Ventilating Elderly Not Futile

February 10, 2012 (Houston, Texas) — Extremely elderly individuals can survive mechanical ventilation, especially if they have good functional status before entering the hospital, according to a study presented here at the Society of Critical Care Medicine 41st Critical Care Congress.

"There is a perception that using mechanical ventilation in the elderly, especially people in their 80s, is futile, but we should not have a nihilistic approach to these individuals," Fouad Otaki, MD, from the Stamford Hospital in Connecticut, told Medscape Medical News.

Dr. Fouad Otaki

This is even more important when the utility of healthcare expenditures are being increasingly scrutinized, Dr. Otaki said.

In this study, Dr. Otaki and his coauthor, James Krinsley, MD, also from the Stamford Hospital, sought to determine whether age is an independent predictor of mortality and what the effect of an individual's preadmission functional status has on mortality.

They retrospectively reviewed prospectively collected data on 1940 patients with respiratory failure who were placed on mechanical ventilation in their hospital's 16-bed intensive care unit (ICU) from 2005 to 2011.

The patients were stratified into 4 age groups: 85 years or older (extreme elderly), 70 to 84 years, 50 to 69 years, and younger than 50 years.

The 260 extreme elderly patients were further categorized into 4 functional status groups: patients living at home and able to care for themselves, patients living at home but requiring care from a visiting nurse or family member, patients living in a nursing home or rehab facility, and patients completely dependent on caregivers for activities of daily living.

As expected, mortality was related to age. "Older patients pass away, which is not surprising. But placing them on mechanical ventilation was not futile," Dr. Otaki said.

Roughly half (51.5%) of the extreme elderly individuals survived to hospital discharge. There were no significant differences in resource use between the extreme elderly and the younger patients on mechanical ventilation.

The researchers also found that survival was strongly influenced by the patient's preadmission functional status. Patients who lived at home but who required care had the worst outcomes of all 4 functional status groups, Dr. Otaki said.

"This study suggests that we should consider age as a tool to triage patients entering the ICU, but we should also take into account their functional status. We should not dismiss extreme elderly patients; half of these patients survived their hospital course," he said.

"The utility of this study is when we talk to the families, when their grandmother or grandfather is in the ICU...about the DNR status, whether we should ventilate them or not, and what the outcomes are going to be. We all wish we had a crystal ball to tell them what is going to happen, but of course we don't," said Charu Paranjape, MD, from the Akron General Hospital in Ohio, who moderated the poster session.

"These kinds of studies are going to help us give them a ballpark figure of what might happen," he told Medscape Medical News.

Dr. Paranjape suggested that the researchers attempt to determine whether putting older patients on mechanical ventilation changed their functional status when they left the hospital. "It would be good to know the long-term outcome. Did mechanical ventilation change their functional status...? That would be useful information for us to have."

Dr. Otaki, Dr. Krinsley, and Dr. Paranjape have disclosed no relevant financial relationships.

Society of Critical Care Medicine (SCCM) 41st Critical Care Congress: Abstract 513. Presented February 6, 2012.