Factors associated to mortality of critical geriatrics patients admitted in intensive care
Keywords:
aged, health of the elderly, hospital mortality, critical care outcomes, prognosis.Abstract
Introduction: The determination of factors associated with the mortality of seriously ill geriatric patients, allows taking the measures that improve the prognosis.Objective: To determine the factors associated with the mortality of serious geriatric patients admitted to intensive care.
Method: An observational, prospective and longitudinal study was carried out in geriatric patients admitted to the intensive care unit of the Central Military Hospital "Dr. Luis Díaz Soto", from January to December 2014. The variables studied were: age, sex, mortality, prognostic indices (APACHE II and SOFA), diagnostic profile, therapeutic methods, mechanical ventilation time and causes of death. Statistical analysis was performed with the chi square test and a confidence level of 95%.
Results: 220 patients were studied, there was a predominance of the male sex (53.6%), age less than 80 years (79%), APACHE II index less than 20 points (70.4%), SOFA index less than or equal to 5 points, (67.7%) and clinical profile (66.8%). Mortality was 39.5% and was associated with age less than 80 years, female sex, APACHE II index and SOFA greater than 20 and 5 points, respectively, clinical profile and mechanical ventilation time greater than 7 days. The most frequent direct cause of death was septic shock and the basic cause, atherosclerotic disease.
Conclusions: Higher mortality associated with age, sex, APACHE II and SOFA indexes, diagnostic profile and mechanical ventilation time were evidenced.
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References
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24. Littich A. Síndrome coronario agudo. En: Ciesielski TM, de Fer TM. Manual Washington en medicina interna hospitalaria. 3ra ed. Philadelphia: Wolters Kluwer; 2018. p79-98.
25. Hollemberg SM. Myocardial ischemia. En: Hall JB, Schmidt GA, Kress JP. Principles of Critical Care. 4ta ed. New York: McGraw-Hill Education; 2015. p 293-308.
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27. Maestre Romero A, Ruiz de Azúa López Z. Retirada de la ventilación mecánica: destete. En: Montejo González JC, García de Lorenzo A , Marco Garde MP, Ortiz Leyba C, editores. Manual de Medicina Intensiva. 5ta ed. Barcelona: Elsevier; 2017. p 21-24.
28. Singer M, Deutschman CS, Seymour CW, Shankar Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016[acceso:10/12/2016];315(8):801-810. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968574/
29. Bell SP, Orr MN, Dodson JA, Rich MW ,Wenger NK, Blum K, et al. What to expect from the evolving field of Geriatric Cardiology. Journal of the American College of Cardiology. 2015. [acceso: 19/09/2016];66(11):1286-89. Disponible en: https://www.onlinejacc.org/content/accj/66/11/1286.full.pdf
30. Ministerio de Salud Pública. Anuario Estadístico de Salud. La Habana: Dirección de Registros Médicos y Estadísticas de Salud 2017. 2018. [acceso: 03/09/2018]. Disponible en: https://files.sld.cu/dne/files/2018/04/Anuario-Electronico-Espa%C3%B1ol-2017-ed-2018.pdf
31. Borja García-Cosío Piqueras B, Agustí García-Navarro A. Enfermedad pulmonar obstructiva crónica: concepto, factores etiológicos y patogenia. En: Alvarez-Sala Walther JL, Casan Clará P, Rodríguez de Castro F, Rodríguez Hermosa JL, Villena Garrido V. Neumología Clínica. 2da ed. Barcelona: Elsevier; 2017. p 168-74.
2. OMS. Informe mundial sobre el envejecimiento y la salud. Ginebra: Ediciones de la OMS. 2015.[acceso: 14/11/2016]. Disponible en: https://apps.who.int/iris/bitstream/handle/10665/186466/9789240694873 _spa.pdf; jsessionid=99B13B59C58587178E185EE69E20DFE0?sequence=1
3. de Cabo R, Le Couteur DG. Biología del envejecimiento. En: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editores. Harrison. Principios de Medicina Interna. Vol 1. 19ª ed. México DF: McGraw-Hill Interamericana. 2016. p457.
4. Bonne SL, Livingston DH. Changes in Organ Physiology in the aging adult. Current Trauma Reports. 2014 [acceso: 16/12/2017];3:8-12. Disponible en: https://doi.org/10.1007/s40719-016-0069-4
5. Fuchs L, Novack V, McLennan S, Celi LA, Baumfeld Y, Park S, et al. Trends in Severity of Illness on ICU Admission and Mortality among the Elderly. PlosOne. 2014[acceso: 14/03/2016];9(4):e93234. Disponible en: https://doi.org/10.1371/journal.pone.0093234
6. Russell JA. Assessment of Severity of Illness. In: Hall JB, Schmidt GA, Kress JP Principles of Critical Care. 4th ed. New York: McGraw-Hill Education; 2015.p 83-96.
7. Roch A, Wiramus S, Pauly V, Forel JM, Guervilly C, Gainnier M, et al. Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care. 2011[acceso: 07/04/2017];15(R36):1-7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222073/pdf/cc.9984.pdf
8. Lai CC, Ko SC, Chen CM, Weng SF, Tseng KL, Cheng KC. The outcomes of prognostic factors of the very elderly requiring prolonged mechanical ventilation in a single respiratory center. Medicine. 2016 [acceso: 07/09/2017];95(2):1-5. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718278/
9. Tripathy S . Geriatric Critical Care in India. Indian J Crit Care Med. 2015[acceso: 08/07/2017];19(3):191-2. Disponible en: https://europepmc.org/article/pmc/pmc4366927
10. Dávila Cabo de Villa, E. Riesgo anestésico. Anestesia en el anciano. 2da Edición. Editorial Ciencias Médicas: La Habana; 2015.
11. Desserud KF, Veen T, Soreide K. Emergency general surgery in the geriatric patient. BJS. 2016[acceso: 07/09/2017];103:e52-61. Disponible en: https://www.surgeon.co.za/wp-content/uploads/2016/01/Desserud_et_al-British_Journal_of_Surgery.pdf
12. Larrondo Muguercia HM, Martinez Alfonso JL, Leon Perez DO, Gutierrez Rojas AR. Valoración de una escala de disfunción multiorgánica como pronóstica de mortalidad en una terapia intensiva. Rev Cub Med Int Emerg. 2014[acceso: 11/02/2017];13(4):425-439. Disponible en: https://www.revmie.sld.cu/index.php/mie/article/view/50/120
13. Estrella A, Frutos Vivar F, Esteban A. Epidemiología de la ventilación mecánica. En: Carrillo Esper R. Ventilación mecánica. México DF: Editorial Alfil; 2013. p11 -24.
14. Ayuso Baptista F, Artacho Ruiz R, Berlango Jiménez A, Calderón de la Barca Gázquez JM, Montero Pérez FJ, Jiménez Murillo L. Ventilación mecánica no invasiva. En: Jiménez Murillo L, Montero Pérez FJ, editores. Medicina de urgencias y emergencias. Guía diagnóstica y protocolos de actuación. 5ta ed. Barcelona: Elsevier; 2015. p194-6.
15. Ferrer Monreal M. Ventilación mecánica. En: Álvarez-Sala Walther JL, Casan Clara P, Rodríguez de Castro F, Rodríguez Hermosa JL, Villena Garrido V, editores. Neumología Clínica. 2da ed. Barcelona: Elsevier; 2017. p806-810.
16. Cambridge B, Willman M, Wessman BT. Procedimientos: Manejo del ventilador. En: Levine MD, Gilmore WS. Editores. Manual Washington de medicina de urgencias. Philadelphia: Wolters Kluger; 2018. p847-854.
17. Valente Barbas CS, Marini Ísola A, de Carvalho Farias AM, Biasi Cavalcanti A, Casati Gama AM, Magalhães Duarte AC, et al. Brazilian recommendations of mechanical ventilation 2013. Part I. Rev Bras Ter Intensiva. 2014[acceso: 29/09/2017];26(2):89-121. Disponible en: https://www.scielo.br/pdf/rbti/v26n2/en_0103-507X-rbti-26-02-0089.pdf
18. Aggarwal V, Singh R, Bahadur Singh J, Bawa JPS, Gaur N, Kumar S, et al. Outcomes of Mechanically Ventilated Critically Ill Geriatric Patients in Intensive Care Unit. J Clin Diagn Res . 2017[acceso: 29/09/2017];11(7): OC01-OC03. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583825/
19. García Gómez A, Gutiérrez Gutiérrez L, Goenaga Martínez N, Hernández Hernández I, Coca Machado JL. Pacientes en ventilación mecánica con traqueostomía. Rev Cub Med Milit. 2014[acceso: 09/09/2017];43(4):[aprox.14 p.]. Disponible https://scielo.sld.cu/scielo.php?pid=S0138-65572014000400002&script=sci_arttext&tlng=pt
20. Ho YM, Wysocki AP, Hogan J, White H. An audit of characteristics and outcomes in adult intensive care patients following tracheostomy. Indian J Crit Care Med. 2012[acceso:02/07/2016];16:100-5. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3439770/
21. Wu SC, Fu CY, Hsieh CH, Wang YC, Lo HC, Cheng HT, et al. Early predictors for tissue healing deficit and leakage in geriatric critically ill patients receiving emergent abdominal surgery: a case control study. Int J Surg. 2014[acceso: 23/09/2017]; 12(4):315-9. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed?linkname=pubmedpubmed&from_uid=-24486934
22. Pascoal G. Drogas vasoactivas. En: Remigio de Oliveira A, Utino Taniguchi L, Park M, Scalabrini Neto A, Tadeu Velasco I. Manual da Residência de Medicina Intensiva 4ta edición. Sao Paulo: Editora Manole Ltda; 2013. p27.
23. Llancaqueo M. Manejo del síndrome coronario agudo en el paciente adulto mayor. Rev. Med. Clin. Las Condes 2017[acceso: 05/03/2017];28(2):291-300. Disponible en: https://www.elsevier.es/es-revista-revista-medica-clinica-las-condes-202-articulo-manejo-del-sndrome-coronario-agudo-S0716864017300457
24. Littich A. Síndrome coronario agudo. En: Ciesielski TM, de Fer TM. Manual Washington en medicina interna hospitalaria. 3ra ed. Philadelphia: Wolters Kluwer; 2018. p79-98.
25. Hollemberg SM. Myocardial ischemia. En: Hall JB, Schmidt GA, Kress JP. Principles of Critical Care. 4ta ed. New York: McGraw-Hill Education; 2015. p 293-308.
26. Loss SH, de Oliveira RP, Maccari JG, Savi A, Boniatti MM, Hetzel MP, et al. The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Rev Bras Ter Intensiva. 2015[acceso:20/04/2017];27(1):26-35. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396894/
27. Maestre Romero A, Ruiz de Azúa López Z. Retirada de la ventilación mecánica: destete. En: Montejo González JC, García de Lorenzo A , Marco Garde MP, Ortiz Leyba C, editores. Manual de Medicina Intensiva. 5ta ed. Barcelona: Elsevier; 2017. p 21-24.
28. Singer M, Deutschman CS, Seymour CW, Shankar Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016[acceso:10/12/2016];315(8):801-810. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968574/
29. Bell SP, Orr MN, Dodson JA, Rich MW ,Wenger NK, Blum K, et al. What to expect from the evolving field of Geriatric Cardiology. Journal of the American College of Cardiology. 2015. [acceso: 19/09/2016];66(11):1286-89. Disponible en: https://www.onlinejacc.org/content/accj/66/11/1286.full.pdf
30. Ministerio de Salud Pública. Anuario Estadístico de Salud. La Habana: Dirección de Registros Médicos y Estadísticas de Salud 2017. 2018. [acceso: 03/09/2018]. Disponible en: https://files.sld.cu/dne/files/2018/04/Anuario-Electronico-Espa%C3%B1ol-2017-ed-2018.pdf
31. Borja García-Cosío Piqueras B, Agustí García-Navarro A. Enfermedad pulmonar obstructiva crónica: concepto, factores etiológicos y patogenia. En: Alvarez-Sala Walther JL, Casan Clará P, Rodríguez de Castro F, Rodríguez Hermosa JL, Villena Garrido V. Neumología Clínica. 2da ed. Barcelona: Elsevier; 2017. p 168-74.
Published
2020-10-06
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Hernández Pedroso W, González Mesana R, Rittoles Navarro A, Venegas Rodríguez R, Santana Sánchez R, Chacón Montano D. Factors associated to mortality of critical geriatrics patients admitted in intensive care. Rev Cubana Med Milit [Internet]. 2020 Oct. 6 [cited 2025 Jan. 9];49(4):e0200595. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/595
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