التفاصيل البيبلوغرافية
| العنوان: |
Impact of Early Limitation of Therapeutic Effort in Elderly COVID-19 Patients Admitted to the Intensive Care Unit—A Cohort Study. |
| المؤلفون: |
Lacoste-Palasset, Thomas, Sutterlin, Laetitia, M'Rad, Aymen, Modestin, Louis, Mourman, Vianney, Pepin-Lehalleur, Adrien, Malissin, Isabelle, Naim, Giulia, Grant, Caroline, Guérin, Emmanuelle, Ekhérian, Jean-Michel, Deye, Nicolas, Mégarbane, Bruno, Voicu, Sebastian |
| المصدر: |
Journal of Personalized Medicine; Sep2022, Vol. 12 Issue 9, pN.PAG-N.PAG, 12p |
| مصطلحات موضوعية: |
INTENSIVE care units, OLDER patients, COVID-19, INTENSIVE care patients, COHORT analysis, HOSPITAL mortality, RENAL replacement therapy |
| مستخلص: |
(1) Background: Admission to the ICU and intensity of care provided to elderly COVID-19 patients are difficult choices guided by the expected patient-centered benefits. However, the impact of an early discussion of limitation of therapeutic effort (LTE) has been poorly investigated. (2) Methods: We performed a single-center retrospective cohort study including all ≥70-year-old COVID-19 patients admitted to the ICU. Factors associated with early LTE discussion (defined as before or up to 2 days post-ICU admission) and in-hospital mortality were evaluated. (3) Results: Eighty-two patients (59 M/23 F; 78 years (74–82) [median (interquartile range)]; 43/82 with LTE) were included. The in-hospital mortality rate was 55%. Early LTE was decided upon for 22/82 patients (27%), more frequently in older (p < 0.001) and frailer patients (p = 0.004). Using a multivariable logistic regression model including clinical frailty scale grade ≥4, hospital acquisition of COVID-19, ventilation support modality and SOFA score on admission, early LTE was not associated with mortality (adjusted odds ratio = 0.57 (0.15–2.00), p = 0.39). LTE resulted in less frequent invasive mechanical ventilation (23% versus 65%, p = 0.001), renal replacement therapy (5% versus 27%, p = 0.03) and norepinephrine infusion (23% versus 60%, p = 0.005), and shorter ICU stay (6 days (2–12) versus 14 days (7–24), p = 0.001). (4) Conclusions: In this small sample exploratory study, we were unable to demonstrate any increase in in-hospital mortality associated with early LTE discussion in elderly COVID-19 patients while reducing the use of organ support techniques. These findings require confirmation in larger studies. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
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