Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 25 , ISSUE 6 ( June, 2021 ) > List of Articles

Original Article

Etiology and Outcomes of ARDS in the Elderly Population in an Intensive Care Unit in North India

Inderpaul S Sehgal, Ritesh Agarwal, Sahajal Dhooria, Kuruswamy T Prasad, Valliappan Muthu, Ashutosh N Aggarwal

Keywords : Acute respiratory distress syndrome, Elderly, Pneumonia, Respiratory failure, Sepsis

Citation Information : Sehgal IS, Agarwal R, Dhooria S, Prasad KT, Muthu V, Aggarwal AN. Etiology and Outcomes of ARDS in the Elderly Population in an Intensive Care Unit in North India. Indian J Crit Care Med 2021; 25 (6):648-654.

DOI: 10.5005/jp-journals-10071-23878

License: CC BY-NC 4.0

Published Online: 01-06-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Whether age would impact the outcomes in subjects with acute respiratory distress syndrome (ARDS) remains unclear. Herein, we study the effect of age as a predictor of mortality in ARDS. Materials and methods: We categorized consecutive subjects with ARDS as either ARDSelderly (age >65 years) or ARDSnonelderly (age ≤65 years) admitted to the respiratory intensive care unit (ICU) of a tertiary care hospital in North India between January 2007 and December 2019. We compared the baseline clinical and demographic characteristics, lung mechanics, and mortality between the two groups. We also analyzed the factors predicting ICU survival using multivariate logistic regression analysis. Results: We included 625 patients (ARDSelderly, 140 [22.4%] and ARDSnonelderly, 485 [77.6%]) with a mean (standard deviation) age (56.3% males) of 40.6 (17.8) years. The ARDSelderly were more likely (p = 0.0001) to have the presence of any comorbid illness compared to ARDSnonelderly. The elderly subjects had significantly higher pulmonary ARDS than the younger group. The severity of ARDS was however, similarly distributed between the two study arms. There were 224 (35.8%) deaths, and the mortality was significantly higher (p = 0.012) in the ARDSelderly than the to ARDSnonelderly (ARDSelderly vs ARDSnonelderly, 45 vs 33.2%). On multivariate logistic regression analysis, the baseline sequential organ failure assessment scores, presence of pulmonary ARDS, and the development of new organ dysfunction were the independent predictors of mortality. Conclusion: The outcomes in subjects with ARDS are dependent on the severity of illness at admission and the etiology of ARDS rather than the age alone.


PDF Share
  1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967;2:319–323. DOI: 10.1016/s0140-6736(67)90168-7.
  2. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA 2012;307(23):2526–2533. DOI: 10.1001/jama.2012.5669.
  3. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 2012;38(10):1573–1582. DOI: 10.1007/s00134-012-2682-1.
  4. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 2015;372(8):747–755. DOI: 10.1056/NEJMsa1410639.
  5. Nin N, Muriel A, Penuelas O, Brochard L, Lorente JA, Ferguson ND, et al. Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome. Intensive Care Med 2017;43(2):200–208. DOI: 10.1007/s00134-016-4611-1.
  6. Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368(23):2159–2168. DOI: 10.1056/NEJMoa1214103.
  7. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342(18):1301–1308. DOI: 10.1056/NEJM200005043421801.
  8. Suchyta MR, Clemmer TP, Elliott CG, Orme JF Jr, Morris AH, Jacobson J, et al. Increased mortality of older patients with acute respiratory distress syndrome. Chest 1997;111(5):1334–1339. DOI: 10.1378/chest.111.5.1334.
  9. Zilberberg MD, Epstein SK. Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome. Am J Respir Crit Care Med 1998;157:1159–1164. DOI: 10.1164/ajrccm.157.4.9704088.
  10. Sloane PJ, Gee MH, Gottlieb JE, Albertine KH, Peters SP, Burns JR, et al. A multicenter registry of patients with acute respiratory distress syndrome. Physiology and outcome. Am Rev Respir Dis 1992;146(2):419–426. DOI: 10.1164/ajrccm/146.2.419.
  11. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351(4):327–336. DOI: 10.1056/NEJMoa032193.
  12. Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006;354(24):2564–2575. DOI: 10.1056/NEJMoa062200.
  13. Flaatten H, de Lange DW, Artigas A, Bin D, Moreno R, Christensen S, et al. The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med 2017;43(9):1319–1328. DOI: 10.1007/s00134-017-4718-z.
  14. Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, et al. Variability of intensive care admission decisions for the very elderly. PLoS One 2012;7(4):e34387. DOI: 10.1371/journal.pone.0034387.
  15. Gee MH, Gottlieb JE, Albertine KH, Kubis JM, Peters SP, Fish JE. Physiology of aging related to outcome in the adult respiratory distress syndrome. J Appl Physiol (1985) 1990;69(3):822–829. DOI: 10.1152/jappl.1990.69.3.822.
  16. Guidet B, Leblanc G, Simon T, Woimant M, Quenot JP, Ganansia O, et al. Effect of systematic intensive care unit triage on long-term mortality among critically ill elderly patients in France: a randomized clinical trial. JAMA 2017;318(15):1450–1459. DOI: 10.1001/jama.2017.13889.
  17. Muthu V, Dhooria S, Aggarwal AN, Behera D, Sehgal IS, Agarwal R. Acute respiratory distress syndrome due to tuberculosis in a respiratory ICU over a 16-year period. Crit Care Med 2017;45(10):e1087–e1090. DOI: 10.1097/CCM.0000000000002479.
  18. Muthu V, Dhooria S, Agarwal R, Prasad KT, Aggarwal AN, Behera D, et al. Profile of patients with active tuberculosis admitted to a respiratory intensive care unit in a tertiary care center of North India. Indian J Crit Care Med 2018;22(2):63–66. DOI: 10.4103/ijccm.IJCCM_491_17.
  19. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286(14):1754–1758. DOI: 10.1001/jama.286.14.1754.
  20. Sehgal IS, Agarwal R, Dhooria S, Prasad KT, Muthu V, Aggarwal AN. Risk stratification of acute respiratory distress syndrome using a PaO2:FiO2 threshold of 150 mm Hg: a retrospective analysis from an Indian intensive care unit. Lung India 2020;37(6):473–478. DOI: 10.4103/lungindia.lungindia_146_20.
  21. Kao KC, Hsieh MJ, Lin SW, Chuang LP, Chang CH, Hu HC, et al. Survival predictors in elderly patients with acute respiratory distress syndrome: a prospective observational cohort study. Sci Rep 2018;8:13459. DOI: 10.1038/s41598-018-31811-w.
  22. Eachempati SR, Hydo LJ, Shou J, Barie PS. Outcomes of acute respiratory distress syndrome (ARDS) in elderly patients. J Trauma 2007;63(2):344–350. DOI: 10.1097/TA.0b013e3180eea5a1.
  23. Stupka JE, Mortensen EM, Anzueto A, Restrepo MI. Community-acquired pneumonia in elderly patients. Aging Health 2009;5(6):763–774. DOI: 10.2217/ahe.09.74.
  24. Laporte L, Hermetet C, Jouan Y, Gaborit C, Rouve E, Shea KM, et al. Ten-year trends in intensive care admissions for respiratory infections in the elderly. Ann Intensive Care 2018;8(1):84. DOI: 10.1186/s13613-018-0430-6.
  25. Kothe H, Bauer T, Marre R, Suttorp N, Welte T, Dalhoff K. Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J 2008;32(1):139–146. DOI: 10.1183/09031936.00092507.
  26. Sehgal IS, Dhooria S, Behera D, Agarwal R. Acute respiratory distress syndrome: pulmonary and extrapulmonary not so similar. Indian J Crit Care Med 2016;20(3):194–197. DOI: 10.4103/0972-5229.178188.
  27. Pelosi P, D’Onofrio D, Chiumello D, Paolo S, Chiara G, Capelozzi VL, et al. Pulmonary and extrapulmonary acute respiratory distress syndrome are different. Eur Respir J Suppl 2003;42:48s–56s. DOI: 10.1183/09031936.03.00420803.
  28. Milberg JA, Davis DR, Steinberg KP, Hudson LD. Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983-1993. JAMA 1995;273:306–309. PMID: 7815658.
  29. Moreno R, Vincent JL, Matos R, Mendonca A, Cantraine F, Thijs L, et al. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med 1999;25(7):686–696. DOI: 10.1007/s001340050931.
  30. Ando K, Doi T, Moody SY, Ohkuni Y, Sato S, Kaneko N. The effect of comorbidity on the prognosis of acute lung injury and acute respiratory distress syndrome. Intern Med 2012;51(14):1835–1840. DOI: 10.2169/internalmedicine.51.6434.
  31. Finney SJ, Zekveld C, Elia A, Evans TW. Glucose control and mortality in critically ill patients. JAMA 2003;290(15):2041–2047. DOI: 10.1001/jama.290.15.2041.
  32. Falciglia M, Freyberg RW, Almenoff PL, D’Alessio DA, Render ML. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med 2009;37(12):3001–3009. DOI: 10.1097/CCM.0b013e3181b083f7.
  33. Boumendil A, Somme D, Garrouste-Orgeas M, Guidet B. Should elderly patients be admitted to the intensive care unit? Intensive Care Med 2007;33(7):1252. DOI: 10.1007/s00134-007-0621-3.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.