RESUMO
OBJECTIVE: To describe ICU admission triage and outcomes in octogenarians. DESIGN: Multicenter prospective observational study. SETTING: Three nonuniversity hospitals and three university hospitals in Norway. PATIENTS: Patients 80 years old or older who were referred for ICU admission from November 2013 to October 2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 355 included patients, 105 (29.6%) were refused ICU treatment. Risk factors for ICU refusal in patients considered "too ill/old" were advanced age and low functional status. Risk factors for ICU refusal in patients considered "too well" were advanced age, male sex, university hospital admission, comorbidity, and low Simplified Acute Physiology Score 3. Overall ICU survival was 71.6%. Hospital and 1-year survival were 56.0% and 40.0% in the ICU-admitted, 65.2% and 50.0% in the nonadmitted patients considered too well, and 32.7% and 11.5% in patients considered too ill/old, respectively. The adjusted Kaplan-Meier curves showed significantly lower survival for nonadmitted patients considered too ill/old than for ICU-admitted patients and nonadmitted patients considered too well. At follow-up, triage patients had lower health-related quality of life than an age- and sex-matched control group in the domains of self-care, usual care, and anxiety and depression, and a lower EuroQol visual analog scale scores. CONCLUSIONS: Overall, 29.6% of the patients were refused ICU treatment. The adjusted survival analyses showed a significantly higher survival for ICU-admitted octogenarians than for nonadmitted patients who were considered too ill/old, indicating a benefit of ICU admission. Overall, the follow-up of triage patients showed lower health-related quality of life than an age- and sex-matched control population.
Assuntos
Nível de Saúde , Unidades de Terapia Intensiva , Admissão do Paciente , Recusa em Tratar , Índice de Gravidade de Doença , Triagem , Fatores Etários , Idoso de 80 Anos ou mais , Estado Terminal/mortalidade , Estado Terminal/terapia , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Noruega , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Qualidade de Vida , Taxa de Sobrevida , Fatores de TempoRESUMO
We describe a case where inhaled nitric oxide (iNO) was successfully initiated during cardiopulmonary resuscitation (CPR) in a younger patient with cardiac arrest related to pulmonary hypertension after disseminated intravascular coagulation (DIC) postpartum bleeding and hysterectomy. This case illustrates that iNO might be a potential lifesaving tool for resuscitation of patients with cardiac arrest related to pulmonary hypertension, for whom most other resuscitation strategies often are futile.
Assuntos
Administração por Inalação , Broncodilatadores/administração & dosagem , Reanimação Cardiopulmonar , Parada Cardíaca/tratamento farmacológico , Parada Cardíaca/etiologia , Hipertensão Pulmonar/complicações , Óxido Nítrico/administração & dosagem , Adulto , Broncodilatadores/uso terapêutico , Feminino , Humanos , Óxido Nítrico/uso terapêutico , Respiração ArtificialRESUMO
The European HEMS and Air ambulance Committee's Medical working group recently published Best Practice advice on pre-hospital emergency anaesthesia and advanced airway management. We believe that this initiative is important. In our opinion however, the competence requirements recommended by the authors do not meet the standards that we should aim for in HEMS services. We argue that pre-hospital emergency anaesthesia should be delivered with a competence level approximating in-hospital standard. In our experience, our patients benefit from pre-hospital emergency anaesthesia delivered by consultants with regular in-hospital rotations and a sound clinical governance system.