How do older ventilated patients fare? A survival/functional analysis of 641 ventilations

Lieberman, David; Nachshon, Liat; Miloslavsky, Oleg; Dvorkin, Valery; Shimoni, Avi; Lieberman, Devora

doi:10.1016/j.jcrc.2009.01.015

« Previous Next »Journal of Critical Care
Volume 24, Issue 3 , Pages 340-346, September 2009

How do older ventilated patients fare? A survival/functional analysis of 641 ventilations☆

David Lieberman, MD
- Pulmonary Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Division of Internal Medicine, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Corresponding author. Pulmonary Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel. Tel.: +972 8 6400411; fax: +972 8 6403022.
Liat Nachshon, MD
- Division of Internal Medicine, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Oleg Miloslavsky, MD
- Division of Internal Medicine, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Valery Dvorkin, MD
- Division of Internal Medicine, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Avi Shimoni, MD
- Division of Internal Medicine, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Devora Lieberman, MD
- Division of Internal Medicine, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Geriatric Medicine, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Abstract

Background

The outcome of mechanical ventilation in elderly patients should be evaluated by integrating survival rates with functional state over time after the ventilation episode.

Objectives

The aim of this study was to measure the survival rate and functional state of elderly ventilated patients and to present an integrated analysis of both outcome measures.

Methods

This is a prospective observational, noninterventional study of 641 invasive medical ventilations of elderly (65+ years) patients in medical wards and intensive care units.

The functional state, by the Functional Independence Measure scale, was measured before hospitalization, at discharge from the hospital, and 1 year later.

Results

Survival rates at the end of hospitalization and 3, 6, and 12 months later were 33%, 28%, 25%, and 22%, respectively. According to a combined survival/functional analysis, only 11% of all ventilated elderly patients were doing well (Functional Independence Measure scale score, ≥90) a year after the hospitalization. The rates for this condition ranged from 23% for acute exacerbation of chronic obstructive pulmonary disease to 0% for stroke and hospital-acquired pneumonia.

Conclusions

In elderly patients treated with mechanical ventilation, the outcomes in the period immediately after ventilation and later on are poor. In this group of patients, functional outcomes should be integrated with survival analysis for a meaningful assessment of the outcomes of treatment with mechanical ventilation to provide patients, families, practitioners, and society with reliable information on which life or death decisions can be based.

Keywords: Mechanical ventilation, Outcome, Survival, Functional state, Elderly persons