Characteristics and outcome of Emergency Department intubation in geriatric patients.

INTRODUCTION: The number of elderly patients admitted to the Emergency Department (ED) continues to grow due to the natural aging of the population. Consequently, tracheal intubation will be increasingly used in the oldest old. The objective of this retrospective study is to evaluate the characteristics and outcome of patients of 75 years and older undergoing an endotracheal intubation in the ED. METHODS: In a single center, retrospective study we reviewed digital medical files of patients of 75 years and older in the period from 1/01/2008 to 31/12/2010, who were admitted to the ED of the Universitair Ziekenhuis Brussel in Brussels, Belgium and underwent endotracheal intubation. Survival served as primary outcome and survival without sequelae as secondary endpoint. RESULTS: In the study period, 88 patients of 75 years and older were intubated in the ED. Sixty three (72%) patients died after intubation and 25 (28%) survived until discharge. All 23 patients (26%), who were intubated during cardiopulmonary resuscitation died. A survival rate of 48% was observed in patients, who were intubated for respiratory failure (28%), intracerebral hemorrhage or ischemic stroke (17%), cardiac failure (8%) or other reasons. Non-survivors were significant older, of male sex, had higher APACHE scores and more frequently used cholesterol lowering drugs. CONCLUSION: Senior adults, aged 75 years or older and undergoing endotracheal intubation at the ED, have a high mortality rate. Younger age and female sex at admission were positively correlated with survival. Of those who left the hospital, one-third were able to return home without major sequelae.

At risk populations: from children to the elderly.

At risk populations:from children to the elderly. PROBLEMS/OBJECTIVES: When considering emergencies in children and elderly people, the risks and consequences are considerably different. For example, the anatomical differences of children have direct consequences on intubation and airway physiology influences breathing, circulation and neurological outcomes.Pharmacotherapy should be adapted for children according to their differences (maturational changes) where drug metabolism and disposition is concerned and for the elderly, to geriatric pharmacokinetics, pharmacodynamics, the existence of poly-medications and the risk of adverse drug reactions. METHODOLOGY: Literature review Results: Children respond better to rapid medical care than adults. Hypoxia is dangerous for the child and is responsible for bradycardia and cardiac arrest. Hypoxia can be deleterious for elderly patients because of their fragility, e.g., less metabolic reserves, poor muscular compensation and higher risk of heart failure. CONCLUSIONS: It is widely accepted that children require paediatric-specific assessment/treatment equipment and pharmacotherapy. When compared to adults, there is no difference in the Royal College of Physician guidelines for elderly people's reanimation, however, other criteria such as polypathology, co-morbidity, polypharmacy, fragility, risk of delirium, adverse drug reaction, poor outcome and quality of life should be considered.

[Delirium in the elderly]. / Etat confusionnel aigu chez la personne âgée.

Delirium in the elderly is common but unfortunately underdiagnosed. The consequences could be significant such as an increase of the mortality in the hospital, loss of autonomy and increased risk to be institutionalized. The presentation of the delirium could be hyperactive, hypoactive or mixed. The predisposing and precipating factors are well known. The physiopathology is not yet well defined but the inflammation and the neuromediators are involved. It is important to develop primary and secondary prevention, but also to propose a follow in memory clinics for all elderly people who having suffered from delirium during hospitalization because a confusional state could be the first step towards future dementia.