Abstract
Aim
Many factors affecting noninvasive ventilation (NIV) in critically ill patients have been reported in the literature, but there is no study about the effect of frailty. With this study, the frailty prevalence was evaluated with two different frailty scores among the NIV population of a medical intensive care unit (ICU). Besides, the impact of frailty on NIV success and mortality and its association with NIV application problems were evaluated.
Method
A prospective observational cohort study was performed on patients who were over 50 years of age and assigned to NIV due to hypercapnic respiratory failure. For the assessment of frailty, Clinical Frailty Scale (CFS) and The Edmonton Frailty Scale (EFS) were used and the ones with CFS ≥5 and EFS ≥8 were considered as fragile. The study population was classified and compared according to NIV success, ICU outcome (discharge or exitus) and NIV application problems.
Results
A total of 103 patients with the mean age of 73 ± 11 years were included. The incidence of frailty was 41% with CFS ≥5 and 36% with EFS ≥8. The NIV failure occurred in 30 (29%) patients. Among them frailty and SOFA score was higher; Glasgow Coma Scale (GCS) was lower. In multivariate analysis GCS (OR: 1.2, p: 0.042) and frailty with EFS (OR: 2.8, p: 0.027) were identified as independent risk factors of NIV failure. Sixty-five (63%) patients had NIV application problems and frailty was higher among them with both CFS and EFS (p < 0.05). Mortality occurred in 18 (17%) patients; NIV failure and frailty according to CFS were independent risk factors of mortality.
Conclusion
The frailty is associated with higher NIV application problems, failure and mortality risk in elderly ICU patients. The CFS and EFS frailty scores can be used to predict NIV success and outcomes in ICUs.
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References
Clegg A, Young J (2011) The frailty syndrome. Clin Med 11:72–75
Bagshaw SM, Stelfox T, Johnson JA et al (2015) Long-term association between frailty and health-related quality of life among survivors of critical illness: a prospective multicenter cohort study. Crit Care Med 43:973–982
Malmstrom TK, Miller DK, Morley JE (2014) A comparison of four frailty models. J Am Geriatr Soc 62:721–726
Topinková E (2008) Aging, disability and frailty. Ann Nutr Metab 52(suppl 1):6–11
Fisher C, Karalapillai D, Jones D et al (2016) Frailty in the critically ill patient. ICU management and practice. Within HealthManagement.org, vol 16, p 1. https://healthmanagement.org/c/icu/issuearticle/frailty-in-the-critically-ill-patient
Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Med Sci 56:M146–M156
Schortgen F, Follin A, Piccari L et al (2012) Results of noninvasive ventilation in very old patients. Ann Intensive Care 2:5
Boumendil A, Aegerter P, Guidet B (2005) Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study. J Am Geriatr Soc 53:88–93
Singh G, Pitoyo CW (2014) Non-invasive ventilation in acute respiratory failure. Acta Med Indones 46:74–80
Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495
Rolfson DB, Majumdar SR, Tsuyuki RT et al (2006) Validity and reliability of the Edmonton Frail Scale. Age Ageing 35:526–529
Gursel G, Aydogdu M, Tasyurek S et al (2012) Factors associated with noninvasive ventilation response in the first day of therapy in patients with hypercapnic respiratory failure. Ann Thorac Med 7:92–97
Basic D, Shanley C (2015) Frailty in an older inpatient population: using the clinical frailty scale to predict patient outcomes. J Aging Health 27:670–685
Collard RM, Boter H, Schoevers RA et al (2012) Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 60:1487–1492
Maguet P Le, Roquilly A, Lasocki S et al (2014) Prevalence and impact of frailty on mortality in elderly ICU patients: a prospective, multicenter, observational study. Intensive Care Med 40:674–682
Rockwood K, Andrew M, Mitnitski A (2007) A comparison of two approaches to measuring frailty in elderly people. J Gerontol Series A Biol Sci Med Sci 62:738–743
Bagshaw SM, Stelfox TH, McDermid RC et al (2014) Association between frailty and short-and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 186:E95–E102
Ozsancak AU, Sidhom SS, Khodabandeh A et al (2016) Use and outcomes of noninvasive ventilation for acute respiratory failure in different age groups. Respir Care 61:36–43
Ozsancak Ugurlu A, Sidhom SS, Khodabandeh A et al (2014) Use and outcomes of noninvasive positive pressure ventilation in acute care hospitals in Massachusetts. Chest 145:964–971
Liu J, Duan J, Bai L et al (2016) Noninvasive ventilation intolerance: characteristics, predictors, and outcomes. Respir Care 61:277–284
Corrêa TD, Sanches PR, Caus de Morais L et al (2015) Performance of noninvasive ventilation in acute respiratory failure in critically ill patients: a prospective, observational, cohort study. BMC Pulm Med 15:144
Galizia G, Cacciatore F, Testa G et al (2011) Role of clinical frailty on long term mortality of elderly subjects with and without chronic obstructive pulmonary disease. Aging Clin Exp Res 23:118–125
Gill TM, Gahbauer EA, Han L et al (2010) Trajectories of disability in the last year of life. N Engl J Med 362:1173–1180
Zeng A, Song X, Dong J et al (2015 Dec) Mortality in relation to frailty in patients admitted to a specialized geriatric intensive care unit. J Gerontol A Biol Sci Med Sci 70:1586–1594
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All the authors contributed in the literature search, data collection, analysis of data and review of the manuscript. Study design was performed by Dr. IK, Dr. FY, Dr. AZ, Dr. MT, Dr. MA, Dr. GA, Dr. ZU and Dr. GG. Manuscript was prepared by Dr. IK, Dr. FY, Dr. MA and Dr. GG.
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All the authors of this manuscript declare that there are no conflicts of interest for this study.
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No sponsorship has been received for this study (no sponsorship for design, methods, subject recruitment, data collection, analysis and preparation of paper).
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The ethics committee of the institution had approved the study (Gazi University Research Ethics Committee of Medical Faculty, 23.10.2015 and No: 92). The study has been conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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An informed consent was obtained either from patients (if competent) or from their family.
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Kara, I., Yildirim, F., Zerman, A. et al. The impact of frailty on noninvasive mechanical ventilation in elderly medical intensive care unit patients. Aging Clin Exp Res 30, 359–366 (2018). https://doi.org/10.1007/s40520-017-0774-z
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DOI: https://doi.org/10.1007/s40520-017-0774-z