Abstract
Objectives: This study aimed to investigate the effect of nurse-led, goal-directed lung physiotherapy (GDLPT) on the prognosis of older patients with sepsis caused by pneumonia in the intensive care unit.Methods: We conducted a prospective, two-phase (before-and-after) study over 3 years called the GDLPT study. All patients received standard lung therapy for sepsis caused by pneumonia and patients in phase 2 also received GDLPT. In this study, 253 older patients (age ≥ 65 years) with sepsis and pneumonia were retrospectively analyzed. The main outcome was 28 day mortality.Results: Among 742 patients with sepsis, 253 older patients with pneumonia were divided into the control group and the treatment group. Patients in the treatment group had a significantly shorter duration of mechanical ventilation [5 (4, 6) vs. 5 (4, 8) days; P = 0.045], and a lower risk of intensive care unit (ICU) mortality [14.5% (24/166) vs. 28.7% (25/87); P = 0.008] and 28 day mortality [15.1% (25/166) vs. 31% (27/87); P = 0.005] compared with those in the control group. GDLPT was an independent risk factor for 28 day mortality [odds ratio (OR), 0.379; 95% confidence interval (CI), 0.187–0.766; P = 0.007].Conclusions: Nurse-led GDLPT shortens the duration of mechanical ventilation, decreases ICU and 28-day mortality, and improves the prognosis of older patients with sepsis and pneumonia in the ICU.
Highlights
IntroductionThe proportion of individuals older than 60 years has tripled over the last 50 years and will triple again before 2050
Aging of the population is a critical worldwide trend
There were no significant differences in age, sex, underlying diseases, source of admission, disease severity scores (APACHE II, Sequential Organ Failure Assessment (SOFA), and Clinical Pulmonary Infection Score (CPIS) scores), vital signs, ventilatory parameters, arterial blood gases, clinical laboratory evaluation, life-sustaining treatments, coexisting pathogens, or drug therapy between the two groups after intensive care unit (ICU) admission
Summary
The proportion of individuals older than 60 years has tripled over the last 50 years and will triple again before 2050. This aging has major consequences on the health system, including the intensive care unit (ICU). In the USA, almost half (48.7%) of the patients admitted to an ICU are aged 65 years or older, and patients aged 85 years or older account for 7 to 25% of the admission rate [1, 2]. 19% of adults hospitalized with pneumonia have an ICU admission, Nurse-Led Lung Physiotherapy for Older Patients including 60.7% of patients aged 65 years or older [3]. An appropriate treatment protocol for pneumonia in older patients needs to be determined
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