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Mechanical ventilation in elderly patients

D Benhamou1, J F Muir, B Melen

  • 1Service de Pneumologie (CHU de Rouen) and Etudes et Recherches en Pneumologie, Université de Rouen, CHU de Rouen, France.

Monaldi Archives for Chest Disease = Archivio Monaldi Per Le Malattie Del Torace
|December 23, 1998
PubMed
Summary

Older patients (80+) receiving mechanical ventilation (MV) in the ICU have higher mortality but similar outcomes to younger patients when selected. Noninvasive ventilation offers better short-term results for this group.

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Area of Science:

  • Critical Care Medicine
  • Geriatric Medicine
  • Respiratory Medicine

Background:

  • Elderly patients, particularly those 80 years and older, are increasingly receiving intensive care unit (ICU) treatment involving mechanical ventilation (MV).
  • Understanding the specific outcomes and treatment nuances for this demographic is crucial for optimizing care.

Purpose of the Study:

  • To review specific aspects of mechanical ventilation in older elderly patients (80 years and older).
  • To compare outcomes of older elderly patients undergoing MV with those of younger patients.

Main Methods:

  • Retrospective study of patients undergoing mechanical ventilation (endotracheal ventilation [ETV] or noninvasive ventilation [NIV]) in a respiratory ICU over a 2-year period.
  • Comparison of older elderly patients (≥80 years) with younger patients based on severity of illness (Simplified Acute Physiology Scores [SAPS]), treatment received, and outcomes.

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Main Results:

  • Older elderly patients were more severely ill on admission. Noninvasive ventilation (NIV) was used more frequently and for shorter durations in older patients.
  • ICU mortality was higher in older patients overall and in the NIV group, but comparable to younger patients in the ETV group.
  • Long-term survival (2 years) was low (12%) for older patients admitted to the ICU.

Conclusions:

  • Age alone should not preclude older patients from intensive care; selection biases may influence observed outcomes.
  • Noninvasive ventilation, when feasible, is associated with fewer complications and better short-term results than endotracheal ventilation for older adults.
  • Despite intensive care, the long-term prognosis for the oldest elderly patients remains poor.