Abstract
Purpose: The development of technologies for the prolongation of life
has resulted in an increase in the number of older ventilated patients
in internal medicine and chronic care wards. Our study aimed to
determine the factors influencing the outcomes of older ventilated
patients in internal medicine wards. Methods: We performed a prospective
observational cohort study including all newly ventilated medical
patients aged 65 years and older over a period of 18 months. Data were
acquired from computerized medical records and from an interview of the
medical personnel initiating mechanical ventilation. Results: A total of
554 underwent mechanical ventilation for the first time during the study
period. The average age was 79 years, and 80% resided at home.
Following mechanical ventilation, 8% died in the emergency room, and
the majority of patients (351; 63%) were hospitalized in internal
medicine wards. In-hospital mortality was 64.1%, with 48% dying during
the first week of hospitalization. Overall 6-month survival was 26%. We
found that a combination of age 85 years and older, functional status
prior to ventilation, and associated morbidity (diabetes with target
organ injury and / or oncological solid organ disease) were the
strongest negative predictors of survival after discharge from the
hospital. Conclusion: Mechanical ventilation at older age is associated
with poor survival and it is possible to identify factors predicting
survival. In the midst of the Covid-19 pandemic, the findings of this
study may help in the decision-making process regarding mechanical
ventilation for older people.