Old patients in intensive care unit (ICU): what decisions to make?
This report is aimed at identifying and suggesting a decision-making approach to handle old patients in ICUs in the light of current epidemiological findings and literature. We reviewed the data provided by the GIVITI network on 107,459 patients admitted to 150 Italian ICUs between 2000 and 2005; patients were divided into age groups (18-65 years: group I; 66-75 years: group II; 76-85 years: group III; > or =85 years: group IV). Comorbidities were recorded on admission in all groups [I (62.2%), II (92.2%), III (94.9%) and IV (94.5%), respectively]. Therapeutic means were virtually applied in the same way to all groups under examination [I (82.1%), II (83.9%), III (85.9%) and IV (83.5%), respectively]. Mortality in ICU was higher in group IV (27.2%), followed by groups III (24.3%), II (19.1%) and I (13.2%). The multivariate logistic regression analysis of GIVITI and some reviewed studies suggest that age is an independent mortality factor; however, current literature is controversial. The choice of admitting and treating old patients in ICUs should result from a balance between clinical and ethical factors.
Galzerano
Antonio
A
Anesthesiology and Resuscitation Department, Santa Maria della Misericordia Hospital, S. Andrea delle Fratte, I-06156 Perugia, Italy. Electronic address: antoniogalzerano@libero.it.
Sabatini
Elena
E
Anesthesiology and Resuscitation Department, Santa Maria della Misericordia Hospital, S. Andrea delle Fratte, I-06156 Perugia, Italy.
Durì
Davide
D
Anesthesiology and Resuscitation Department, Sant'Antonio Hospital, Viale Trento Trieste 8, I-33038 San Daniele del Friuli, Italy.
Rossi
Carlotta
C
Clinical Epidemiology Laboratory, Mario Negri Institute of Pharmacological Researches, Villa Camozzi, I-24020 Ranica, Italy.
Silvestri
Luciano
L
Anesthesiology and Resuscitation Department, Gorizia Hospital, Via Vittorio Veneto 171, I-34170 Gorizia, Italy.
Mazzon
Davide
D
Anaesthesiology and Resuscitation Department, S. Martino Hospital, Viale Europa 22, I-32100 Belluno, Italy.
Gullo
Antonino
A
Anesthesiology and Resuscitation Department, Cattinara Hospital, Strada di Fiume 447, I-34100 Trieste, Italy.
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003657:Decision Making; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics*; D007558:Italy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D028761:Withholding Treatment / Q000941:ethics*; D055815:Young Adult