title: The Outcomes and Prognostic Factors of the Very Elderly Requiring Prolonged Mechanical Ventilation in a Single Respiratory Care Center.
abstract: This study investigated the outcomes and the prognostic factors among the very elderly (patients ≥80 years old) requiring prolonged mechanical ventilation (PMV).Between 2006 and 2014, all of the very elderly patients of age 80 or more transferred to respiratory care center (RCC) of a tertiary medical center were retrospectively identified, and only patients who used mechanical ventilation (MV) for >3 weeks were included in this study.A total of 510 very elderly patients undergoing PMV were identified. The mean age of the patients was 84.3 ± 3.3 years, and it ranged from 80 to 96 years. Male comprised most of the patients (n = 269, 52.7%), and most of the patients were transferred to RCC from medical ICU (n = 357, 70.0%). The APACHE II scores on RCC admission was 17.6 ± 6.0. At least 1 comorbidity was found in 419 (82.2%) patients. No significant differences of gender, disease severity, diagnosis, dialysis, laboratory examinations, comorbidities, and outcome were found between octogenarians (aged 80-89) and nonagenarians (aged ≥ 90). The overall in-hospital mortality rate was 21.8%. In the multivariate analysis, patients who had APACHE II score ≥ 15(odds ratio [OR], 2.30, 95% confidence interval [CI], 1.36-3.90), or albumin ≤ 2 g/dL (OR, 3.92, 95% CI, 2.17-7.01) were more likely to have significant in-hospital mortality (P < 0.05).The in-hospital mortality rate of the very elderly PMV patients in our RCC is 21.8%, and poor outcomes in this specific population were found to be associated with a higher APACHE II score and lower albumin level.
authors.affiliation: From the Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying (C-CL); Department of Internal Medicine (S-CK, K-LT, K-CC); Intensive Care Medicine (C-MC); Medical research, Chi Mei Medical Center, Tainan(C-MC); Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung (S-FW); and Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan (K-CC).
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
authors.forename: Shian-Chin
authors.initials: SC
authors.lastname: Ko
authors.forename: Chin-Ming
authors.initials: CM
authors.lastname: Chen
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.forename: Kuei-Ling
authors.initials: KL
authors.lastname: Tseng
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Cheng
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods* / Q000401:mortality; D012124:Respiratory Care Units; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome