al. Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France: A Randomized Clinical Trial. JAMA. 2017;318(15):1450-9.
- 3. Boumendil A, Somme D, Garrouste-Orgeas M, et al. Should elderly patients be admitted to the intensive care unit? Intensive Care Med. 2007;33(7):1252.
- 4. Demoule A, Cracco C, Lefort Y, et al. Patients aged 90 years or older in the intensive care unit. J Gerontol A Biol Sci Med Sci. 2005;60(1):129-32.
- 5. Ely WE. Optimizing outcomes for older patients treated in the intensive care unit. Intensive Care Med. 2003;29(12):2112-5.
- 6. Nguyen YL, Angus DC, Boumendil A, et al. The challenge of admitting the very elderly to intensive care. Ann Intensive Care. 2011;1(1):29.
- 7. Yu W, ASh AS, Levinsky NG, Moskowitz MA. Intensive care unit and mortality in the elderly. J Gen Intern Med. 2000;15(2): 97–102.
- 8. Garrouste-Orgeas M, Boumendil A, Pateron D, et al. Selection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: An observational, multicenter, prospective study. Crit Care Med. 2009;37(11):2919-28.
- 9. Guidelines for intensive care unit admission, discharge, and triage. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med. 1999: 27(3):633-8.
- 10. Kramer AA, Higgins TL, Zimmerman JE. The association between ICU readmission rate and patient outcomes. Crit Care Med. 2013; 41:24–33.
- 11. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.
- 12. Vosylius S, Sipylaite J, Ivaskevicius J. Determinents of outcome in elderly patients admitted to the intensive care unit. Age and Aging. 2005; 34:157–162.
- 13. Fuchs L, Chronaki CE, Park S, et al. ICU admission characteristics and mortality rates among elderly and very elderly patients. Intensive Care Med. 2012;38(10):1654–61.
- 14. Somme D, Maillet JM, Gisselbrecht M, et al. Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med. 2003;29(12):2137-43.
- 15. Andersen FH, Kvåle R. Do elderly intensive care unit patients receive less intensive care treatment and have higher mortality? Acta Anaesthesiol Scand. 2012;56(10):1298-305.
- 16. Ducos G, Mathe O, Balardy L, et al. Influence of age on decision-making process to limit or withdraw life-sustaining treatment in the intensive care unit—a single center prospective observational study. J Frailty Aging. 2017;6(3):148-53.
- 17. Flaatten H, De Lange DW, Morandi A, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (⩾80 years). Intensive Care Med. 2017; 43(12):1820–8.
- 18. Heyland DK, Stelfox HT, Garland A, et al. Canadian Critical Care Trials Group and the Canadian Researchers at the End of Life Network. Predicting performance status 1 year after critical illness in patients 80 years or older: development of a multivariable clinical prediction model. Crit Care Med. 2016; 44(9): 1718–26.
- 19. Hwang LC, Hsu CP, Tjung JJ, et al. Predictors of in-hospital mortality in oldest-old patients in Taiwan. Int J Gerontol. 2013;7(1):22–6.
- 20. Bo M, Massaia M, Raspo S, et al. Predictive factors of in-hospital mortality in older patients admitted to a medical intensive care unit. J Am Geriatr Soc. 2003; 51(4):529-33.
- 21. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: A severity of disease classification system. Crit Care Med. 1985;13(10):818-29.
- 22. Le Gall JR, Lemeshow S, Saulnier F. A new Simplifed Acute Physiology Score (SAPS-II) based on a European/North American multicenter study. JAMA. 1993; 270(24):2957-63.
- 23. Norena M, Wong H, Thompson WD, et al. Adjustment of intensive care unit outcomes for severity of illness and comorbidity scores. J Crit Care. 2006; 21(2):142-50.
- 24. Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP; DELAY-ED study group. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007;35(6):1477-83.
- 25. Cardoso LT, Grion CM, Matsuo Tet al. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care. 2011;15(1): R28.
- 26. Beynon T, Gomes B, Murtagh FE, et al. How common are palliative care needs among older people who die in the emergency department? Emerg Med J. 2011;28(6):491-5.
Toplam 26 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Aralık 2021 |
| Gönderilme Tarihi | 22 Kasım 2020 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 8 Sayı: 3 |
