Clinical Research Papers:
The outcomes and prognostic factors of acute respiratory failure in the patients 90 years old and over
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Wan-Ling Chen1,*, Chin-Ming Chen2,3,*, Shu-Chen Kung1, Ching-Min Wang4, Chih-Cheng Lai5 and Chien-Ming Chao5,6
1Department of Respiratory Therapy, Chi Mei Medical Center, Tainan, Taiwan
2Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
3Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
4Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
5Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
6Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
*These authors have contributed equally to this work
Chien-Ming Chao, email: [email protected]
Keywords: aged; 90 and over; mechanical ventilation; outcome; risk factor
Received: July 29, 2017 Accepted: December 24, 2017 Published: January 09, 2018
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.
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