title: Early hemodynamic assessment and treatment of elderly patients in the medical ICU.
abstract: OBJECTIVE
  The aim of this retrospective study was to analyze differences in the initial hemodynamic assessment and its impact on the treatment in patients aged 80 years or older compared to younger patients during the first 6 h after admission to the medical intensive care unit (ICU).
  
  
  RESULTS
  We analyzed 615 consecutive patients admitted to the medical ICU of which 124 (20%) were aged 80 years or more. The older group had a significantly higher acute physiology and chronic health evaluation (APACHE II) score, an overall mortality in the ICU and a presence of pre-existing cardiac disease. Both groups did not differ in the presence of shock and shock types on admission. In 57% of older and in 56% of younger patients, transthoracic echocardiography was performed with a higher therapeutic impact in the older patients. Transesophageal echocardiography was performed in 3% of the patients in both groups for specific diagnostic problems. Early reassessment with transthoracic echocardiography was necessary in 5% of the older and in 6% of the younger patients and resulted in a change of the treatment in one third of the patients. Continuous invasive hemodynamic monitoring was used in 11% of the older and in 10% of the younger patients and resulted in a therapeutic change in 71% of the older and in 64% of the younger patients.
  
  
  CONCLUSIONS
  Patients aged 80 years or older represent 20% of all admissions to the medical ICU. Once admitted the older patients were similarly hemodynamically assessed as the younger ones with a similar impact on the treatment.
authors.affiliation: Department of Intensive Internal Medicine, General Hospital Celje, Oblakova 5, 3000, Celje, Slovenia. gorazd.voga@guest.arnes.si.
authors.forename: Gorazd
authors.initials: G
authors.lastname: Voga
authors.affiliation: Intensive Care Unit, Topolšica Hospital, Topolšica 63, 3326, Topolšica, Slovenia.
authors.forename: Lucija
authors.initials: L
authors.lastname: Gabršček-Parežnik
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003422:Critical Care / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006334:Heart Function Tests / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D012770:Shock, Cardiogenic / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D017524:Slovenia / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Echocardiography; Geriatric patients; Hemodynamic assessment; Intensive care; Invasive hemodynamic monitoring