Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis.

Details

Serval ID
serval:BIB_B61D5610A17A
Type
Article: article from journal or magazin.
Collection
Publications
Title
Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis.
Journal
Critical Care
Author(s)
Ray P., Birolleau S., Lefort Y., Becquemin M.H., Beigelman C., Isnard R., Teixeira A., Arthaud M., Riou B., Boddaert J.
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Publication state
Published
Issued date
2006
Volume
10
Number
3
Pages
R82
Language
english
Notes
Publication types: Comparative Study ; Journal Article
Abstract
INTRODUCTION: Our objectives were to determine the causes of acute respiratory failure (ARF) in elderly patients and to assess the accuracy of the initial diagnosis by the emergency physician, and that of the prognosis. METHOD: In this prospective observational study, patients were included if they were admitted to our emergency department, aged 65 years or more with dyspnea, and fulfilled at least one of the following criteria of ARF: respiratory rate at least 25 minute-1; arterial partial pressure of oxygen (PaO2) 70 mmHg or less, or peripheral oxygen saturation 92% or less in breathing room air; arterial partial pressure of CO2 (PaCO2) > or = 45 mmHg, with pH < or = 7.35. The final diagnoses were determined by an expert panel from the completed medical chart. RESULTS: A total of 514 patients (aged (mean +/- standard deviation) 80 +/- 9 years) were included. The main causes of ARF were cardiogenic pulmonary edema (43%), community-acquired pneumonia (35%), acute exacerbation of chronic respiratory disease (32%), pulmonary embolism (18%), and acute asthma (3%); 47% had more than two diagnoses. In-hospital mortality was 16%. A missed diagnosis in the emergency department was noted in 101 (20%) patients. The accuracy of the diagnosis of the emergency physician ranged from 0.76 for cardiogenic pulmonary edema to 0.96 for asthma. An inappropriate treatment occurred in 162 (32%) patients, and lead to a higher mortality (25% versus 11%; p < 0.001). In a multivariate analysis, inappropriate initial treatment (odds ratio 2.83, p < 0.002), hypercapnia > 45 mmHg (odds ratio 2.79, p < 0.004), clearance of creatinine < 50 ml minute-1 (odds ratio 2.37, p < 0.013), elevated NT-pro-B-type natriuretic peptide or B-type natriuretic peptide (odds ratio 2.06, p < 0.046), and clinical signs of acute ventilatory failure (odds ratio 1.98, p < 0.047) were predictive of death. CONCLUSION: Inappropriate initial treatment in the emergency room was associated with increased mortality in elderly patients with ARF.
Keywords
Acute Disease, Aged, Aged, 80 and over, Emergency Medical Services/methods, Emergency Service, Hospital, Female, Hospital Mortality, Humans, Male, Physicians, Prognosis, Prospective Studies, Pulmonary Edema/complications, Pulmonary Edema/diagnosis, Respiratory Insufficiency/diagnosis, Respiratory Insufficiency/etiology
Pubmed
Open Access
Yes
Create date
31/08/2011 12:46
Last modification date
20/08/2019 15:24
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