Respiratory failure & ventilation
Differences in directives to limit treatment and discontinue mechanical ventilation between elderly and very elderly patients: a substudy of a multinational observational study
Authors' conclusion
Very elderly (vs. elderly) patients had more orders to withhold treatments after ICU admission and higher hospital mortality, but similar ICU outcomes and IMV discontinuation.
Study context
- Population
- Elderly and very elderly intensive care unit (ICU) patients receiving invasive mechanical ventilation (IMV) in 142 ICUs from 6 regions (Canada, India, UK, Europe, Australia/New Zealand, US)
- Participants
- 788 elderly
- Comparison
- Very elderly vs elderly ICU patients
- Very elderlyn = 202
- Elderlyn = 586reference
- Primary endpoint
- Directives to limit treatments (withholding/withdrawal orders) and IMV discontinuation strategies
Methodological details142 ICUs, 6 regions
- 142 ICUs, 6 regions
Primary result
As reported in the abstract
Withholding orders after ICU admission
P = 0.002
Further findings
Time to orders to withhold reintubation
P = 0.02
Direct extubation
Direct tracheostomy
Initial SBT
Initial successful SBT
Hospital mortality
ICU outcomes (mortality, LOS, duration of ventilation)
- Similar in very elderly vs elderly
Direct tracheostomy and initial failed spontaneous breathing trial (SBT)
- Associated with worse outcomes
Regional differences
- Regional differences in withholding orders at ICU admission and in withholding and withdrawal orders after ICU admission
Original publication
Differences in directives to limit treatment and discontinue mechanical ventilation between elderly and very elderly patients: a substudy of a multinational observational study. Intensive Care Med. Published 22 September 2023. doi:10.
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