Patients aged 90 years or older in the intensive care unit.
BACKGROUND
Age is an important prognostic factor in patients admitted to intensive care units (ICUs), but it is not as important as illness severity. However, age seems to remain an important independent triage criterion for ICU admission, and 90 years of age seems to represent a psychological barrier for many ICU physicians. The aim of this preliminary study is to compare the management and outcome of patients aged 90 years or older admitted to a respiratory ICU with those of patients aged 70 years or younger.


METHODS
In our matched case-control study over a 6-year period, 36 patients aged 90 years or older (case patients) were selected and matched according to sex with 72 controls chosen in the 20- to 69-year age range. The Simplified Acute Physiology Score (SAPS) II was then computed without using age as a variable.


RESULTS
Pre-existing comorbidities were significantly less frequent in cases than in controls (5.1% vs 30.5%, p <.01). Compared to controls, cases were more frequently admitted for cardiac failure (22% vs 7%, p <.05) and less frequently for neurological diseases (0% vs 11%, p <.05). The use of advanced life-support measures in the ICU such as mechanical ventilation, central venous or arterial catheterization, and vasoactive and/or inotropic drugs was not significantly different between case patients and controls. This was also the case for ICU mortality and for the mean duration of ICU and hospital stay. Although there was a trend toward a higher hospital mortality among case patients than among controls, it did not reach statistical significance (47% vs 27%, p =.07).


CONCLUSIONS
Our results reinforce the idea that age alone is not a relevant criterion for ICU admission.
Demoule
Alexandre
A
Unité de Réanimation, Service de Pneumologie et de Réanimation, Groupe Hospitalier Pitié-SalpItriêre, 47-83, Bd de l'Hôpital, 75651 Paris Cedex 13, France. alexandre.demoule@psl.ap-hop-paris.fr
Cracco
Christophe
C
Lefort
Yannick
Y
Ray
Patrick
P
Derenne
Jean-Philippe
JP
Similowski
Thomas
T
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies