ABSTRACT
BACKGROUND AND OBJECTIVES: The care of older patients in intensive care units (ICU) is becoming more frequent. To describe characteristics of elderly patients admitted to the ICU and to analyze the factors associated with mortality. PATIENTS AND METHODS: Retrospective cross-sectional study, with patients ≥80 years, admitted to the ICU of the Rey Juan Carlos University Hospital, from March 2012 to December 2018. Demographic variables, comorbidities and mortality in the ICU, in hospital and at one year were collected, analyzed by univariate analysis and binary logistic regression. RESULTS: Six hundred twenty patients, mean age 83.6 years (SD: 3.25), 31% required invasive mechanical ventilation (IMV), 25% vasopressors and 29% renal replacement therapy (RRT) due to acute renal failure (ARF). The 60% were admissions of medical origin. In-hospital mortality was 156 patients (25%), 91 died in the ICU and 65 on the ward, with shorter ICU stays for the survivors (2.72; SD: 0.22) compared to the deceased (3.74; SD: 0.38), with statistically significant differences. 63% remained alive one year after ICU discharge. An explanatory model of ICU mortality was obtained by logistic regression that included the following factors: IMV (OR: 5.78, 95% CI 2.73-12.22), vasopressors (OR: 2.54, 95% CI 1.24-5.19), AKI/TRS (OR: 2.69, 95% CI 1.35-5.35), medical admission (OR: 2.88, 95% CI 1.40-5.92), urgent admission (OR: 2.33, 95% CI 1.30-4.18) and limitation of life support (LTSV) (OR: 47.35, 95% CI 22.96-97.68). The days in the ICU (OR: 0.93, 95% CI 0.87-0.99) would be inversely related to mortality. CONCLUSIONS: In older patients, there is no increase in mortality, with a 1-year survival >63%. The need for IMV, the use of vasopressor drugs and ARF/RTS were factors associated with mortality in the multivariate analysis.
Subject(s)
Acute Kidney Injury , Intensive Care Units , Acute Kidney Injury/therapy , Aged , Aged, 80 and over , Cross-Sectional Studies , Hospital Mortality , Hospitalization , Humans , Retrospective StudiesABSTRACT
Antecedentes y objetivos: Cada vez es más frecuente la asistencia de los pacientes de más edad en las unidades de cuidados intensivos (UCI).Describir las características de los pacientes mayores ingresados en la UCI y analizar los factores asociados a la mortalidad.Pacientes y métodos: Estudio transversal retrospectivo, con pacientes ≥80 años, admitidos en la UCI del Hospital Universitario Rey Juan Carlos, desde marzo 2012 a diciembre 2018. Se recogieron variables demográficas, comorbilidades y mortalidad en la UCI, en hospital y al año, analizadas mediante análisis univariante y regresión logística binaria.Resultados: Seiscientos veinte pacientes, edad media 83,6 años (DE: 3,25), el 31% precisó ventilación mecánica invasiva (VMI), el 25% vasopresores y el 29% terapia renal sustitutiva (TRS) por fracaso renal agudo (FRA). El 60% fueron ingresos de origen médico. La mortalidad intrahospitalaria fue de 156 pacientes (25%), 91 fallecieron en la UCI y 65 en planta, siendo las estancias en la UCI más breves de los supervivientes (2,72; DE: 0,22) respecto a los fallecidos (3,74; DE: 0,38), con diferencias estadísticamente significativa. El 63% permanecieron vivos un año después del alta de la UCI.Se obtuvo un modelo explicativo de mortalidad en la UCI mediante regresión logística que incluía los siguientes factores: VMI (OR: 5,78; IC 95%: 2,73-12,22), vasopresores (OR: 2,54; IC 95%: 1,24-5,19), FRA/TRS (OR: 2,69; IC 95%: 1.35-5.35), ingreso médico (OR: 2,88; IC 95%: 1,40-5,92), ingreso urgente (OR: 2,33; IC 95%: 1,30-4,18) y limitación de soporte vital (LTSV) (OR: 47,35; IC 95%: 22,96-97,68). Los días en la UCI (OR: 0,93; IC 95%: 0,87-0,99) se relacionarían inversamente con la mortalidad.Conclusiones: En los pacientes mayores no hay un aumento de la mortalidad con una supervivencia al año >63%. La necesidad de VMI, el uso de fármacos vasopresores y FRA/TRS, fueron factores asociados a la mortalidad en el análisis multivariante. (AU)
Background and objectives: The care of older patients in intensive care units (ICU) is becoming more frequent.To describe characteristics of elderly patients admitted to the ICU and to analyze the factors associated with mortality.Patients and methods: Retrospective cross-sectional study, with patients ≥80 years, admitted to the ICU of the Rey Juan Carlos University Hospital, from March 2012 to December 2018. Demographic variables, comorbidities and mortality in the ICU, in hospital and at one year were collected, analyzed by univariate analysis and binary logistic regression.Results: Six hundred twenty patients, mean age 83.6 years (SD: 3.25), 31% required invasive mechanical ventilation (IMV), 25% vasopressors and 29% renal replacement therapy (RRT) due to acute renal failure (ARF). The 60% were admissions of medical origin. In-hospital mortality was 156 patients (25%), 91 died in the ICU and 65 on the ward, with shorter ICU stays for the survivors (2.72; SD: 0.22) compared to the deceased (3.74; SD: 0.38), with statistically significant differences. 63% remained alive one year after ICU discharge.An explanatory model of ICU mortality was obtained by logistic regression that included the following factors: IMV (OR: 5.78, 95% CI 2.73-12.22), vasopressors (OR: 2.54, 95% CI 1.24-5.19), AKI/TRS (OR: 2.69, 95% CI 1.35-5.35), medical admission (OR: 2.88, 95% CI 1.40-5.92), urgent admission (OR: 2.33, 95% CI 1.30-4.18) and limitation of life support (LTSV) (OR: 47.35, 95% CI 22.96-97.68). The days in the ICU (OR: 0.93, 95% CI 0.87-0.99) would be inversely related to mortality.Conclusions: In older patients, there is no increase in mortality, with a 1-year survival >63%. The need for IMV, the use of vasopressor drugs and ARF/RTS were factors associated with mortality in the multivariate analysis. (AU)
Subject(s)
Humans , Aged, 80 and over , Intensive Care Units , Hospitalization , Mortality , Cross-Sectional StudiesABSTRACT
To analyze whether there is improvement in adherence to inhaled treatment in patients with COPD and asthma after an educational intervention based on the teach-to-goal method. This is a prospective, non-randomized, single-group study, with intervention and before-after evaluation. The study population included 120 patients (67 females and 53 males) diagnosed with asthma (70.8%) and COPD (29.1%). The level of adherence (low and optimal) and the noncompliance behavior pattern (erratic, deliberate and unwitting) were determined by the Test of the adherence to Inhalers (TAI). This questionnaire allows you to determine the level of adherence and the types of noncompliance. Low Adherence (LowAd) was defined as a score less than 49 points. All patients received individualized educational inhaler technique intervention (IEITI). Before the IEITI, 67.5% of the patients had LowAd. Following IEITI, on week 24, LowAd was 55% (p = 0.024). Each patient can present one or more types of noncompliance. The most frequent type was forgetting to use the inhaler (erratic), 65.8%. The other types were deliberate: 43.3%, and unwitting: 57.5%. All of them had decreased on the final visit: 51.7% (p = 0.009), 25.8% (p = 0.002), 39.2% (p = 0.002). There were no significant differences in adherence between asthma and COPD patients at the start of the study. The only predicting factor of LowAd was the female gender. An individualized educational intervention, in ambulatory patients with COPD and asthma, in real-world clinical practice conditions, improves adherence to the inhaled treatment.
Subject(s)
Asthma , Pulmonary Disease, Chronic Obstructive , Administration, Inhalation , Asthma/epidemiology , Female , Humans , Male , Medication Adherence , Nebulizers and Vaporizers , Prospective Studies , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/epidemiologyABSTRACT
Muscle training, a component of pulmonary rehabilitation (PR), improves the physical performance of patients with chronic obstructive pulmonary disease (COPD). Despite the existing evidence, the traditional center-based PR model is applied to a small percentage of patients and presents numerous problems of accessibility, adherence, and costs. This study presents a home model of simple muscle training, non-presential, monitored by telephone and individualized, according to the severity of the COPD. In addition, to evaluate the results, simple tests associated with the physical performance of the lower limbs, previously validated in COPD, have been used, such as the four-meter walk, speed test (4MGS) and the five-repetition test sitting and standing (5STS). The objective was to evaluate whether the Individualized Non-Presential Exercise Training PrOgram (NIETO) induces improvements in the 4MGS, 5STS and quadriceps muscle strength (QMS) tests in outpatients with advanced COPD (FEV1 ≤ 50%). After one year, the QMS was significantly higher in the intervention group (IG) than in the control group (CG) (2.44 ± 4.07 vs. 0.05 ± 4.26 kg; p = 0.009). The 4MGS and 5STS tests were significantly shorter in IG than in CG (-0.39 ± 0.86 vs. 0.37 ± 0.96 s; p = 0.001) and (-1.55 ± 2.83 vs. 0.60 ± 2.06 s; p = 0.001), respectively. A home model of simple muscle training monitored by telephone such as NIETO, can improve 4MGS, 5STS, and quadriceps strength tests in outpatients with advanced COPD.
