Invasive ventilation and mortality in critically ill nonagenarians: a retrospective cohort study

Area of Science:

• Critical Care Medicine
• Geriatric Medicine
• Intensive Care Research

Background:

• Increasing ICU admissions among the very elderly (≥90 years).
• Uncertainty regarding the benefits and ethical considerations of invasive ventilation (IV) in this population.
• High baseline mortality rates in nonagenarians admitted to the ICU.

Purpose of the Study:

• To evaluate the outcomes of invasive ventilation (IV) in intensive care unit (ICU) patients aged 90 years and older.
• To identify predictors of mortality in this specific elderly cohort.
• To inform clinical decision-making and goals-of-care discussions for nonagenarian ICU patients.

Main Methods:

• Retrospective cohort study of ICU patients aged ≥90 years (2008-2023).
• Analysis of demographic, clinical, and outcome data from electronic health records.
• Multivariable logistic regression and survival analyses (Kaplan-Meier, Cox regression) to identify mortality predictors.

Main Results:

• 1422 patients (1.25% of total admissions) aged ≥90 years were included.
• Invasive ventilation (IV) was used in 31% of patients, associated with higher illness severity (SOFA score), longer ICU stays, and increased need for vasopressors and renal replacement therapy.
• IV was linked to significantly higher ICU (35.7% vs 11.5%) and hospital mortality (49.3% vs 21.5%). Prolonged IV (>72h), high lactate, elevated SOFA, and CCI ≥3 were predictors of hospital mortality.

Conclusions:

• Invasive ventilation, especially beyond 72 hours, identifies nonagenarian ICU patients with very high mortality and illness severity.
• Observational data suggest IV in this age group should prompt early, patient-centered goals-of-care discussions.
• IV in nonagenarians may serve as a marker for high-risk subgroups rather than a direct cause of excess mortality.