RESUMEN
The aim of this study was to evaluate whether frailty was associated with 6-month mortality in older adults who were admitted to the intensive care unit (ICU) with an illness requiring emergency care. The investigation was a prospective, multi-center, observational study conducted among the ICUs of 17 participating hospitals. Patients ≥ 65 years of age who were admitted to the ICU directly from an emergency department visit were assessed to determine their baseline Clinical Frailty Scale (CFS) scores before the illness and were surveyed 6 months after admission. Among 650 patients included in the study, the median age was 79 years old, and overall mortality at 6 months was as low as 21%, ranging from 6.2% in patients with CFS 1 to 42.9% in patients with CFS ≥ 7. When adjusted for potential confounders, CFS score was an independent prognostic factor for mortality (one-point increase in CFS, adjusted risk ratio with 95% confidence interval 1.19 [1.09-1.30]). Quality of life 6 months after admission worsened as baseline CFS score increased. However, there was no association between total hospitalization cost and baseline CFS. CFS is an important predictor of long-term outcomes among critically ill older patients requiring emergent admission.
Asunto(s)
Fragilidad , Humanos , Anciano , Lactante , Fragilidad/complicaciones , Estudios Prospectivos , Calidad de Vida , Cuidados Críticos , Unidades de Cuidados Intensivos , Mortalidad Hospitalaria , Servicio de Urgencia en HospitalRESUMEN
BACKGROUND: The Laryngeal Tube Suction II (LTSII; VBM, Medizintechnik, Sulz, Germany) is a recent revision of the Laryngeal Tube Suction. This study compared insertion and ventilation profiles of the LTSII and the ProSeal Laryngeal Mask Airway (PLMA; Laryngeal Mask Company, Henley-on-Thames, United Kingdom) in anesthetized and paralyzed patients. METHODS: One hundred adult male patients were randomly allocated to an LTSII or PLMArade mark group. The rate of successful insertion, insertion time, airway leak pressure at a cuff pressure of 60 cm H2O, tidal volume during pressure-controlled ventilation, incidence of gas leakage with cuff pressure reduced and with the shaft inclined, position of LTSII under fluoroscopic observation, and postoperative airway morbidity were determined. RESULTS: Insertion was successful in 37 and 48 of 50 patients with LTSII and PLMA, respectively (P = 0.002), with similar insertion times. Tidal volume was lower with LTSII than with PLMA. Median airway leak pressures of LTSII and PLMA were 16 and 21 cm H2O, respectively (P = 0.006). Gas leakage around the cuff was observed more frequently with LTSII than with PLMA when the cuff pressure was reduced or the shaft of the device inclined. The position of LTSII varied significantly and did not statistically correlate with patient height. Postoperative airway-related morbidity was not significantly different. Finally, tracheal misplacement of LTSII occurred in 5 of 50 patients (10%), but ventilation was possible in 4 of them, and misplacement was identified only after fluoroscopic examination was performed. CONCLUSION: Airway management with LTSII is inferior to that with PLMA.