Pre-hospital frailty and hospital outcomes in adults with acute respiratory failure requiring mechanical ventilation

Hope, Aluko A.; Adeoye, O.; Chuang, Elizabeth; Hsieh, Szu‐Chuan; Gershengorn, Hayley B.; Gong, Michelle N.

doi:10.1016/j.jcrc.2017.11.017

Cited by 12 publications

(10 citation statements)

References 24 publications

(38 reference statements)

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“…Initial analysis of 500 elderly patients identified eight variables significantly predictive of mortality including moderate-to-severe degrees of frailty, indicating that incorporating frailty into an ICU outcome model was appropriate – a result in agreement with much of the similar literature. 4,12,17–19 Six of these variables already have a large evidence base indicating these would be expected to be significant predictors of mortality in our population. However, two parameters (the presence of any ECG abnormality and a hospital stay ≥5 days preceding admission) were novel, statistically significant indicators in predicting mortality in patients over 70 years of age in our ICU patient population.…”

Section: Discussionmentioning

confidence: 90%

Using a CriSTAL scoring system to identify pre-morbid conditions associated with a poor outcome after admission to intensive care in people 70 years or older

Jankowski

Bryden

2018

Journal of the Intensive Care Society

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Older people admitted to intensive care are considered to have lower physiological reserves, an increased susceptibility to infection and longer recovery times, resulting in generally poorer outcomes after intensive care treatment. However, biological heterogeneity makes identification of those with the best chances of survival within their group difficult and risks subjecting those at the end of their lives to unsuccessful treatments. There is no fit-for-purpose outcome prediction tool capable of identifying patients most at risk of these poor outcomes at the point of admission to intensive care. This retrospective study sought to identify factors associated with mortality in older patients (≥70 years) admitted to a teaching hospital critical care unit using objective variables readily available at the point of admission. A total of 15 variables were tested for a significant association with mortality. Of these, eight were identified as significant variables (myocardial infarction within 6 months, an abnormal ECG, congestive cardiac failure (NYHA ≥2), chronic pulmonary disease, chronic liver disease, metastatic cancer, a stay in hospital ≥5 days preceding ICU admission, and frailty (Clinical Frailty Score ≥4)). These variables were used from the basis of a novel outcome prediction model. The aim of such a model would be that it could be used at the point of referral to intensive care to inform considerations regarding admission, and to facilitate conversations with the patient and family regarding realistic treatment expectations.

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Section: Discussionmentioning

confidence: 90%

Using a CriSTAL scoring system to identify pre-morbid conditions associated with a poor outcome after admission to intensive care in people 70 years or older

Jankowski

Bryden

2018

Journal of the Intensive Care Society

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“…Multiple comorbidities resulted in prolonged length of hospital stay. The previous studies have already reported that frailty and prolonged length of hospital stay in frail patients [ 11 , 21 , 22 ] are associated with poor long-term survival [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older

et al. 2018

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Background There is an increased need for permanent pacemaker (PPM) implantation for older patients with multiple comorbidities. The current guidelines recommend that, before implanting PPM, clinicians should discuss life expectancy with patients and their families as part of the decision-making process. However, estimating individual life expectancy is always a challenge. Aims We investigated predictors of long-term survival prior to PPM implantation in patients aged 80 or older. Methods and results From September 2004 to September 2015, 100 patients aged ≥ 80 years who received PPM implantation were included for retrospective survival analysis. The end point was all-cause mortality. Follow-up duration was 4.0 ± 2.7 years. By the end of the study, 54 patients (54%) had died. Of the 54 who died, 40 patients (74.1%) died of non-cardiac causes. Their survival rates at 1, 2, 3, 5, and 7 years were 90%, 76%, 54%, 32%, and 16%, respectively. Patients with a longer length of hospital stay before PPM implantation (LOS-B) [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.02–1.05, p < 0.001], estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m 2 (HR 4.07, 95% CI 1.95–8.52, p < 0.001), body mass index (BMI) < 21 kg/m 2 (HR 2.50, 95% CI 1.16–5.39, p = 0.02), and dyspnea as the major presenting symptom (HR 2.88, 95% CI 1.27–6.55, p = 0.01) were associated with lower cumulative survival. Conclusions Longer LOS-B, lower eGFR and BMI, and dyspnea as the major presenting symptom are pre-PPM implantation predictors of long-term survival in patients aged 80 or older.

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“…In traditional rescue protocols, the basic principle in traumatic shock is to facilitate fast anabiosis of patients through early and rapid venous replenishment of fluids so as to recover circulating blood volume, keep vital signs at a normal level to the maximum extent, and maintain hemoperfusion of important organs [7]. Relevant scholars have pointed out that supply of abundant blood, crystalloid solution, and other colloidal fluid is needed immediately in patients with hemorrhagic shock, and the total fluid infusion shall be 50%-100% higher than the blood loss volume [8].…”

Section: Discussionmentioning

confidence: 99%

Clinical effects of two types of fluid infusion in pre-hospital care for traumatic shock

Zhang¹,

Zhu²,

Fan³

et al. 2018

biomedicalresearch

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Objective: The aim of this study is to discuss the clinical effects of two types of fluid infusion in prehospital care for traumatic shock. Methods: A total of 100 patients with traumatic shock in our hospital from November 2016 to August 2017 were chosen and divided into the control group (n=50) and the treatment group (n=50) by random number table method. The control group was treated with the traditional fluid infusion method, and the treatment with subshock therapy. Salvage success rate, death rate, relevant clinical indexes, occurrence rate of complications, time to return of consciousness, and length of stay (LOS) between the two groups were observed and compared. Results: The treatment group shows significantly higher salvage success rate and far lower death rate compared with the control group (P<0.05). It is significantly superior to the control group in terms of hemoglobin, blood platelet count, infusion quantity, prothrombin time, and hematocrit (P<0.05). No significant difference of systolic pressure is observed between the two groups (P>0.05). Moreover, the treatment group has far lower occurrence rate of complications than the control group (P<0.05). The control group has longer time to return of consciousness and LOS than the treatment group, showing statistically significant differences (P<0.05). Conclusions: Subshock therapy can not only increase survival rate of patients with traumatic shock in pre-hospital care but also reduce the occurrence rate of complications and death rate. It has good prognosis and is worthy of extensive clinical promotions.

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Pre-hospital frailty and hospital outcomes in adults with acute respiratory failure requiring mechanical ventilation

Abstract: PHF, identified by frailty diagnoses from before index hospitalization, may be a useful approach for identifying adults with ARF at increased risk of hospital mortality and pLOS.

Cited by 12 publications

References 24 publications

Using a CriSTAL scoring system to identify pre-morbid conditions associated with a poor outcome after admission to intensive care in people 70 years or older

Using a CriSTAL scoring system to identify pre-morbid conditions associated with a poor outcome after admission to intensive care in people 70 years or older

Predictors of long-term survival prior to permanent pacemaker implantation in octogenarians or older

Clinical effects of two types of fluid infusion in pre-hospital care for traumatic shock

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