The impact of frailty on noninvasive mechanical ventilation in elderly medical intensive care unit patients.

AIM: Many factors affecting noninvasive ventilation (NIV) in critically ill patients have been reported in the literature, but there is no study about the effect of frailty. With this study, the frailty prevalence was evaluated with two different frailty scores among the NIV population of a medical intensive care unit (ICU). Besides, the impact of frailty on NIV success and mortality and its association with NIV application problems were evaluated. METHOD: A prospective observational cohort study was performed on patients who were over 50 years of age and assigned to NIV due to hypercapnic respiratory failure. For the assessment of frailty, Clinical Frailty Scale (CFS) and The Edmonton Frailty Scale (EFS) were used and the ones with CFS ≥5 and EFS ≥8 were considered as fragile. The study population was classified and compared according to NIV success, ICU outcome (discharge or exitus) and NIV application problems. RESULTS: A total of 103 patients with the mean age of 73 ± 11 years were included. The incidence of frailty was 41% with CFS ≥5 and 36% with EFS ≥8. The NIV failure occurred in 30 (29%) patients. Among them frailty and SOFA score was higher; Glasgow Coma Scale (GCS) was lower. In multivariate analysis GCS (OR: 1.2, p: 0.042) and frailty with EFS (OR: 2.8, p: 0.027) were identified as independent risk factors of NIV failure. Sixty-five (63%) patients had NIV application problems and frailty was higher among them with both CFS and EFS (p < 0.05). Mortality occurred in 18 (17%) patients; NIV failure and frailty according to CFS were independent risk factors of mortality. CONCLUSION: The frailty is associated with higher NIV application problems, failure and mortality risk in elderly ICU patients. The CFS and EFS frailty scores can be used to predict NIV success and outcomes in ICUs.

Living donor kidney volume as a predictor of graft function: is there a role for proteinuria?

BACKGROUND: The proposed mechanism by which nephron underdosing contributes to graft failure is hyperfiltration damage leading to proteinuria and nephron loss. We evaluated whether proteinuria had an impact on the relationship between graft size and outcome in living donor kidney transplantation. METHODS: We analyzed 69 living donors and their recipients who underwent transplantation between 2003 and 2007. Transplanted kidney volumes were measured by 3-D helical computed tomography scanning. A transplant kidney volume-recipient body weight (Vol/Wt) ratio was calculated for each donor-recipient pair. The subjects were divided into tertiles according to Vol/Wt ratios: low (<2.0), medium (2.0-2.7) and high (>2.7). RESULTS: Recipient glomerular filtration rate (GFR) positively correlated with Vol/Wt ratio at 6, 12, and 24 months posttransplantation (r = .49, P < .001; r = .47, P < .001; r = .42, P < .001, respectively). Mean GFR increased significantly in graded fashion from low to high Vol/Wt ratio groups at 6, 12, and 24 months posttransplantation. Proteinuria did not differ between the three groups during 24 months after transplantation. Upon multivariate analysis, donor age, recipient age, and Vol/Wt ratio showed significant impacts on graft function. CONCLUSION: Vol/Wt ratio displayed a significant independent effect on graft function in living donor kidney transplantation. This close association did not appear to be related to the degree of proteinuria during 24 months.