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Author´s contribution G. Voga prepared the manuscript; L. Gabršček-Parežnik analyzed and collected the data and revised the manuscript.
The aim of this retrospective study was to analyze differences in the initial hemodynamic assessment and its impact on the treatment in patients aged 80 years or older compared to younger patients during the first 6 h after admission to the medical intensive care unit (ICU).
We analyzed 615 consecutive patients admitted to the medical ICU of which 124 (20%) were aged 80 years or more. The older group had a significantly higher acute physiology and chronic health evaluation (APACHE II) score, an overall mortality in the ICU and a presence of pre-existing cardiac disease. Both groups did not differ in the presence of shock and shock types on admission. In 57% of older and in 56% of younger patients, transthoracic echocardiography was performed with a higher therapeutic impact in the older patients. Transesophageal echocardiography was performed in 3% of the patients in both groups for specific diagnostic problems. Early reassessment with transthoracic echocardiography was necessary in 5% of the older and in 6% of the younger patients and resulted in a change of the treatment in one third of the patients. Continuous invasive hemodynamic monitoring was used in 11% of the older and in 10% of the younger patients and resulted in a therapeutic change in 71% of the older and in 64% of the younger patients.
Patients aged 80 years or older represent 20% of all admissions to the medical ICU. Once admitted the older patients were similarly hemodynamically assessed as the younger ones with a similar impact on the treatment.
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AzuRea group, Muller L, Bobbia X, Toumi M, et al. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Crit Care. 2012;16:R188. CrossRef
Garrouste-Orgeas M, Boumendil A, Pateron D, Aergerter P, Somme D, Simon T, Guidet B. Selection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: an observational, multicenter, prospective study. Crit Care Med. 2009;37(11):2919–28. CrossRefPubMed
De Rooij SE, Govers AC, Korevaar JC, Giesbers AW, Levi M, de Jonge E. Cognitive, functional, and quality-of-life outcomes of patients aged 80 and older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment. J Am Geriatr Soc. 2008;56:816–22. CrossRefPubMed
Fuchs JB, Goerge G, Morschel C, Bruch C, Erbel R. Wert der echocardiography auf einer algemeininternistischen intensivstation. Intensivmed Notfallmed. 1997;34:549–55. CrossRef
Manasia A, Cucu D, Oropello J, DelGiudice R, Hufanda J, Benjamin E. Clinical impact of early goal-directed echocardiography in shock patients performed by non-cardiologist intensivists free to view. Chest. 2005;128:222. CrossRef
Hofer CK, Cecconi M, Marx G, della Roca G. Minimally invasive hemodynamic monitoring. Eur J Anesthesiol. 2009;26:996–1002. CrossRef
- Early hemodynamic assessment and treatment of elderly patients in the medical ICU
MD, Ph.D., EDIC Assoc. Prof. Gorazd Voga
MD Lucija Gabršček-Parežnik
- Springer Vienna