RESUMO
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.
Assuntos
Injúria Renal Aguda , Unidades de Terapia Intensiva , Injúria Renal Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Mortalidade Hospitalar , Hospitalização , Humanos , Estudos RetrospectivosRESUMO
BACKGROUND & AIMS: COVID-19 patients present a high hospitalization rate with a high mortality risk for those requiring intensive care. When these patients have other comorbid conditions and older age, the risk for severe disease and poor outcomes after ICU admission are increased. The present work aims to describe the preliminary results of the ongoing NUTRICOVID study about the nutritional and functional status and the quality of life of adult COVID-19 survivors after ICU discharge, emphasizing the in-hospital and discharge situation of this population. METHODS: A multicenter, ambispective, observational cohort study was conducted in 16 public hospitals of the Community of Madrid with COVID-19 survivors who were admitted to the ICU during the first outbreak. Preliminary results of this study include data retrospectively collected. Malnutrition and sarcopenia were screened at discharge using MUST and SARC-F; the use of healthcare resources was measured as the length of hospital stay and requirement of respiratory support and tracheostomy during hospitalization; other study variables were the need for medical nutrition therapy (MNT); and patients' functional status (Barthel index) and health-related quality of life (EQ-5D-5L). RESULTS: A total of 176 patients were included in this preliminary analysis. Most patients were male and older than 60 years, who suffered an average (SD) weight loss of 16.6% (8.3%) during the hospital stay, with a median length of stay of 53 (27-89.5) days and a median ICU stay of 24.5 (11-43.5) days. At discharge, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, respectively, but only 38% were prescribed MNT. In addition, more than 70% of patients had significant impairment of their mobility and to conduct their usual activities at hospital discharge. CONCLUSIONS: This preliminary analysis evidences the high nutritional and functional impairment of COVID-19 survivors at hospital discharge and highlights the need for guidelines and systematic protocols, together with appropriate rehabilitation programs, to optimize the nutritional management of these patients after discharge.
Assuntos
COVID-19 , Desnutrição , Sarcopenia , Adulto , Humanos , Masculino , Feminino , Qualidade de Vida , COVID-19/epidemiologia , Sarcopenia/epidemiologia , Estado Funcional , Estudos Retrospectivos , Unidades de Terapia Intensiva , Hospitalização , Sobreviventes , Desnutrição/epidemiologia , Surtos de Doenças , Estado NutricionalRESUMO
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)
Assuntos
Humanos , Idoso de 80 Anos ou mais , Unidades de Terapia Intensiva , Hospitalização , Mortalidade , Estudos TransversaisRESUMO
BACKGROUND & AIMS: To assess the effect of an enteral diet enriched with eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA), and anti-oxidants on the incidence of organ dysfunction and nosocomial infections in septic patients with acute lung injury or acute respiratory distress syndrome (ARDS) compared with a standard enteral diet. METHODS: This prospective, randomized, open-label study was performed in 11 Spanish intensive care units (ICU). Adult patients with sepsis and acute lung injury or ARDS were randomly allocated to receive either an EPA-GLA diet or a control diet. RESULTS: Of the 198 patients that were eligible, 160 were randomized and 132 were studied. Patient demographics, APACHE II and SOFA scores, and nutritional variables on admission were similar between the EPA-GLA diet and control diet groups. The EPA-GLA diet group showed a trend toward a decreased SOFA score, but it was not significant. No differences were observed in the PaO(2)/FiO(2) ratio or the days on mechanical ventilation between the groups. Incidence of infections was similar in the groups. The control group stayed longer in the ICU than the EPA-GLA diet group (16 vs. 18; p = 0.02). CONCLUSIONS: A diet enriched with EPA, GLA, and anti-oxidants does not improve gas exchange or decrease the incidence of novel organ failures in critically ill septic patients with acute lung injury or ARDS. Patients treated with the EPA-GLA diet stayed in the ICU for less time, but we did not find any differences in infectious complications.