Heyland D, Cook D, Bagshaw SM, Garland A, Stelfox HT, Mehta S, Dodek P, Kutsogiannis J, Burns K, Muscedere J, Turgeon AF, Fowler R, Jiang X, Day AG; Canadian Critical Care Trials Group and the Canadian Researchers at the End of Life Network.; Crit Care Med. 2015 Jul;43(7):1352-60.
Objective: Very elderly persons admitted to ICUs are at high risk of death. To document life-sustaining interventions (mechanical ventilation, vasopressors, renal replacement therapy) provided in the ICU and outcomes of care.
Design: Multicenter, prospective cohort study.
Setting: ICUs of 24 Canadian hospitals.
Participants/Setting: Patients 80 years old or older admitted to the ICU.
Interventions: None.
Measurements and Main Results: One thousand six hundred seventy-one patients were included. The average age of the cohort was 85 years (range, 80–100 yr). Median total length of stay in ICU was 4 days (interquartile range, 2–8 d) and in hospital was 17 days (interquartile range, 8–33 d). Of all patients included, 502 (30%) stayed in ICU for 7 days or more and 344 (21%) received some form of life-sustaining treatment for at least 7 days. ICU and hospital mortality were 22% and 35%, respectively. For nonsurvivors, the median time from ICU admission to death was 10 days (interquartile range, 3–20 d). Of those who died (n = 5 85), 289 (49%) died while receiving mechanical ventilation, vasopressors, or dialysis. The presence of frailty or advance directives had little impact on limiting use of life-sustaining treatments or shortening the time from admission to death.
Conclusions: In this multicenter study, one third of very elderly ICU patients died in hospital, many after a prolonged ICU stay while continuing to receive aggressive life-sustaining interventions. These findings raise questions about the use of critical care at the end of life for the very elderly.
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