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Mortality and long-term functional status after discharge from a medical ICU: a comparison between elderly (¿ 80 years) and young (\80 years) ICU patients

JUCARA GASPARETTO MACCARI, JAQUELINE SANGIOGO HAAS, TULIO FREDERICO TONIETTO, AUGUSTO SAVI, ROSELAINE PINHEIRO DE OLIVEIRA, CASSIANO TEIXEIRA, CLÁUDIA DA ROCHA CABRAL, JOSE HERVE DIEL BARTH, NILTON BRANDAO DA SILVA

Em: Annual Congress ESICM LIVES 2014. 27, 2014, Barcelona, v. 40, n. Suppl 1, p. 286-286.

Motivo: Produção Colaborador HMV

Setor HMV: CTI-Adulto+IEP

Área da saúde: Medicina Intensiva

Resumo: INTRODUCTION. Admission of elderly patients to the intensive care unit (ICU) is frequently and it will grow in the near future. The hospital- and post-discharge mortality and disability in activities of daily living (ADL) post-ICU-discharge is high; however, the results of the studies have been very heterogeneous and depending on the reason for ICU admission and previous diseases. OBJECTIVES. To investigate the mortality, and disability in ADLs and reduction in autonomy in 24-months after ICU discharge, comparing elderly (C 80 years) and young (\80 years) ICU medical survivors patients. METHODS. Prospective cross-sectional cohort study. Data were collected in two mixed ICUs (31-bed, closed ICU in a private hospital; and 18-bed, open ICU in a university hospital) by interview by telephone 2 years after ICU-discharge, and compared with data collected during ICU-stay. The baseline characteristics, pre-existing diseases, Lawton-ADL (L-ICU) index, Karnofsky (K-ICU) index, scores of severity of disease, and data on respiratory, cardiovascular, and dialysis treatments were recorded during the period of ICU stay. Complications during ICU-hospitalization, survival status at ICU and at hospital discharge were also recorded. After 24 months, were collected Lawton-ADL (L-24mo) and Karnofsky indices (K-24mo), and cognitive assessment by Six-Item Screener. RESULTS. One thousand two hundred fifty-six patients were admitted in two ICU during the study period. At 24 months, 79 (32.2 %) patients aged C 80 years and 421 (43.3 %) aged\80 years were alive and could be evaluated. Elderly patients have poor functional status at 24 months compared with young patients L-24mo: 25.7 ± 9.7 vs. 16.6 ± 12.9 (p\0.0001) and K-24mo: 82.9 ± 14.4 vs. 66.8 ± 21.2 (p\0.0001). Total functionality recovery occurred more likely in younger patients (Lawton-ADL: OR 1.71 [95 %CI 1.31-2.23], and Karnofsky index: OR 1.69 [95 %CI 1.30-2.19]). Only younger patients were able to improve their functional status after 24 month. Immediately after ICU discharge, the elderly had more cognitive deficits (18 % vs. 3.5 %, p\0.0001) compared to younger patients. Two years after ICU discharge this difference was maintained (23.4 % vs. 10.6 %, p\0.0001). CONCLUSIONS. In our study elderly critically patients have poor functional status at 24 months compared with young patients and more cognitive deficits even after two years of discharge ICU. The intensive care is a devastating experience for the elderly. REFERENCE(S). 1. Tabah A, Philippart F, Timsit JF, et al. Quality of life in patients aged 80 or over after ICU discharge. Critical Care (London, England) 2010;14(1):R2. 2. Sacanella E, Perez-Castejon JM, Nicolas JM, et al. Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study. Critical Care (London, England) 2011;15(2):R105.

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