Advertisement

Critical Care in Older Adults

  • David W. Rittenhouse
  • Niels D. Martin
  • Michael S. Weinstein
Chapter

Abstract

Geriatric patients constitute a substantial proportion of those utilizing critical care services in acute care hospital settings. This chapter reviews clinical indications for critical care services in this population. Specific treatments are reviewed in the context of overall care, including care at the end of life. Critical care medicine plays an important role in the management of elderly urologic patients with complex care requirements.

Keywords

Intensive Care Unit Atrial Fibrillation Elderly Patient Intensive Care Unit Stay Pulmonary Artery Catheter 
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.

References

  1. 1.
    Udekwu P, Gurkin B, Oller D, Lapio L, Bourbina J. Quality of life and functional level in elderly patients surviving surgical intensive care. J Am Coll Surg. 2001;193(3):245–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Menaker J, Scalea TM. Geriatric care in the surgical intensive care unit. Crit Care Med. 2010;38(9 Suppl):S452–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Aging Statistics, Administration on Aging. http://www.aoa.gov/Aging_Statistics/.
  4. 4.
    U.S. Census Bureau. United States Census 2000. Washington, DC: US Census Bureau; 2000.Google Scholar
  5. 5.
    Ito Y, Kenmochi T, Irino T, et al. The impact of surgical outcome after pancreaticoduodenectomy in elderly patients. World J Surg Oncol. 2011;9:102. doi:10.1186/1477-7819-9-102; 10.1186/1477-7819-9-102.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Zoller DP. The physiology of aging. Am Fam Physician. 1987;36(1):112–6.PubMedGoogle Scholar
  7. 7.
    Evers BM, Townsend CM, Thompson JC. Organ physiology of aging. Surg Clin North Am. 1994;1(74):23–39.Google Scholar
  8. 8.
    Lakatta EG. Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons. Heart Fail Rev. 2002;7(1):29–49.PubMedCrossRefGoogle Scholar
  9. 9.
    Goldman L, Caldera DL, Southwick FS, et al. Cardiac risk factors and complications in non-cardiac surgery. Medicine (Baltimore). 1978;57(4):357–70.CrossRefGoogle Scholar
  10. 10.
    Tresch DD, McGough MF. Heart failure with normal systolic function: a common disorder in older people. J Am Geriatr Soc. 1995;43(9):1035–42.PubMedGoogle Scholar
  11. 11.
    Marik PE. Management of the critically ill geriatric patient. Crit Care Med. 2006;34(9 Suppl):S176–82. doi: 10.1097/01.CCM.0000232624.14883.9A.PubMedCrossRefGoogle Scholar
  12. 12.
    Morley JE, Reese SS. Clinical implications of the aging heart. Am J Med. 1989;86(1):77–86.PubMedCrossRefGoogle Scholar
  13. 13.
    Tockman M. Aging of the respiratory system. In: Katlic M, editor. Geriatric surgery, comprehensive care of the elderly patient. Baltimore-Munich: Urban & Schwarzenberg; 1990. p. 75–84.Google Scholar
  14. 14.
    Dhar S, Shastri SR, Lenora RA. Aging and the respiratory system. Med Clin North Am. 1976;60(6):1121–39.PubMedGoogle Scholar
  15. 15.
    Morris JF, Koski A, Johnson LC. Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis. 1971;103(1):57–67.PubMedGoogle Scholar
  16. 16.
    Kronenberg RS, Drage CW. Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal men. J Clin Invest. 1973;52(8):1812–9.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Pisani MA. Considerations in caring for the critically ill older patient. J Intensive Care Med. 2009;24(2):83–95.PubMedCrossRefGoogle Scholar
  18. 18.
    Adler S, Lindeman RD, Yiengst MJ, Beard E, Shock NW. Effect of acute acid loading on urinary acid excretion by the aging human kidney. J Lab Clin Med. 1968;72(2):278–89.PubMedGoogle Scholar
  19. 19.
    Liu LL, Leung JM. Predicting adverse postoperative outcomes in patients aged 80 years or older. J Am Geriatr Soc. 2000;48(4):405–12.PubMedGoogle Scholar
  20. 20.
    Keller SM, Markovitz LJ, Wilder JR, Aufses Jr AH. Emergency and elective surgery in patients over age 70. Am Surg. 1987;53(11):636–40.PubMedGoogle Scholar
  21. 21.
    Scalea TM, Simon HM, Duncan AO, et al. Geriatric blunt multiple trauma: improved survival with early invasive monitoring. J Trauma. 1990;30(2):129–34. discussion 134-6.PubMedCrossRefGoogle Scholar
  22. 22.
    Clermont G, Kong L, Weissfeld LA, et al. The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury. PLoS One. 2011;6(7):e22512.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Harvey S, Stevens K, Harrison D, et al. An evaluation of the clinical and cost-effectiveness of pulmonary artery catheters in patient management in intensive care: a systematic review and a randomised controlled trial. Health Technol Assess. 2006;10(29):iii–iv, ix–xi, 1–133.Google Scholar
  25. 25.
    Sandham JD, Hull RD, Brant RF, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348(1):5–14.PubMedCrossRefGoogle Scholar
  26. 26.
    Richard C, Monnet X, Teboul JL. Pulmonary artery catheter monitoring in 2011. Curr Opin Crit Care. 2011;17(3):296–302.PubMedCrossRefGoogle Scholar
  27. 27.
    Levy MM, Dellinger RP, Townsend SR, et al. The surviving sepsis campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38(2):367–74.PubMedCrossRefGoogle Scholar
  28. 28.
    Durairaj L, Schmidt GA. Fluid therapy in resuscitated sepsis: less is more. Chest. 2008;133(1):252–63.PubMedCrossRefGoogle Scholar
  29. 29.
    Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.PubMedCrossRefGoogle Scholar
  30. 30.
    Wiesenack C, Prasser C, Rodig G, Keyl C. Stroke volume variation as an indicator of fluid responsiveness using pulse contour analysis in mechanically ventilated patients. Anesth Analg. 2003;96(5):1254–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Greenfield N, Balk RA. Evaluating the adequacy of fluid resuscitation in patients with septic shock: controversies and future directions. Hosp Pract (1995). 2012;40(2):147–57.CrossRefGoogle Scholar
  32. 32.
    Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288(17):2151–62.PubMedCrossRefGoogle Scholar
  33. 33.
    Watters JM, Bessey PQ. Critical care for the elderly patient. Surg Clin North Am. 1994;74(1):187–97.PubMedGoogle Scholar
  34. 34.
    Heidegger CP, Darmon P, Pichard C. Enteral vs. parenteral nutrition for the critically ill patient: a combined support should be preferred. Curr Opin Crit Care. 2008;14(4):408–14.PubMedCrossRefGoogle Scholar
  35. 35.
    Bistrian BR, McCowen KC. Nutritional and metabolic support in the adult intensive care unit: key controversies. Crit Care Med. 2006;34(5):1525–31.PubMedCrossRefGoogle Scholar
  36. 36.
    Alpers DH. Enteral feeding and gut atrophy. Curr Opin Clin Nutr Metab Care. 2002;5(6):679–83.PubMedCrossRefGoogle Scholar
  37. 37.
    Phelps SJ, Brown RO, Helms RA, Christensen ML, Kudsk K, Cochran EB. Toxicities of parenteral nutrition in the critically ill patient. Crit Care Clin. 1991;7(3):725–53.PubMedGoogle Scholar
  38. 38.
    Doig GS. Parenteral versus enteral nutrition in the critically ill patient: additional sensitivity analysis supports benefit of early parenteral compared to delayed enteral nutrition. Intensive Care Med. 2013;39(5):981–2.PubMedCrossRefGoogle Scholar
  39. 39.
    Falzone E, Hoffmann C, Keita H. Postoperative analgesia in elderly patients. Drugs Aging. 2013;30(2):81–90.PubMedCrossRefGoogle Scholar
  40. 40.
    Bowie MW, Slattum PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother. 2007;5(3):263–303.PubMedCrossRefGoogle Scholar
  41. 41.
    Mann C, Pouzeratte Y, Boccara G, et al. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology. 2000;92(2):433–41.PubMedCrossRefGoogle Scholar
  42. 42.
    Rich MW. Epidemiology, clinical features, and prognosis of acute myocardial infarction in the elderly. Am J Geriatr Cardiol. 2006;15(1):7–11. quiz 12.PubMedCrossRefGoogle Scholar
  43. 43.
    Gregoratos G. Clinical manifestations of acute myocardial infarction in older patients. Am J Geriatr Cardiol. 2001;10(6):345–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Kannel WB, Dannenberg AL, Abbott RD. Unrecognized myocardial infarction and hypertension: the Framingham study. Am Heart J. 1985;109(3 Pt 1):581–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Wadke R. Atrial fibrillation. Dis Mon. 2013;59(3):67–73.PubMedCrossRefGoogle Scholar
  46. 46.
    Nantsupawat T, Nugent K, Phrommintikul A. Atrial fibrillation in the elderly. Drugs Aging. 2013;30(8):593–601.PubMedCrossRefGoogle Scholar
  47. 47.
    Aronow WS. Atrial fibrillation. Heart Dis. 2002;4(2):91–101.PubMedGoogle Scholar
  48. 48.
    Chalfin DB. Outcome assessment in elderly patients with critical illness and respiratory failure. Clin Chest Med. 1993;14(3):583–9.PubMedGoogle Scholar
  49. 49.
    Somme D, Maillet JM, Gisselbrecht M, Novara A, Ract C, Fagon JY. Critically ill old and the oldest-old patients in intensive care: short- and long-term outcomes. Intensive Care Med. 2003;29(12):2137–43.PubMedCrossRefGoogle Scholar
  50. 50.
    Heuser MD, Case LD, Ettinger WH. Mortality in intensive care patients with respiratory disease. Is age important? Arch Intern Med. 1992;152(8):1683–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.PubMedCrossRefGoogle Scholar
  52. 52.
    Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.PubMedCrossRefGoogle Scholar
  53. 53.
    Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34(1):15–21.PubMedCrossRefGoogle Scholar
  54. 54.
    Parrillo JE, Parker MM, Natanson C, et al. Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med. 1990;113(3):227–42.PubMedCrossRefGoogle Scholar
  55. 55.
    McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc. 2003;51(5):591–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Sacanella E, Perez-Castejon JM, Nicolas JM, et al. Mortality in healthy elderly patients after ICU admission. Intensive Care Med. 2009;35(3):550–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Teno JM, Gozalo PL, Bynum JP, et al. Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309(5):470–7.Google Scholar
  58. 58.
    Hennessy D, Juzwishin K, Yergens D, Noseworthy T, Doig C. Outcomes of elderly survivors of intensive care: a review of the literature. Chest. 2005;127(5):1764–74.PubMedCrossRefGoogle Scholar
  59. 59.
    Stapleton RD, Engelberg RA, Wenrich MD, Goss CH, Curtis JR. Clinician statements and family satisfaction with family conferences in the intensive care unit. Crit Care Med. 2006;34(6):1679–85.PubMedCrossRefGoogle Scholar
  60. 60.
    Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356(5):469–78.PubMedCrossRefGoogle Scholar
  61. 61.
    O’Mahony S, McHenry J, Blank AE, et al. Preliminary report of the integration of a palliative care team into an intensive care unit. Palliat Med. 2010;24(2):154–65.PubMedCrossRefGoogle Scholar
  62. 62.
    Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med. 2007;35(6):1530–5.PubMedCrossRefGoogle Scholar
  63. 63.
    Campbell ML, Guzman JA. Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest. 2003;123(1):266–71.PubMedCrossRefGoogle Scholar
  64. 64.
    Nelson JE, Mulkerin CM, Adams LL, Pronovost PJ. Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback. Qual Saf Health Care. 2006;15(4):264–71.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • David W. Rittenhouse
    • 1
  • Niels D. Martin
    • 2
  • Michael S. Weinstein
    • 3
  1. 1.Department of SurgeryJefferson Medical College of Thomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Traumatology, Surgical Critical Care and Emergency SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Division of Acute Care, Department of SurgeryJefferson Medical College of Thomas Jefferson UniversityPhiladelphiaUSA

Personalised recommendations