Canadian Journal of Anesthesia

, 53:1244 | Cite as

Review article: Age related alterations in respiratory function — anesthetic considerations

  • Juraj Sprung
  • Ognjen Gajic
  • David O. Warner
Cardiothoracic Anesthesia, Respiration and Airway



This review examines the effect of aging on pulmonary reserve. Special emphasis is placed on how anesthetic and surgical factors may impose substantial stresses on the respiratory system of elderly patients, leading to increased risk for postoperative pulmonary complications including respiratory failure.


A MEDLINE-based English-language literature search was undertaken for the period 1966–2006, and an EMBASE search covered the overlapping period 1988–2006. Selected articles were limited to those applying to elderly subjects/patients.

Principal findings

Age-related loss of the lung static recoil forces, stiffening of the chest wall and diminished alveolar surface area lead to a decrease in vital capacity, an increase in residual volume, decrease in expiratory flows and increased ventilation-perfusion heterogeneity. Respiratory muscle strength consistently declines with age further increasing the work of breathing. While gas exchange may be well preserved at rest and during exertion, pulmonary reserve is diminished, and under conditions of positive fluid balance, positioning for surgery, and increased metabolic demand, postoperative respiratory failure can occur. Increased sensitivity to respiratory depressants and muscle weakness pose additional risks for the development of postoperative respiratory complications in elderly patients. Regional anesthetic techniques provide for superior postoperative analgesia, without necessarily altering the frequency of postoperative pulmonary complications in the older surgical population.


Alterations in respiratory physiology associated with aging must be appreciated to anticipate and minimize potential complications associated with surgery and anesthesia in the elderly. Individualized care to optimize preoperative cardiorespiratory function, minimize intraoperative respiratory pertubations, and to gently restore postoperative pulmonary function are essential anesthetic goals for elderly patients who require surgery.


Obstructive Sleep Apnea Continuous Positive Airway Pressure Pulmonary Complication Respir Crit Functional Residual Capacity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Article de synthèse: Les modifications de fonction respiratoire liées à l’âge — considérations anesthésiques



Cet article traite de l’effet du vieillissement sur la réserve pulmonaire. En particulier, on se tourne vers les facteurs anesthésiques et chirurgicaux qui imposent un stress substantiel sur le système respiratoire des patients âgés, en les mettant à risque de complications respiratoires postopératoires, dont l’insuffisance respiratoire.


Une recherche des articles publiés en langue anglaise de 1966 à 2006 a été entreprise en se servant de MEDLINE. La période 1988–2006 a aussi été fouillée avec EMBASE. On a sélectionné que les articles portant sur les patients ou sujets âgés.

Constatations principales

Avec l’âge, l’atténuation de la force statique de recul des poumons, la rigidité de la cage thoracique et la diminution de la surface des alvéoles produit une réduction de la capacité vitale, une augmentation du volume résiduel, une diminution des débits expiratoires et une plus grande inadéquation ventilationperfusion. La force des muscles respiratoires diminue constamment avec l’âge, ce qui augmente le travail respiratoire. L’échange gazeux est normal au repos et pendant l’exercice, mais la réserve pulmonaire est diminuée. Ainsi, avec une surcharge liquidienne, un positionnement pour la chirurgie et une demande métabolique accrue, une insuffisance respiratoire peut survenir en période postopératoire. Les patients âgés sont plus sensibles aux médicaments qui dépriment la respiration et leurs muscles sont plus faibles, d’où un risque augmenté de complications respiratoires postopératoires. Les techniques d’anesthésie loco-régionales produisent une analgésie postopératoire de qualité, sans toujours modifier l’incidence de complications pulmonaires postopératoires chez les sujets âgés.


On doit tenir compte des changements physiologiques respiratoires découlant du vieillissement pour prévoir et atténuer les complications qui peuvent survenir suite à une chirurgie et une anesthésie chez les sujets âgés. L’anesthésiologiste doit viser un traitement individualisé pour optimiser la fonction cardiorespiratoire avant la chirurgie, limiter l’atteinte respiratoire pendant la chirurgie et assurer une récupération en douceur de la fonction pulmonaire en postopératoire.


  1. 1.
    Janssens JP, Pache JC, Nicod LP. Physiological changes in respiratory function associated with ageing. Eur Respir J 1999; 13: 197–205.PubMedCrossRefGoogle Scholar
  2. 2.
    Pollock ML, Mengelkoch LJ, Graves JE, et al. Twenty- year follow-up of aerobic power and body composition of older track athletes. J Appl Physiol 1997; 82: 1508–16.PubMedGoogle Scholar
  3. 3.
    McClaran SR, Babcock MA, Pegelow DF, Reddan WG, Dempsey JA. Longitudinal effects of aging on lung function at rest and exercise in healthy active fit elderly adults. J Appl Physiol 1995; 78: 1957–68.PubMedGoogle Scholar
  4. 4.
    Zaugg M, Lucchinetti E. Respiratory function in the elderly. Anesthesiol Clin North America 2000; 18: 47–58.PubMedCrossRefGoogle Scholar
  5. 5.
    Turner JM, Mead J, Wohl ME. Elasticity of human lungs in relation to age. J Appl Physiol 1968; 25: 664–71.PubMedGoogle Scholar
  6. 6.
    Crapo RO. The aging lung.In: Mahler DA (Ed.). Pulmonary Disease in the Elderly Patient. NY: Marcel Dekker; 1993: 1–21.Google Scholar
  7. 7.
    Campbell EJ, Lefrak SS. How aging affects the structure and function of the respiratory system. Geriatrics 1978; 33: 68–74.PubMedGoogle Scholar
  8. 8.
    Verbeken E, Cauberghs M, Mertens I, Clement J, Lauweryns JM, Van de Woestijne KP. The senile lung. Comparison with normal and emphysematous lungs. 2. Functional aspects. Chest 1992; 101: 800–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Murray JF. Aging.In: Murray JF (Ed.). The Normal Lung. PA: W.B. Saunders: 1986: 339–60.Google Scholar
  10. 10.
    Larsson L. Histochemical characteristics of human skeletal muscle during aging. Acta Physiol Scand 1983; 117: 469–71.PubMedCrossRefGoogle Scholar
  11. 11.
    Polkey MI, Harris ML, Hughes PD, et al. The contractile properties of the elderly human diaphragm. Am J Respir Crit Care Med 1997; 155: 1560–4.PubMedGoogle Scholar
  12. 12.
    Tolep K, Higgins N, Muza S, Criner G, Kelsen SG. Comparison of diaphragm strength between healthy adult elderly and young men. Am J Respir Crit Care Med 1995; 152: 677–82.PubMedGoogle Scholar
  13. 13.
    Knudson RJ, Slatin RC, Lebowitz MD, Burrows B. The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. Am Rev Respir Dis 1976; 113: 587–600.PubMedGoogle Scholar
  14. 14.
    Brandstetter RD, Kazemi H. Aging and the respiratory system. Med Clin North Am 1983; 67: 419–31.PubMedGoogle Scholar
  15. 15.
    Griffith KA, Sherrill DL, Siegel EM, Manolio TA, Bonekat HW, Enright PL. Predictors of loss of lung function in the elderly: the Cardiovascular Health Study. Am J Respir Crit Care Med 2001; 163: 61–8.PubMedGoogle Scholar
  16. 16.
    Enright PL, Kronmal RA, Higgins M, Schenker M, Haponik EF. Spirometry reference values for women and men 65 to 85 years of age. Cardiovascular health study. Am Rev Respir Dis 1993; 147: 125–33.PubMedGoogle Scholar
  17. 17.
    Niewoehner DE, Kleinerman J. Morphologic basis of pulmonary resistance in human lung and effects of aging. J Appl Physiol 1974; 36: 412–8.PubMedGoogle Scholar
  18. 18.
    Fowler RW, Pluck RA, Hetzel MR. Maximal expiratory flow-volume curves in Londoners aged 60 years and over. Thorax 1987; 42: 173–82.PubMedCrossRefGoogle Scholar
  19. 19.
    Hyatt RE, Flath RE. Influence of lung parenchyma on pressure-diameter behavior of dog bronchi. J Appl Physiol 1966; 21: 1448–52.PubMedGoogle Scholar
  20. 20.
    Hyatt RE. Expiratory flow limitation. J Appl Physiol 1983; 55(1 Pt 1): 1–7.PubMedGoogle Scholar
  21. 21.
    Babb TG, Rodarte JR. Mechanism of reduced maximal expiratory flow with aging. J Appl Physiol 2000; 89: 505–11.PubMedGoogle Scholar
  22. 22.
    DeLorey DS, Babb TG. Progressive mechanical ventilatory constraints with aging. Am J Respir Crit Care Med 1999; 160: 169–77.PubMedGoogle Scholar
  23. 23.
    Johnson BD, Badr MS, Dempsey JA. Impact of the aging pulmonary system on the response to exercise. Clin Chest Med 1994; 15: 229–46.PubMedGoogle Scholar
  24. 24.
    Craig DB, Wahba WM, Don HF, Couture JG, Becklake MR. “Closing volume” and its relationship to gas exchange in seated and supine positions. J Appl Physiol 1971; 31: 717–21.PubMedGoogle Scholar
  25. 25.
    Raine JM, Bishop JM. A-a difference in O2 tension and physiological dead space in normal man. J Appl Physiol 1963; 18: 284–8.PubMedGoogle Scholar
  26. 26.
    Cerveri I, Zoia MC, Fanfulla F, et al. Reference values of arterial oxygen tension in the middle-aged and elderly. Am J Respir Crit Care Med 1995; 152: 934–41.PubMedGoogle Scholar
  27. 27.
    Wahba WM. Influence of aging on lung function--clinical significance of changes from age twenty. Anesth Analg 1983; 62: 764–76.PubMedCrossRefGoogle Scholar
  28. 28.
    Guenard H, Marthan R. Pulmonary gas exchange in elderly subjects. Eur Respir J 1996; 9: 2573–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Neas LM, Schwartz J. The determinants of pulmonary diffusing capacity in a national sample of U.S. adults. Am J Respir Crit Care Med 1996; 153: 656–64.PubMedGoogle Scholar
  30. 30.
    Thurlbeck WM, Angus GE. Growth and aging of the normal human lung. Chest 1975; 67(2 Suppl): 3S-6S.PubMedCrossRefGoogle Scholar
  31. 31.
    Krumpe PE, Knudson RJ, Parsons G, Reiser K. The aging respiratory system. Clin Geriatr Med 1985; 1: 143–75.PubMedGoogle Scholar
  32. 32.
    Mahler DA, Rosiello RA, Loke J. The aging lung. Clin Geriatr Med 1986; 2: 215–25.PubMedGoogle Scholar
  33. 33.
    Peterson DD, Pack AI, Silage DA, Fishman AP. Effects of aging on ventilatory and occlusion pressure responses to hypoxia and hypercapnia. Am Rev Respir Dis 1981; 124: 387–91.PubMedGoogle Scholar
  34. 34.
    Brischetto MJ, Millman RP, Peterson DD, Silage DA, Pack AI. Effect of aging on ventilatory response to exercise and CO2. J Appl Physiol 1984; 56: 1143–50.PubMedGoogle Scholar
  35. 35.
    Tack M, Altose MD, Cherniack NS. Effect of aging on respiratory sensations produced by elastic loads. J Appl Physiol 1981; 50: 844–50.PubMedGoogle Scholar
  36. 36.
    Tack M, Altose MD, Cherniack NS. Effect of aging on the perception of resistive ventilatory loads. Am Rev Respir Dis 1982; 126: 463–7.PubMedGoogle Scholar
  37. 37.
    Manning H, Mahler D, Harver A. Dyspnea in the elderly.In: Mahler D (Ed.). Pulmonary Disease in the Elderly Patient. NY: Marcel Dekker; 1993: 81–111.Google Scholar
  38. 38.
    Krieger J, Sforza E, Boudewijns A, Zamagni M, Petiau C. Respiratory effort during obstructive sleep apnea: role of age and sleep state. Chest 1997; 112: 875–84.PubMedCrossRefGoogle Scholar
  39. 39.
    Ancoli-Israel S, Coy T. Are breathing disturbances in elderly equivalent to sleep apnea syndrome? Sleep 1994; 17: 77–83.PubMedGoogle Scholar
  40. 40.
    Hoch CC, Reynolds CF 3rd, Monk TH, et al. Comparison of sleep-disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life. Sleep 1990; 13: 502–11.PubMedGoogle Scholar
  41. 41.
    Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest 2003; 124: 328–36.PubMedCrossRefGoogle Scholar
  42. 42.
    Rosenthal RA, Kavic SM. Assessment and management of the geriatric patient. Crit Care Med 2004; 32(4 Suppl): S92–105.PubMedCrossRefGoogle Scholar
  43. 43.
    Warner DO. Preventing postoperative pulmonary complications: the role of the anesthesiologist. Anesthesiology 2000; 92: 1467–72.PubMedCrossRefGoogle Scholar
  44. 44.
    Weenig CS, Pietak S, Hickey RF, Fairley HB. Relationship of preoperative closing volume to functional residual capacity and alveolar-arterial oxygen difference during anesthesia with controlled ventilation. Anesthesiology 1974; 41: 3–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Sorbini CA, Grassi V, Solinas E, Muiesan G. Arterial oxygen tension in relation to age in healthy subjects. Respiration 1968; 25: 3–13.PubMedCrossRefGoogle Scholar
  46. 46.
    Gunnarsson L, Tokics L, Gustavsson H, Hedenstierna G. Influence of age on atelectasis formation and gas exchange impairment during general anaesthesia. Br J Anaesth 1991; 66: 423–32.PubMedCrossRefGoogle Scholar
  47. 47.
    Gunnarsson L, Tokics L, Lundquist H, et al. Chronic obstructive pulmonary disease and anaesthesia: forma tion of atelectasis and gas exchange impairment. Eur Respir J 1991; 4: 1106–16.PubMedGoogle Scholar
  48. 48.
    McAlister FA, Khan NA, Straus SE, et al. Accuracy of the preoperative assessment in predicting pulmonary risk after nonthoracic surgery. Am J Respir Crit Care Med 2003; 167: 741–4.PubMedCrossRefGoogle Scholar
  49. 49.
    Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg 2000; 232: 242–53.PubMedCrossRefGoogle Scholar
  50. 50.
    Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 1990; 34: 144–55.PubMedCrossRefGoogle Scholar
  51. 51.
    Qaseem A, Snow V, Fitterman N, et al.;Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med 2006; 144: 575–80.PubMedGoogle Scholar
  52. 52.
    Smetana GW. Preoperative pulmonary evaluation. N Engl J Med 1999; 340: 937–44.PubMedCrossRefGoogle Scholar
  53. 53.
    Wong DH, Weber EC, Schell MJ, Wong AB, Anderson CT, Barker SJ. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg 1995; 80: 276–84.PubMedCrossRefGoogle Scholar
  54. 54.
    Smetana GW, Lawrence VA, Cornell JE;American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006; 144: 581–95.PubMedGoogle Scholar
  55. 55.
    Gerson MC, Hurst JM, Hertzberg VS, Baughman R, Rouan GW, Ellis K. Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am J Med 1990; 88: 101–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Williams-Russo P, Charlson ME, MacKenzie CR, Gold JP, Shires GT. Predicting postoperative pulmonary complications. Is it a real problem? Arch Int Med 1992; 152: 1209–13.CrossRefGoogle Scholar
  57. 57.
    Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Obesity is not a risk factor for significant adverse outcomes after cardiac surgery. Circulation 1996; 94(9 Suppl): II87–92.PubMedGoogle Scholar
  58. 58.
    Whalen FX, Gajic O, Thompson GB, et al. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg 2006; 102: 298–305.PubMedCrossRefGoogle Scholar
  59. 59.
    Marik PE. Aspiration pneumonitis and aspiration pneu- monia. N Engl J Med 2001; 344: 665–71.PubMedCrossRefGoogle Scholar
  60. 60.
    Lawrence VA, Cornell JE, Smetana GW;American College of Physicians. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006; 144: 596–608.PubMedGoogle Scholar
  61. 61.
    Beard K, Jick H, Walker AM. Adverse respiratory events occurring in the recovery room after general anesthesia. Anesthesiology 1986; 64: 269–72.PubMedCrossRefGoogle Scholar
  62. 62.
    Berg H, Roed J, Viby-Mogensen J, et al. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand 1997; 41: 1095–103.PubMedCrossRefGoogle Scholar
  63. 63.
    Lawrence VA, Page CP, Harris GD. Preoperative spirometry before abdominal operations. A critical appraisal of its predictive value. Arch Intern Med 1989; 149: 280–5.PubMedCrossRefGoogle Scholar
  64. 64.
    Warner DO, Warner MA, Offord KP, Schroeder DR, Maxson P, Scanlon PD. Airway obstruction and perioperative complications in smokers undergoing abdominal surgery. Anesthesiology 1999; 90: 372–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Warner DO. Helping surgical patients quit smoking: why, when, and how. Anesth Analg 2005; 101: 481–7.PubMedCrossRefGoogle Scholar
  66. 66.
    Warner DO. Perioperative abstinence from cigarettes: physiologic and clinical consequences. Anesthesiology 2006; 104: 356–67.PubMedCrossRefGoogle Scholar
  67. 67.
    Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984; 130: 12–5.PubMedGoogle Scholar
  68. 68.
    Castillo R, Haas A. Chest physical therapy: comparative efficacy of preoperative and postoperative in the elderly. Arch Phys Med Rehabil 1985; 66: 376–9.PubMedGoogle Scholar
  69. 69.
    Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000; 321: 1493.PubMedCrossRefGoogle Scholar
  70. 70.
    Myles PS, Power I, Jamrozik K. Epidural block and outcome after major surgery (Editorial). Med J Aust 2002; 177: 536–7.PubMedGoogle Scholar
  71. 71.
    Jayr C, Thomas H, Rey A, Farhat F, Lasser P, Bourgain JL. Postoperative pulmonary complications. Epidural analgesia using bupivacaine and opioids versus parenteral opioids. Anesthesiology 1993; 78: 666–76; discussion 22A.PubMedCrossRefGoogle Scholar
  72. 72.
    Norris EJ, Beattie C, Perler BA, et al. Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery. Anesthesiology 2001; 95: 1054–67.PubMedCrossRefGoogle Scholar
  73. 73.
    Freye E, Levy JV. Use of opioids in the elderly - pharmacokinetic and pharmacodynamic considerations (German). Anasthesiol Intensivmed Notfallmed Schmerzther 2004; 39: 527–37.PubMedCrossRefGoogle Scholar
  74. 74.
    Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 2003; 38: 843–53.PubMedCrossRefGoogle Scholar
  75. 75.
    Valentine SJ, Marjot R, Monk CR. Preoxygenation in the elderly: a comparison of the four-maximal-breath and three-minute techniques. Anesth Analg 1990; 71: 516–9.PubMedCrossRefGoogle Scholar
  76. 76.
    Eichenberger A, Proietti S, Wicky S, et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg 2002; 95: 1788–92.PubMedCrossRefGoogle Scholar
  77. 77.
    Bindslev L, Hedenstierna G, Santesson J, Norlander O, Gram I. Airway closure during anaesthesia, and its prevention by positive end expiratory pressure. Acta Anaesthesiol Scand 1980; 24: 199–205.PubMedCrossRefGoogle Scholar
  78. 78.
    Lachmann B. Open up the lung and keep the lung open. Intensive Care Med 1992; 18: 319–21.PubMedCrossRefGoogle Scholar
  79. 79.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Reexpansion of atelectasis during general anaesthesia may have a prolonged effect. Acta Anaesthesiol Scand 1995; 39: 118–25.PubMedGoogle Scholar
  80. 80.
    Rothen HU, Sporre B, Engberg G, Wegenius G, Hedenstierna G. Re-expansion of atelectasis during general anaesthesia: a computed tomography study. Br J Anaesth 1993; 71: 788–95.PubMedCrossRefGoogle Scholar
  81. 81.
    Brooks-Brunn JA. Postoperative atelectasis and pneumonia. Heart Lung 1995; 24: 94–115.PubMedCrossRefGoogle Scholar
  82. 82.
    Esteban A, Frutos-Vivar F, Ferguson ND, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med 2004; 350: 2452–60.PubMedCrossRefGoogle Scholar
  83. 83.
    Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995; 333: 817–22.PubMedCrossRefGoogle Scholar
  84. 84.
    Pennock BE, Kaplan PD, Carlin BW, Sabangan JS, Magovern JA. Pressure support ventilation with a simplified ventilatory support system administered with a nasal mask in patients with respiratory failure. Chest 1991; 100: 1371–6.PubMedCrossRefGoogle Scholar
  85. 85.
    Squadrone V, Coha M, Cerutti E, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA 2005; 293: 589–95.PubMedCrossRefGoogle Scholar
  86. 86.
    Sevransky JE, Haponik EF. Respiratory failure in elderly patients. Clin Geriatr Med 2003; 19: 205–24.PubMedCrossRefGoogle Scholar
  87. 87.
    Sloane PJ, Gee MH, Gottlieb JE, et al. A multicenter registry of patients with acute respiratory distress syndrome. Physiology and outcome. Am Rev Respir Dis 1992; 146: 419–26.PubMedGoogle Scholar
  88. 88.
    Luhr OR, Karlsson M, Thorsteinsson A, Rylander C, Frostell CG. The impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation. Intensive Care Med 2000; 26: 508–17.PubMedCrossRefGoogle Scholar
  89. 89.
    Ely EW, Evans GW, Haponik EF. Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit. Ann Intern Med 1999; 131: 96–104.PubMedGoogle Scholar
  90. 90.
    Thompson LF. Failure to wean: exploring the influence of age-related pulmonary changes. Crit Care Nurs Clin North Am 1996; 8: 7–16.PubMedGoogle Scholar
  91. 91.
    Kleinhenz ME, Lewis CY. Chronic ventilator dependence in elderly patients. Clin Geriatr Med 2000; 16: 735–56.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  1. 1.Department of AnesthesiologyMayo Clinic College of MedicineRochesterUSA
  2. 2.Division of Pulmonary and Critical Care MedicineMayo Clinic College of MedicineRochesterUSA

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