Treatment Intensity and Outcomes in Elderly Mechanically Ventilated ICU Patients

Background: The global population is aging, and the proportion of elderly patients admitted to ICUs is increasing. In this scenario, achieving a balance between judicious utilization of a limited and high-cost resource and providing optimal intensity of care presents a challenge given that in very elderly patients the value of ICU care is uncertain. The aim of our study was to evaluate the survival of older subjects admitted to ICU who require mechanical ventilation at different levels of treatment intensity. Methods: A comprehensive longitudinal ICU database was retrospectively analyzed at a single tertiary center, from January 2008-December 2014, of ICU subjects 80 y old or older who required mechanical ventilation. Results: From January 2009-December 2014, 482 subjects were admitted to the ICU and required mechanical ventilation. Among them, 376 (78%) were age 80-89 y; and 106 (22%) were age ≥ 90 y, with a mean age of 85.84 (4.56). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 21.53 (7.42), and the mean Sequential Organ Failure Assessment score was 5.75 (3.38). The total mortality during ICU admission was 46%, and the hospital mortality was 58%. Only age higher than 90 y (1.41 [1.05-1.91], P = .02) and APACHE score (1.03 [1.01-1.05], P < .001) were associated with mortality after adjustments. The Therapeutic Intervention Scoring System score was analyzed in tertiles and was not related to mortality in univariate analysis or after adjustments. Conclusions: Our data indicate that in older subjects who received mechanical ventilation higher intensity of treatment does not seem to translate into a survival benefit. This finding highlights the importance of considering individualized treatment plans for elderly patients in the ICU.