Outcomes of severe sepsis in very elderly (age >80 years) patients with metastatic cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9558-9558
Author(s):  
Zahra Touqir ◽  
Shagufta Shaheen ◽  
Shivanck Upadhyay ◽  
Creticus Petrov Marak ◽  
Gagan Kumar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Severe Sepsis ◽  
Elderly Patients ◽  
Metastatic Disease ◽  
Metastatic Cancer ◽  
Invasive Mechanical Ventilation ◽  
Care Providers ◽  
Very Elderly ◽  
Central Venous ◽  
Discharge Disposition

9558 Background: With better treatment and prolonged life expectancy of cancer patients, more elderly patients with metastatic cancer are being treated aggressively for sepsis. There has been philosophical debate about how aggressive the treatment should be for very elderly patients with metastatic disease admitted to intensive care unit with severe sepsis. The data with regards to the outcome of severe sepsis in those above 80 years with metastatic disease is very limited. Methods: Using the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample 2007-2008, patients older than 80 years, discharged with severe sepsis were identified using ICD-9-CM codes. Those with metastatic disease were identified using ICD-9-CM codes 196-199. The outcomes studied were mortality and discharge disposition. We also examined the rates of invasive mechanical ventilation, blood transfusion, use of central venous catheter, tracheostomy and dialysis. The outcomes were compared to those who did not have cancer. Chi square test was used to compare the variables. Significance was defined as p value <0.05. Results: There were 458,443 discharges with severe sepsis in patients aged ≥80 years. Of these 3.3% had metastatic disease. The in-hospital mortality was significantly higher in those with metastatic disease (43.7% vs. 33.3%, p<0.001). The discharge disposition of the very elderly is shown in the Table. The rates of invasive mechanical ventilation, tracheostomy, use of central venous lines and dialysis were similar in both the groups. Blood transfusions were observed to be higher in metastatic group. Conclusions: Resource utilization in elderly with severe sepsis is similar regardless of the presence of metastatic disease. However, the mortality is significantly higher in those with metastatic disease. Of the survivors, only a fraction reaches home with independent functioning. Involvement of palliative care services at an early stage and addressing code status promptly during the beginning of each hospitalization may help relieve resource and financial burden to health care providers. [Table: see text]

Outcomes of invasive mechanical ventilation in elderly patients with metastatic cancer.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. 9554-9554
Author(s):  
Achuta Kumar Guddati ◽  
Touqir Zahra ◽  
Guibenson Hyppolite ◽  
Parijat Saurav Joy ◽  
Creticus Petrov Marak ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Elderly Patients ◽  
Metastatic Cancer ◽  
Invasive Mechanical Ventilation

Mechanical Ventilation for Very Elderly Patients with Severe Pneumonia

2014 ◽  
Vol 17 (4) ◽  
pp. 383-384 ◽  
Author(s):  
Miyuki Mitamura ◽  
Kosaku Komiya ◽  
Hiromi Watanabe ◽  
Jun-ichi Kadota
Keyword(s):  
Mechanical Ventilation ◽  
Elderly Patients ◽  
Severe Pneumonia ◽  
Very Elderly

Abstract NS25: Alteplase Administration in the Very Elder

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Lynn Klassman ◽  
Peggy Siegele ◽  
Dee Behrens ◽  
Joy Boerschinger ◽  
Karen De Re ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Retrospective Data ◽  
Very Elderly ◽  
Treatment Benefit ◽  
Hospital System ◽  
Discharge Disposition ◽  
Discharge Outcomes ◽  
Intravenous Alteplase ◽  
First Time

Background /Purpose: The highest rate of first time strokes occurs in those 80 years and older. Despite the higher stroke rates, increased incidence of atrial fibrillation and often increased severity of stroke in the very elderly, initial clinical trials related to intravenous alteplase did not recruit patients over 80 years of age. Newer evidence supporting use of Alteplase in the very elder recommends that age alone should not be a contraindication for administering alteplase and urges that the risks and benefits be carefully weighed. Additional evidence concludes that although elderly patients have a higher mortality rate and poorer functional outcomes, this finding is consistent with the natural course of aging and treatment benefit may be realized. The purpose of this multihospital system retrospective review is to examine data in patients who received alteplase with the hypothesis that elders greater than 80 years benefited just as much from treatment when compared to those less than 80. Methods: Retrospective data collected at a large Midwestern hospital system compared alteplase administration in patients greater than 80 years of age to patients less than 80. Data examined included initial NIHSS, symptomatic hemorrhage rates, discharge disposition, and incidence of atrial fibrillation. Results: Comparisons (> 80 years vs. < 80 years) revealed: 1) 34% of patients treated with alteplase were greater than 80 years, 2) symptomatic hemorrhage rates were not statistically different (13% vs 8%, p=0.1904), 3) negative discharge outcomes (destination other than home or acute rehab) were more prevalent in the elder population (48% vs. 19%, p< .0001), 4) atrial fibrillation was more prevalent in elders (53%). Conclusions: Despite newer evidence, reluctance among practitioners to administer alteplase to the very elderly persists. In very elderly patients, retrospective data findings indicated that hemorrhage rates were not increased but short-term discharge outcomes were negatively impacted. This may be the result of the aging process and multiple comorbidities. Evaluation and dissemination of findings will emphasize to providers that this vulnerable population may still benefit from alteplase treatment.

Severe Sepsis and its Impact on Outcome in Elderly and Very Elderly Patients Admitted in Intensive Care Unit

2011 ◽  
Vol 27 (3) ◽  
pp. 179-183 ◽  
Author(s):  
Prashant Nasa ◽  
Deven Juneja ◽  
Omender Singh ◽  
Rohit Dang ◽  
Vikas Arora
Keyword(s):  
Intensive Care Unit ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Elderly Patients ◽  
Very Elderly

scholarly journals The Effect of Esmolol on Tissue Perfusion and Clinical Prognosis of Patients with Severe Sepsis: A Prospective Cohort Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Xiuling Shang ◽  
Kaiyu Wang ◽  
Jingqing Xu ◽  
Shurong Gong ◽  
Yong Ye ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Severe Sepsis ◽  
Treatment Time ◽  
Venous Catheter ◽  
Tissue Perfusion ◽  
Control Group ◽  
Target Level ◽  
Central Venous ◽  
Clinical Prognosis ◽  
Kaplan Meier

Purpose. This study was aimed at investigating the effect of esmolol on tissue perfusion and the clinical prognosis of patients with severe sepsis.Materials and Methods. One hundred fifty-one patients with severe sepsis were selected and divided into the esmolol group (n=75) or the control group (n=76), who received conventional antiseptic shock treatment. The esmolol group received a continuous infusion of esmolol via a central venous catheter, and their heart rate (HR) was maintained at 70–100 bpm over 72 hours.Results. The HR of all patients reached the target level within 72 hours of treatment for both groups. The effect of esmolol on PvaCO2was only significant at 48 hours (P<0.05). ScvO2increased in the esmolol group and decreased in the control group (P<0.01). Lac showed a linear downward trend over the treatment time, but the reduction was more significant in the control group at 48 hours (P<0.05) between the two groups. Kaplan-Meier analysis showed a significantly shorter duration of mechanical ventilation in the esmolol group than in the control group (P<0.05).Conclusions. Esmolol reduced the duration of mechanical ventilation in patients with severe sepsis, with no significant effect on circulatory function or tissue perfusion.

scholarly journals Respiratory Care in Children with COVID-19

2021 ◽  
Author(s):  
Shalu Gupta ◽  
Suresh K. Angurana ◽  
Virendra Kumar
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress ◽  
Health Care Providers ◽  
Respiratory System ◽  
Oxygen Delivery ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Critically Ill Children ◽  
Care Providers ◽  
Novel Coronavirus

AbstractThe novel coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is causing significant morbidity and mortality worldwide. The common presentations in children include involvement of respiratory system leading to pneumonia and acute respiratory distress syndrome, as well as multiorgan dysfunction syndrome and multisystem inflammatory syndrome in children (MIS-C). Pediatric COVID-19 is a milder disease as compared with the adults. Also, there is rise in MIS-C cases which is a hyperinflammatory condition temporally associated with SARS-CoV-2. Since respiratory system is predominantly involved, few of these critically ill children often require respiratory support which can range from simple oxygen delivery devices, high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), invasive mechanical ventilation, and extracorporeal membrane oxygenation (ECMO). Most of the oxygen delivery devices and respiratory interventions generate aerosols and pose risk of transmission of virus to health care providers (HCPs). The use of HFNC and NIV should be limited to children with mild respiratory distress preferably in negative pressure rooms and with adequate personnel protective equipments (PPEs). However, there should be low thresholds for intubation and invasive mechanical ventilation in the event of clinical deterioration while on any respiratory support. The principle of providing respiratory support requires special droplet and air-borne precautions to limit exposure or transmission of virus to HCPs and at the same time ensuring safety of the patient.

When Technology Enters at Home: The Challenges of Home Health Care Providers in a Developing Country

2021 ◽  
Author(s):  
Maryam Esmaeili ◽  
Nahid Dehghan nayeri ◽  
Fatemeh Bahramnezhad ◽  
Samrand Fattah Ghazi ◽  
Parvaneh Asgari
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
Home Care ◽  
Health Care Providers ◽  
Home Health Care ◽  
Invasive Mechanical Ventilation ◽  
Home Health ◽  
Care Providers ◽  
Care Agency ◽  
At Home

Abstract Background: The number of patients with chronic diseases requiring invasive mechanical ventilation at home is increasing. Family caregiving for patients with home mechanical ventilation (HMV) is associated with a particularly heavy workload. Thus, identifying the challenges of this valuable type of care can be an elective step for achieving health-related goals. This study was carried out to determine the challenges faced by home health care providers.Methods: 15 participants (9 family caregivers, 3 home nurses, and 3 home care attendants) were selected. Data were collected through semi-structured interviews and structured observation. All the interviews were recorded, transcribed, and then analyzed using qualitative content analysis and Max Qualitative Data Analysis 2010.Results: Three themes emerged from the data analysis: (1) Hospital-based challenges with two subthemes the family unpreparedness for home care and the lack of continuous education, (2) Home health care agency challenges with two sub themes. Home health care workers and the deficiency in organizational policies, and (3) Economic challenges.Conclusions: Three themes of hospital-related challenges, home health care agency challenges, and economic challenges emerged in the study showed that support from the insurance system, improvement of home care agency policies, and holistic care for patients through a multidisciplinary team approach are essential for addressing the current challenges of home care for patients under invasive mechanical ventilation at home.

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