Abstract
Objective: The increase in the mean age of the general population is reflected in the patient populations who are in need of intensive care. Increasing number of comorbidities with age is also an important issue to be considered in the management of these patients. We evaluated clinical and laboratory features of the elderly (65-79 years) and very elderly (≥80 years) patients in our medical intensive care unit (ICU).Methods: The clinical and laboratory data of intensive care patients aged 65 and over were retrospectively analyzed. Comorbidities were commented with 19 diseaseweighted Charlson Comorbidity Index (CCI).Results: 231 elderly and 216 very elderly patients were included in this study. Pulmonary diseases were the most prevalent primary cause of admission to ICU in both groups. The most common comorbidities were hypertension and heart failure in both groups. Number of patients whose CCI scores>3 were higher in very elderly patients group than in elderly patients group. While there was no difference in terms of median ICU-survival between two groups in general, when 30 days and longer intensive care follow-ups were evaluated, it was found 81.0 (95% CI: 48.8-113.2) days and 41.0 (95% CI: 36.6- 45.4) days in the elderly and very elderly patients respectively (p = 0.009).Conclusion: We concluded that, age is not the main factor affecting the ICU-survival in patient over 65 years old in intensive care unit. However, increasing age may be associated with short survival at prolonged hospitalizations in ICU. J Clin Exp Invest 2015; 6 (2): 144-149
Keywords
References
- Abrams WB, Beers MH, Berkow R. The Merck Manual of Geriatrics A Cross National Perspective, 2nd edn. Whitehouse Station, NJ: Merck Research Laboratories, 1996;123-129.
- Zülfikaroğlu B, Özalp N, Keşkek M, Bilgiç İ, Koç M. 80 yaş ve üzerindeki hastalarda acil abdominal cerrahi. Turk J Geriatrics 2005;8:115-119.
- Nguyen YL, Angus DC, Boumendil A, Guidet B. The challenge of admitting the very elderly to intensive care. Ann Intensive Care 2011;1:29.
- Boumendil A, Aegerter P, Guidet B; CUB-Rea Network. Treatment intensity and outcome of patients aged 80 and older in intensive care units: A multicenter matched-cohort study. J Am Geriatr Soc 2005;53:88-93.
- Kahramansoy N, Büyükaşık O, Erkol H, Çöl C. İleri yaş hastalarda lokal anestezi altında kasık fıtığı tamiri. Dicle Tıp Dergisi 2012;39:513-517.
- Işık T, Uyarel H, Ergelen M, ve ark. Primer anjiyoplastinin 75 yaş ve üstü hastalarda kısa ve uzun dönem sonuçları. Dicle Tıp Dergisi 2011;38:189-196.
- 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;29:2137-2143.
- Leong IY, Tai DY. Is increasing age associated with mortality in the critically ill elderly. Singapore Med J 2002;43:33-36.
- Aydın ZD. Yaşlanan dünya ve geriatri eğitimi. Turk J Geriatrics 1999;2:179-187.
- Çilingiroğlu N, Demirel S. Yaşlılık ve yaşlı ayrımcılığı. Turk J Geriatrics 2004;7:225-230.
- Angus DC, Kelley MA, Schmitz RJ, et al. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: Can we meet the requirements of an aging population? JAMA 2000;284:2762-2770.
- Altun Y, Demircan F, Mengeloğlu FM, Namuslu M. Yoğun bakım hastalarında ortalama trombosit hacminin mortalite ile ilişkisi. J Clin Exp Invest 2011;2:408-411.
- Behrendt CE. Acute respiratory failure in the United States: incidence and 31-day survival. Chest 2000;118:1100-1105.
- Rockwood K, Noseworthy TW, Gibney RT, et al. One-year outcome of elderly and young patients admitted to intensive care units. Crit Care Med 1993;21:687-691.
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383.
- Bagshaw SM, Webb SA, Delaney A, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 2009;13:R45.
- Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-829.
- Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-710.
- 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;270:2957-2963.
- 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;21:142-150.
- Oltean S, Ţăţulescu D, Bondor C, et al. Charlson’s weighted index of comorbidities is useful in assessing the risk of death in septic patients. J Crit Care 2012;27:370-375.
Abstract
Amaç: Genel nüfustaki yaş ortalamalarındaki artış yoğun bakıma ihtiyaç duyan hasta popülasyonuna da yansımaktadır. Yaşla birlikte eşlik eden hastalıkların artması bu hastaların takibinde ayrıca dikkat edilmesi gereken bir konudur. Biz de medikal yoğun bakım (YB) ünitemizde takip edilen yaşlı (65–79 yaş) ve çok yaşlı (80 yaş üstü) gruptaki hastalarımızın klinik ve laboratuvar özelliklerini karşılaştırdık.
Yöntemler: 65 yaş ve üstü YB hastalarının klinik ve laboratuvar verileri retrospektif olarak tarandı. Hastaların komorbiditeleri 19 hastalık ağırlıklı Charlson Comorbidity Index (CCI) ile değerlendirildi.
Bulgular: Çalışmaya 231 yaşlı ve 216 çok yaşlı hasta alındı. Her iki hasta grubunda da pulmoner hastalıklar YB’ye en sık primer alınış sebebiydi. Yine her iki grupta da hipertansiyon ve kalp yetmezliği en sık komorbid hastalıklardı. Çok yaşlı hasta grubunda CCI skoru >3 olanların sayısı daha fazla idi. Takip süresince gruplar arasında medyan YB-sağkalım açısından fark saptanmazken 30 gün ve üzerindeki YB takiplerinde ise median YB-sağkalım yaşlı hastalarda 81 gün (%95 CI: 48,8-113,2) iken çok yaşlı hastalarda 41 gün (%95 CI: 36,6-45,4) idi (p=0,009).
Sonuç: 65 yaşın üzerindeki hastalarda artan yaşın YB-sağ kalımlarında primer faktör olmadığını saptadık. Ancak yoğun bakımda uzun süreli yatışlarda artan yaş kısa sağ kalımla ilişkili olabilir.
Anahtar kelimeler: Yoğun bakım, yaşlı, sağkalım
Keywords
References
- Abrams WB, Beers MH, Berkow R. The Merck Manual of Geriatrics A Cross National Perspective, 2nd edn. Whitehouse Station, NJ: Merck Research Laboratories, 1996;123-129.
- Zülfikaroğlu B, Özalp N, Keşkek M, Bilgiç İ, Koç M. 80 yaş ve üzerindeki hastalarda acil abdominal cerrahi. Turk J Geriatrics 2005;8:115-119.
- Nguyen YL, Angus DC, Boumendil A, Guidet B. The challenge of admitting the very elderly to intensive care. Ann Intensive Care 2011;1:29.
- Boumendil A, Aegerter P, Guidet B; CUB-Rea Network. Treatment intensity and outcome of patients aged 80 and older in intensive care units: A multicenter matched-cohort study. J Am Geriatr Soc 2005;53:88-93.
- Kahramansoy N, Büyükaşık O, Erkol H, Çöl C. İleri yaş hastalarda lokal anestezi altında kasık fıtığı tamiri. Dicle Tıp Dergisi 2012;39:513-517.
- Işık T, Uyarel H, Ergelen M, ve ark. Primer anjiyoplastinin 75 yaş ve üstü hastalarda kısa ve uzun dönem sonuçları. Dicle Tıp Dergisi 2011;38:189-196.
- 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;29:2137-2143.
- Leong IY, Tai DY. Is increasing age associated with mortality in the critically ill elderly. Singapore Med J 2002;43:33-36.
- Aydın ZD. Yaşlanan dünya ve geriatri eğitimi. Turk J Geriatrics 1999;2:179-187.
- Çilingiroğlu N, Demirel S. Yaşlılık ve yaşlı ayrımcılığı. Turk J Geriatrics 2004;7:225-230.
- Angus DC, Kelley MA, Schmitz RJ, et al. Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: Can we meet the requirements of an aging population? JAMA 2000;284:2762-2770.
- Altun Y, Demircan F, Mengeloğlu FM, Namuslu M. Yoğun bakım hastalarında ortalama trombosit hacminin mortalite ile ilişkisi. J Clin Exp Invest 2011;2:408-411.
- Behrendt CE. Acute respiratory failure in the United States: incidence and 31-day survival. Chest 2000;118:1100-1105.
- Rockwood K, Noseworthy TW, Gibney RT, et al. One-year outcome of elderly and young patients admitted to intensive care units. Crit Care Med 1993;21:687-691.
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383.
- Bagshaw SM, Webb SA, Delaney A, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 2009;13:R45.
- Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-829.
- Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-710.
- 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;270:2957-2963.
- 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;21:142-150.
- Oltean S, Ţăţulescu D, Bondor C, et al. Charlson’s weighted index of comorbidities is useful in assessing the risk of death in septic patients. J Crit Care 2012;27:370-375.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | July 10, 2015 |
| Published in Issue | Year 2015 |