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Early hemodynamic assessment and treatment of elderly patients in the medical ICU

  • geriatrics: at crossroads of medicine
  • Published:
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Summary

Background and objectives

The aim of this retrospective study was to analyze differences in the initial hemodynamic assessment and its impact on the treatment in patients aged 80 years or older compared to younger patients during the first 6 h after admission to the medical intensive care unit (ICU).

Results

We analyzed 615 consecutive patients admitted to the medical ICU of which 124 (20%) were aged 80 years or more. The older group had a significantly higher acute physiology and chronic health evaluation (APACHE II) score, an overall mortality in the ICU and a presence of pre-existing cardiac disease. Both groups did not differ in the presence of shock and shock types on admission. In 57% of older and in 56% of younger patients, transthoracic echocardiography was performed with a higher therapeutic impact in the older patients. Transesophageal echocardiography was performed in 3% of the patients in both groups for specific diagnostic problems. Early reassessment with transthoracic echocardiography was necessary in 5% of the older and in 6% of the younger patients and resulted in a change of the treatment in one third of the patients. Continuous invasive hemodynamic monitoring was used in 11% of the older and in 10% of the younger patients and resulted in a therapeutic change in 71% of the older and in 64% of the younger patients.

Conclusion

Patients aged 80 years or older represent 20% of all admissions to the medical ICU. Once admitted the older patients were similarly hemodynamically assessed as the younger ones with a similar impact on the treatment.

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Abbreviations

CCO:

Continuous cardiac output

CO:

Cardiac output

CVC:

Central venous catheter

CVP:

Central venous pressure

EVLW:

Extravascular lung water

GEDV:

Global end-diastolic volume

ICU:

Intensive care unit

ITBV:

Intrathoracic blood volume

IVC:

Inferior vena cava

PAC:

Pulmonary artery catheter

PAOP:

Pulmonary artery occlusion pressure

PiCCO:

Pulse-induced continuous cardiac output

LVEF:

Left ventricular ejection fraction

ScvO2 :

Central venous oxygen saturation

SvO2 :

Mixed venous oxygen saturation

TAPSE:

Tricuspid annular plane systolic excursion

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

VTI:

Velocity time integral

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Authors and Affiliations

  1. Department of Intensive Internal Medicine, General Hospital Celje, Oblakova 5, 3000, Celje, Slovenia

    Gorazd Voga MD, Ph.D., EDIC

  2. Intensive Care Unit, Topolšica Hospital, Topolšica 63, 3326, Topolšica, Slovenia

    Lucija Gabršček-Parežnik MD

Authors
  1. Gorazd Voga MD, Ph.D., EDIC
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  2. Lucija Gabršček-Parežnik MD
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Corresponding author

Correspondence to Gorazd Voga MD, Ph.D., EDIC.

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Conflict of interest

G. Voga and L. Gabršček-Parežnik declare that they have no competing interests.

Additional information

Author´s contribution G. Voga prepared the manuscript; L. Gabršček-Parežnik analyzed and collected the data and revised the manuscript.

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Voga, G., Gabršček-Parežnik, L. Early hemodynamic assessment and treatment of elderly patients in the medical ICU. Wien Klin Wochenschr 128 (Suppl 7), 505–511 (2016). https://doi.org/10.1007/s00508-016-1131-5

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  • DOI: https://doi.org/10.1007/s00508-016-1131-5

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