In-hospital and long-term prognosis of elderly patients requiring endotracheal intubation for life-threatening presentation of cardiogenic pulmonary edema.
OBJECTIVE
We studied the in-hospital course, long-term prognosis, and functional status of elderly patients with life-threatening cardiogenic pulmonary edema requiring mechanical ventilation.


METHODS
Semiprospective evaluation.


METHODS
Twelve intensive care units and one emergency prehospital medical department in university hospitals.


METHODS
Patients, aged >75 yrs, with life-threatening cardiogenic pulmonary edema requiring invasive airway management during the prehospital phase between January 1994 and January 1999 were included.


METHODS
None.


RESULTS
A total of 79 patients were studied, of which 55 were included in the prospective phase and 24 during the retrospective phase. The age range was 75-99 yrs, with a mean age of 82.4 +/- 5.9. The male/female ratio was 35:44. The in-hospital mortality was 26.6%. The mean follow-up time for all 58 survivors was 23 months (range, 2-56 months). Among those discharged, survival at 1 yr was 69%. At 3 months after hospital discharge, 49 (87%) patients lived at home, 46 (82%) were able to bathe themselves, 35 (62%) could walk at least one block, and 34 (61%) could climb one flight of stairs.


CONCLUSIONS
Mortality after severe pulmonary edema requiring endotracheal intubation in a very elderly cohort has a predictably high mortality, although not related directly to the degree of presenting respiratory compromise. However, approximately 50% of the overall cohort returned to relatively good functional status, despite advanced age and a severely compromised presentation. Aggressive airway management appears, therefore, justified in this select group of patients.
Adnet
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SAMU 93, Hôpital Avicenne, Université Paris XIII, Bobigny Cedex, France. frederic.adnet@avc.ap-hop-paris.fr
Le Toumelin
P
P
Leberre
A
A
Minadeo
J
J
Lapostolle
F
F
Plaisance
P
P
Cupa
M
M
D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D005853:Geriatrics; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000401:mortality / Q000628:therapy*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome