This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Analysis of Outcome After Treatment With Mechanical Ventilation

Andrew J. Swinburne, MD; Anthony J. Fedullo, MD; Karen Bixby, RN; David K. Lee, MD; Gary W. Wahl, MD

Arch Intern Med. 1993;153(14):1657-1662.

Abstract
Background
Concerns about rendering futile care, the financial costs of mechanical ventilation, and aging of the population make it important to analyze the benefit of aggressive therapy for respiratory failure in the elderly.

Methods
This study is a retrospective review of 1860 patients treated with mechanical ventilation in the medical intensive care unit for more than 3 hours between 1974 and 1985. Patients were assigned to one of nine diagnostic groups, and 10 premorbid chronic illnesses or organ system dysfunctions were recorded. Survival to discharge was determined for all patients, and the duration of survival after discharge was determined for patients aged 80 years and older. Two hundred eighty-two patients aged 80 years and older were compared with 1578 patients less than 80 years of age.

Results
Fifteen percent of patients treated with mechanical ventilation were 80 years of age or older. Forty-four percent of patients younger than 80 years, and 30.9% of patients aged 80 years and older survived to discharge. Patients aged 80 years or older with preexisting renal disease, liver disease, cancer, systemic illness, or chronic gastrointestinal disease with malnutrition had only a 7% survival compared with 29% for younger patients. For patients without these premorbid conditions (80% of both the younger and older groups) survival among the elderly was better, even though it was still poorer than for younger patients (38% vs 49%). Elderly patients requiring more than 15 days of mechanical ventilation had a 9% survival compared with 36% for younger patients.

Conclusions
A subgroup of patients 80 years of age or older can be identified whose chance for survival from respiratory failure is so poor that withholding or withdrawing treatment with mechanical ventilation may be appropriate. For the majority of elderly patients, short-term survival is nearly as good as in younger patients. Further studies are needed that assess long-term survival and functional recovery after treatment for respiratory failure so that elderly patients and their physicians can better decide whether or not to choose treatment with mechanical ventilation.

(Arch Intern Med. 1993;153:1657-1662)

Author Affiliations
From the Pulmonary Medicine/Critical Care Medicine Unit, Department of Medicine, University of Rochester (NY) at Rochester General Hospital.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Overview of Respiratory Failure in Older Adults
El Solh and Ramadan
J Intensive Care Med 2006;21:345-351.
ABSTRACT  

Prolonged Invasive Ventilation Following Acute Ventilatory Failure in COPD: Weaning Results, Survival, and the Role of Noninvasive Ventilation
Quinnell et al.
Chest 2006;129:133-139.
ABSTRACT | FULL TEXT  

Outcomes, cost and long term survival of patients referred to a regional weaning centre
Pilcher et al.
Thorax 2005;60:187-192.
ABSTRACT | FULL TEXT  

Prevalence and Outcomes of Caregiving After Prolonged ("=" BORDER="0"> 48 Hours) Mechanical Ventilation in the ICU
Im et al.
Chest 2004;125:597-606.
ABSTRACT | FULL TEXT  

Intensive care and invasive ventilation in the elderly patient, implications of chronic lung disease and comorbidities
Nielson and Wingete
Chronic Respiratory Disease 2004;1:43-54.
ABSTRACT  

2-Month Mortality and Functional Status of Critically Ill Adult Patients Receiving Prolonged Mechanical Ventilation
Chest 2002;121:549-558.
ABSTRACT | FULL TEXT  

Acute Respiratory Failure in the United States : Incidence and 31-Day Survival
Behrendt
Chest 2000;118:1100-1105.
ABSTRACT | FULL TEXT  

Four-Year Experience With a Unit for Long-term Ventilation (Respiratory Special Care Unit) at the Cleveland Clinic Foundation
Dasgupta et al.
Chest 1999;116:447-455.
ABSTRACT | FULL TEXT  

Mechanical Ventilation in a Cohort of Elderly Patients Admitted to an Intensive Care Unit
Ely et al.
ANN INTERN MED 1999;131:96-104.
ABSTRACT | FULL TEXT  

Outcome for Cancer Patients Requiring Mechanical Ventilation
Groeger et al.
JCO 1999;17:991-991.
ABSTRACT | FULL TEXT