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1.
Am J Emerg Med ; 35(8): 1213.e5-1213.e8, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28526597

RESUMEN

Slow ventricular tachycardia (VT) in patients with devices such as an implantable cardioverter - defibrillator (ICD) is more common than in the rest of the population. The incidence in elderly patients with an ICD remains largely unknown. In younger patients, slow VT is generally asymptomatic or associated with limited clinical relevance. It may be efficiently and safely terminated by anti-tachycardia pacing. We present a case of slow VT in a 91-year-old man with ICD with type 1 acute respiratory failure and drowsiness. Very elderly patients who have poor cardiac reserve and minor deterioration in cardiac function can face serious consequences such as ventricular fibrillation, cardiac arrest, and sudden cardiac death. The persistent ventricular rhythm may have a deleterious effect on their haemodynamic status, with potential aggravation of symptoms of heart failure and further impairment of ventricular function.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Hipnóticos y Sedantes/uso terapéutico , Midazolam/uso terapéutico , Insuficiencia Respiratoria/terapia , Taquicardia Ventricular/terapia , Fibrilación Ventricular/fisiopatología , Anciano de 80 o más Años , Desfibriladores Implantables , Humanos , Masculino , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/fisiopatología , Fases del Sueño , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatología , Resultado del Tratamiento , Fibrilación Ventricular/complicaciones , Fibrilación Ventricular/terapia
2.
Aging Clin Exp Res ; 29(5): 833-845, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27761759

RESUMEN

Despite technological advances, the mortality rate for critically ill oldest old patients remains high. The intensive caring should be able to combine technology and a deep humanity considering that the patients are living the last part of their lives. In addition to the traditional goals of ICU of reducing morbidity and mortality, of maintaining organ functions and restoring health, caring for seriously oldest old patients should take into account their end-of-life preferences, the advance or proxy directives if available, the prognosis, the communication, their life expectancy and the impact of multimorbidity. The aim of this review was to focus on all these aspects with an emphasis on some intensive procedures such as mechanical ventilation, noninvasive mechanical ventilation, cardiopulmonary resuscitation, renal replacement therapy, hemodynamic support, evaluation of delirium and malnutrition in this heterogeneous frail ICU population.


Asunto(s)
Directivas Anticipadas , Cuidados Críticos/métodos , Enfermedad Crítica/terapia , Anciano de 80 o más Años , Comunicación , Enfermedad Crítica/mortalidad , Humanos , Unidades de Cuidados Intensivos , Pronóstico
3.
Aging Clin Exp Res ; 28(3): 407-12, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26253544

RESUMEN

BACKGROUND AND AIM: Acidosis is able to induce negative changes of different organs that increase progressively with aging. At present it is not known whether the levels of lactate may differently influence the prognosis of younger and older patients. Thus, the aim of this study is to evaluate the prognostic value of lactate levels after admission of younger and older patients to an acute intensive care unit. METHODS: Younger (<65 years, n = 118) and older (≥65 years, n = 165) patients admitted to an acute intensive care unit were prospectively enrolled and classified according to diagnosis of acute heart or/and respiratory failure. For each patient, APACHE II score, time of hospitalization and mortality, blood levels of lactate were collected. RESULTS: Both in-hospital mortality and lactate >2.5 mmol/L at the admission was higher in the older than in the younger patients (42.4 vs. 20.3 %, p < 0.01 and 57.8 vs. 31.9 %, p < 0.01, respectively). Lactate level was higher in older than in the younger patients both at admission and after 24 h (3.9 ± 3.4 vs. 2.4 ± 2.2 mmol/L and 2.4 ± 2.0 vs. 1.4 ± 1.3 mmol, p < 0.01, respectively). Accordingly, multivariate analysis shows that lactate was predictive of mortality in younger (OR = 2.65, 95 % CI 1.62-5.24, p = 0.03) and even more in the older (OR = 4.74, 95 % CI 2.10-6.70, p < 0.01) patients. CONCLUSIONS: Lactate concentration increase is associated with increased mortality in younger patients but, even more so, in older patients admitted to an acute intensive care unit. These results confirm the experimental evidence showing acidosis has a greater effect of leading to organ failure and higher mortality with increasing age.


Asunto(s)
Acidosis Láctica , Síndrome Coronario Agudo , Ácido Láctico/sangre , Insuficiencia Respiratoria , Acidosis Láctica/sangre , Acidosis Láctica/complicaciones , Acidosis Láctica/diagnóstico , Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/etiología , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/prevención & control , Anciano , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Insuficiencia Respiratoria/sangre , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/prevención & control
4.
Aging Clin Exp Res ; 26(6): 615-23, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24781827

RESUMEN

INTRODUCTION: A leading role for non-invasive ventilation (NIV), as comfort treatment or palliative care, is actually recognized for very old patients suffering from ARF. NIV was frequently used in both ICU and respiratory ICU (RICUs) for very old patients and it is associated with a reduced rate of endotracheal intubations and mortality. This study aims to evaluate the effects of NIV, performed in a setting of half-open geriatric ward with family support, in a cohort of very old patients with ARF and DNI decision. METHODS: A consecutive cohort of 20 very old patients with DNI decision was admitted in our 26-bed geriatric ward during a 6 months' period. DNI decision was obtained in emergency room with an intensive care physician supported by a psychologist. Pressure support ventilation was the first choice of NIV. NIV has been performed by three adequately trained geriatricians, with one of them experienced in ICU, and in close collaboration with intensive care physicians. Arterial blood gases, to assess the response to ventilation, were obtained after 1, 6 and 12 h. NIV settings were modified according to arterial blood gas analyses or respiratory fatigue, if needed. RESULTS: Therefore, 75% of patients were discharged home and 12 out of 20 patients had home respiratory support. PaO2/FiO2 ratio and pH increased while PaCO2 decreased during the 12 h of NIV with statistical significance. At the admission, alive patients had PaCO2 significantly lower than dead patients. After 12 h, alive patients had a better pH than dead patients. Dead patients experienced more complication than survivors. CONCLUSION: Very old DNI patients with ARF could be treated with NIV in half-open geriatric ward with trained physicians and nurses. The presence of family members may improve patients' comfort and reduce anxiety level even at the end of life. Further studies are needed to address the effective role of NIV in very old patients with DNI decisions.


Asunto(s)
Insuficiencia Respiratoria/terapia , Anciano de 80 o más Años , Humanos , Unidades de Cuidados Intensivos , Ventilación no Invasiva/métodos , Cuidados Paliativos/métodos , Insuficiencia Respiratoria/mortalidad
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