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Abstract

Introduction: Outcomes from mechanical ventilation of groups of super elderly medical and surgical ICU patients have been described, but the specific group of super elderly trauma patients has not been examined. The purpose of this study is to describe the prevalence of intubation in the cohort of super elderly trauma patients in a Level I trauma center, and define outcomes. Hypothesis: We hypothesize that any intubation in the groups of octogenarian and nonagenarian trauma patients correlates strongly with mortality, and that this effect increases with age. Methods: A five year interval (2007-2012) of a trauma registry of an urban Level I trauma center was queried with regards to incidence and outcomes of mechanical ventilation for cohorts of octogenarian and nonagenarian trauma patients. Cohorts were compared over parameters within the registry. Results: 1,142 trauma patients between the ages of 80 and 99 were included in the analysis; of these, the 126 ever intubated patients comprised the group for analysis. 19 of 214 nonagenarians (8.9%) and 107 of 928 octogenarians (11.5%) required intubation. There was no statistically significant difference in ventilator or ICU days between the two age groups. Only 3 (15.7%) of the nonagenarians were successfully extubated, while 66 (61.7%) of the octogenarians were. In a multivariate model, nonagenarian status strongly predicted extubation failure (OR=11.6 [95%CI=2.8-48.3], p=0.001). 16 of 19 nonagenarians (84%) and 41 of 107 octogenarians (47%) died during the hospitalization, and this was statistically significant (p<0.001). Conclusions: Within the group of super elderly trauma patients, any need for intubation is highly associated with extubation failure as well as mortality, and this risk increases significantly by decade of age.