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Aging Clinical and Experimental Research

, Volume 30, Issue 4, pp 359–366 | Cite as

The impact of frailty on noninvasive mechanical ventilation in elderly medical intensive care unit patients

  • Iskender Kara
  • F. Yildirim
  • A. Zerman
  • Z. Gullu
  • N. Boyaci
  • B. B. Aydogan
  • U. Gaygisiz
  • K. Gonderen
  • G. Arik
  • M. Turkoglu
  • M. Aydogdu
  • G. Aygencel
  • Z. Ulger
  • G. Gursel
Original Article

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.

Keywords

Frailty NIV Success Edmonton Frailty Scale Clinical Frailty Scale 

Notes

Compliance with ethical standards

Author contributions

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.

Conflict of interest

All the authors of this manuscript declare that there are no conflicts of interest for this study.

Sponsor’s role

No sponsorship has been received for this study (no sponsorship for design, methods, subject recruitment, data collection, analysis and preparation of paper).

Ethical approval

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.

Informed consent

An informed consent was obtained either from patients (if competent) or from their family.

References

  1. 1.
    Clegg A, Young J (2011) The frailty syndrome. Clin Med 11:72–75CrossRefGoogle Scholar
  2. 2.
    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 43:973–982CrossRefPubMedGoogle Scholar
  3. 3.
    Malmstrom TK, Miller DK, Morley JE (2014) A comparison of four frailty models. J Am Geriatr Soc 62:721–726CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Topinková E (2008) Aging, disability and frailty. Ann Nutr Metab 52(suppl 1):6–11PubMedGoogle Scholar
  5. 5.
    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
  6. 6.
    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–M156CrossRefGoogle Scholar
  7. 7.
    Schortgen F, Follin A, Piccari L et al (2012) Results of noninvasive ventilation in very old patients. Ann Intensive Care 2:5CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    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 53:88–93CrossRefPubMedGoogle Scholar
  9. 9.
    Singh G, Pitoyo CW (2014) Non-invasive ventilation in acute respiratory failure. Acta Med Indones 46:74–80PubMedGoogle Scholar
  10. 10.
    Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173:489–495CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Rolfson DB, Majumdar SR, Tsuyuki RT et al (2006) Validity and reliability of the Edmonton Frail Scale. Age Ageing 35:526–529CrossRefPubMedGoogle Scholar
  12. 12.
    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 7:92–97Google Scholar
  13. 13.
    Basic D, Shanley C (2015) Frailty in an older inpatient population: using the clinical frailty scale to predict patient outcomes. J Aging Health 27:670–685CrossRefPubMedGoogle Scholar
  14. 14.
    Collard RM, Boter H, Schoevers RA et al (2012) Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 60:1487–1492CrossRefPubMedGoogle Scholar
  15. 15.
    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 40:674–682PubMedGoogle Scholar
  16. 16.
    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 62:738–743CrossRefGoogle Scholar
  17. 17.
    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–E102CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    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 61:36–43CrossRefGoogle Scholar
  19. 19.
    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 145:964–971CrossRefPubMedGoogle Scholar
  20. 20.
    Liu J, Duan J, Bai L et al (2016) Noninvasive ventilation intolerance: characteristics, predictors, and outcomes. Respir Care 61:277–284CrossRefPubMedGoogle Scholar
  21. 21.
    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 15:144CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    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 23:118–125CrossRefPubMedGoogle Scholar
  23. 23.
    Gill TM, Gahbauer EA, Han L et al (2010) Trajectories of disability in the last year of life. N Engl J Med 362:1173–1180CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    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 70:1586–1594CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Iskender Kara
    • 1
  • F. Yildirim
    • 1
  • A. Zerman
    • 1
  • Z. Gullu
    • 1
  • N. Boyaci
    • 1
  • B. B. Aydogan
    • 1
  • U. Gaygisiz
    • 1
  • K. Gonderen
    • 1
  • G. Arik
    • 2
  • M. Turkoglu
    • 3
  • M. Aydogdu
    • 4
  • G. Aygencel
    • 3
  • Z. Ulger
    • 2
  • G. Gursel
    • 4
  1. 1.Critical Care Fellowship ProgramGazi University Faculty of MedicineAnkaraTurkey
  2. 2.Department of GeriatricsGazi University Faculty of MedicineAnkaraTurkey
  3. 3.Department of Internal Medicine and Critical CareGazi University Faculty of MedicineAnkaraTurkey
  4. 4.Department of Pulmonary Diseases and Critical Care UnitGazi University Faculty of MedicineAnkaraTurkey

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