In-hospital and long-term prognosis of elderly patients requiring endotracheal intubation for life-threatening presentation of cardiogenic pulmonary edema
F. Adnet et al., In-hospital and long-term prognosis of elderly patients requiring endotracheal intubation for life-threatening presentation of cardiogenic pulmonary edema, CRIT CARE M, 29(4), 2001, pp. 891-895
Objective: We studied the in-hospital course, long-term prognosis, and func
tional status of elderly patients with life-threatening cardiogenic pulmona
ry edema requiring mechanical ventilation.
Design: Semiprospective evaluation.
Setting: Twelve intensive care units and one emergency prehospital medical
department in university hospitals.
Patients: Patients, aged >75 yrs, with life-threatening cardiogenic pulmona
ry edema requiring invasive airway management during the prehospital phase
between January 1994 and January 1999 were included,
Intervention: None.
Measurements and Main Results:A total of 79 patients were studied, of which
55 were included in the prospective phase and 24 during the retrospective
phase. The age range was 75-99 yrs, with a mean age of 82.4 +/- 5,9, The ma
le/female ratio was 35:44, The in-hospital mortality was 26,6%, The mean fo
llow-up time for all 58 survivors was 23 months (range, 2-56 months), Among
those discharged, survival at 1 yr was 69%, At 3 months after hospital dis
charge, 49 (87%) patients lived at home, 46 (82%) were able to bathe themse
lves, 35 (62%) could walk at least one block, and 34 (61%) could climb one
flight of stairs,
Conclusions: Mortality after severe pulmonary edema requiring endotracheal
intubation in a very elderly cohort has a predictably high mortality, altho
ugh not related directly to the degree of presenting respiratory compromise
, However, approximately 50% of the overall cohort returned to relatively g
ood functional status, despite advanced age and a severely compromised pres
entation. Aggressive airway management appears, therefore, justified in thi
s select group of patients.