Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis.
Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis.
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DOI：
10.1186/cc4926
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Boddaert J
中科院分区：
文献类型：
--
作者：
Ray P;Birolleau S;Lefort Y;Becquemin MH;Beigelman C;Isnard R;Teixeira A;Arthaud M;Riou B;Boddaert J
我们的目标是确定老年患者急性呼吸衰竭（ARF）的原因，并评估急诊医生初步诊断和预后的准确性。在这项前瞻性观察研究中，纳入我们急诊科的患者，年龄为 65 岁或以上，有呼吸困难，并且至少满足以下 ARF 标准之一：呼吸频率至少 25 分钟-1；动脉氧分压（PaO2）≤70mmHg，或呼吸室内空气中外周血氧饱和度≤92%；动脉二氧化碳分压 (PaCO2) ≥ 45 mmHg，pH ≤ 7.35。最终诊断由专家小组根据完整的医疗图表确定。总共纳入 514 名患者（年龄（平均值±标准差）80±9 岁）。引起ARF的主要原因为心源性肺水肿（43%）、社区获得性肺炎（35%）、慢性呼吸道疾病急性加重（32%）、肺栓塞（18%）和急性哮喘（3%）； 47% 的人有两次以上诊断。院内死亡率为 16%。急诊室有 101 名 (20%) 患者被漏诊。急诊医生诊断的准确度从心源性肺水肿的0.76到哮喘的0.96不等。 162 名 (32%) 患者发生了不适当的治疗，并导致较高的死亡率（25% 对比 11%；p < 0.001）。在多变量分析中，初始治疗不当（比值比 2.83，p < 0.002）、高碳酸血症 > 45 mmHg（比值比 2.79，p < 0.004）、肌酐清除率 < 50 ml 分钟-1（比值比 2.37，p < 0.013）、NT-pro-B 型利钠肽或 B 型升高 利钠肽（比值比 2.06，p < 0.046）和急性通气衰竭的临床症状（比值比 1.98，p < 0.047）是死亡的预测因素。急诊室初始治疗不当与老年 ARF 患者死亡率增加相关。
Our objectives were to determine the causes of acute respiratory failure (ARF) in elderly patients and to assess the accuracy of the initial diagnosis by the emergency physician, and that of the prognosis. In this prospective observational study, patients were included if they were admitted to our emergency department, aged 65 years or more with dyspnea, and fulfilled at least one of the following criteria of ARF: respiratory rate at least 25 minute-1; arterial partial pressure of oxygen (PaO2) 70 mmHg or less, or peripheral oxygen saturation 92% or less in breathing room air; arterial partial pressure of CO2 (PaCO2) ≥ 45 mmHg, with pH ≤ 7.35. The final diagnoses were determined by an expert panel from the completed medical chart. A total of 514 patients (aged (mean ± standard deviation) 80 ± 9 years) were included. The main causes of ARF were cardiogenic pulmonary edema (43%), community-acquired pneumonia (35%), acute exacerbation of chronic respiratory disease (32%), pulmonary embolism (18%), and acute asthma (3%); 47% had more than two diagnoses. In-hospital mortality was 16%. A missed diagnosis in the emergency department was noted in 101 (20%) patients. The accuracy of the diagnosis of the emergency physician ranged from 0.76 for cardiogenic pulmonary edema to 0.96 for asthma. An inappropriate treatment occurred in 162 (32%) patients, and lead to a higher mortality (25% versus 11%; p < 0.001). In a multivariate analysis, inappropriate initial treatment (odds ratio 2.83, p < 0.002), hypercapnia > 45 mmHg (odds ratio 2.79, p < 0.004), clearance of creatinine < 50 ml minute-1 (odds ratio 2.37, p < 0.013), elevated NT-pro-B-type natriuretic peptide or B-type natriuretic peptide (odds ratio 2.06, p < 0.046), and clinical signs of acute ventilatory failure (odds ratio 1.98, p < 0.047) were predictive of death. Inappropriate initial treatment in the emergency room was associated with increased mortality in elderly patients with ARF.
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DOI：
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发表时间：
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影响因子：
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