Abstract
This retrospective cohort study investigated the outcomes and prognostic factors in nonagenarians (patients 90 years old or older) with acute respiratory failure. Between 2006 and 2016, all nonagenarians with acute respiratory failure requiring invasive mechanical ventilation (MV) were enrolled. Outcomes including in-hospital mortality and ventilator dependency were measured. A total of 173 nonagenarians with acute respiratory failure were admitted to the intensive care unit (ICU). A total of 56 patients died during the hospital stay and the rate of in-hospital mortality was 32.4%. Patients with higher APACHE (Acute Physiology and Chronic Health Evaluation) II scores (adjusted odds ratio [OR], 5.91; 95 % CI, 1.55-22.45; p = 0.009, APACHE II scores ≥ 25 vs APACHE II scores < 15), use of vasoactive agent (adjust OR, 2.67; 95% CI, 1.12-6.37; p = 0.03) and more organ dysfunction (adjusted OR, 11.13; 95% CI, 3.38-36.36, p < 0.001; ≥ 3 organ dysfunction vs ≤ 1 organ dysfunction) were more likely to die. Among the 117 survivors, 25 (21.4%) patients became dependent on MV. Female gender (adjusted OR, 3.53; 95% CI, 1.16-10.76, p = 0.027) and poor consciousness level (adjusted OR, 4.98; 95% CI, 1.41-17.58, p = 0.013) were associated with MV dependency. In conclusion, the mortality rate of nonagenarians with acute respiratory failure was high, especially for those with higher APACHE II scores or more organ dysfunction.
Highlights
After stepwise logistic regression analysis, we identified two independent risk factors – gender and consciousness level - which were associated with mechanical ventilation (MV) dependence
The outcome of these very elderly patients with acute respiratory failure was poor and the in-hospital mortality rate was high at 32.4%
Similar findings have been noted in several studies with all-cause hospital mortality rates for critically ill patients 80 years old and older admitted to the intensive care unit (ICU) ranging from 26% to 50% [14,15,16]
Summary
Even if elderly patients survive acute illness, they are at high risk of prolonged MV [4,5,6,7] These very elderly patients are near the end of life and many may prefer preserving quality of life rather than prolonging survival [8,9,10]. This specific population may be reluctant to accept unnecessary prolongation of life by life-sustaining www.impactjournals.com/oncotarget therapy such as invasive MV [10, 11]. The aims of this study were to investigate the outcomes of nonagenarians (patients 90 years old or older) with acute respiratory failure requiring invasive MV and to identify risk factors associated with mortality
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call