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Journal of Intensive Care Medicine, Vol. 21, No. 6, 345-351 (2006)
DOI: 10.1177/0885066606292873

Overview of Respiratory Failure in Older Adults

Ali A. El Solh, MD, MPH

Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, solh{at}buffalo.edu

Fadi H. Ramadan, MD

Division of Geriatrics, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York

Older adults comprise 48% of the critically ill population in intensive care units and will continue to represent a substantial proportion of patients requiring intensive care for decades to come. Aging both decreases the reserve capacity of vital organs and increases the risk of concurrent illnesses that challenge the respiratory system, such as pneumonia, renal failure, or heart diseases. Because respiratory failure is one of the leading causes of death in intensive care units, implementation of strategies to prevent the need for reintubation should be considered early in the course of respiratory decompensation. For those who require mechanical ventilation, protocols to identify patients who are ready to wean should facilitate liberation from respiratory support and reduce complications of mechanical ventilation. Finally, allocation of potentially limited health care resources necessitates knowing about the risk-benefit of mechanical ventilation and other treatment for respiratory failure in this population.

Key Words: respiratory failure • geriatrics • intensive care • mechanical ventilation

References

  • Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government; 2001.
  • Nicolas F, Le Gall J, Alperovitch A, Loirat P, Villers D. Influence of patient’s age on survival, level of therapy and length of stay in ICU. Intensive Care Med. 1987;13: 9-13.[Medline] [Order article via Infotrieve]
  • Walker MK. The physiology of normal aging: implications for nursing management of critically compromised adults. In: Fulmer TT, Walker M, eds. Critical Care Nursing of the Elderly. New York, NY: Springer-Verlag; 1992:32-54.
  • Danis M, Patrick D, Southerland L, Green M. Patients’ and families’ preferences for medical intensive care unit. JAMA. 1988;260: 797-802.[Abstract]
  • Pack A, Millman R. The lungs in later life. In: Fishman AP, ed. Pulmonary Diseases and Disorders. New York, NY: McGraw-Hill; 1988:79-90.
  • Enright P, Kronmal R, Higgins M, Schenker M, Haponik E. Spirometry reference values for women and men 65-85 years of age. Am Rev Respir Dis. 1993;147: 125-133.[Medline] [Order article via Infotrieve]
  • Murray JF. Aging: The Normal Lung. 2nd ed. Philadelphia, Pa: Sanders; 1986:339-360.
  • Mauderly J. Effect of age on pulmonary structure and function of immature and adults animals and man. Fed Proc. 1979;38: 173-177.[Medline] [Order article via Infotrieve]
  • Thompson A, Scholer S, Daughton D, Potter J, Rennard S. Altered epithelial lining fluid parameters in old normal individuals. J Gerontol. 1992;47: M171-M176.[Medline] [Order article via Infotrieve]
  • Meyer K, Rosenthal N, Soergel P, Peterson K. Neutrophils and low-grade inflammation in the seemingly normal aging human lung. Mech Ageing Dev. 1998;104: 169-181.[CrossRef][Medline] [Order article via Infotrieve]
  • Zaugg M, Lucchinetti E. Respiratory function in the elderly. Anesthesiol Clin North Am. 2000;18: 47-58.[CrossRef][Medline] [Order article via Infotrieve]
  • Polkey MI, Harris ML, Hughes PD, Rafferty GF, Moxham J, Green M. The contractile properties of the elderly human diaphragm. Am J Respir Crit Care Med. 1997;155: 1560-1564.[Abstract]
  • Taffet GE. Age-related physiologic changes. In: Cobbs EL, Duthie EH, Murphy JB, eds. Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine. 4th ed. Dubuque, Iowa: Kendall/Hunt for the American Geriatrics Society; 1999:10-23.
  • Enright PL. Aging of the respiratory system. In: Hazzard WR, Blass JP, Halter JB, et al., eds. Principles of Geriatric Medicine and Gerontology. 5th ed. York, Pa: McGraw-Hill; 2004:511-515.
  • Carpo RO, Campbell EJ. Aging of the respiratory system. In: Fishman AP, ed. Pulmonary Diseases and Disorders. New York, NY: McGraw-Hill; 1998:251-264.
  • Nitzan M, Mahler Y, Schechter D, Yaffe S, Bocher M, Chisin R. A measurement of pulmonary blood volume increase during systole in humans. Physiol Meas. 1994;15: 489-498.[CrossRef][Medline] [Order article via Infotrieve]
  • Mahler DA, Rosiello RA, Loke J. The aging lung. Clin Geriatr Med. 1986;2: 215-225.[Medline] [Order article via Infotrieve]
  • Raffin TA. Indications for arterial blood gas analysis. In: Cox HC, ed. Common Diagnostic Tests. Use and Interpretation. 2nd ed. Philadelphia, Pa: American College of Physicians; 1990:102-102.
  • Cerveri I, Zoia MC, Fanfulla F, et al. Reference values of arterial oxygen tension in the middle-aged and elderly. Am J Respir Crit Care Med. 1995;152: 934-941.[Abstract]
  • Sorbini CA, Grassi V, Solinas E, Muiesan G. Arterial oxygen tension in relation to age in healthy subjects. Respiration. 1968;25: 3-13.[Medline] [Order article via Infotrieve]
  • Pack A, Millman R. Changes in control of ventilation, awake and sleep, in the elderly. J Am Geriatr Soc. 1986;34: 533-544.[Medline] [Order article via Infotrieve]
  • Poulin MJ, Cunningham DA, Paterson D, Kowalchuk JM, Smith WD. Ventilatory sensitivity to CO2 in hyperoxia and hypoxia in older aged humans. J Appl Physiol. 1993;75: 2209-2216.[Abstract/Free Full Text]
  • Chapman KR, Cherniack NS. Aging effects on the interaction of hypercapnia and hypoxia as ventilatory stimuli. J Gerontol. 1987;42: 202-209.[Medline] [Order article via Infotrieve]
  • Peterson DD, Pack AI, Silage DA, Fishman AP. Effects of aging on ventilatory and occlusion pressure responses to hypoxia and hypercapnia. Am Rev Respir Dis. 1981;124: 387-391.[Medline] [Order article via Infotrieve]
  • Zaugg M, Lucchinetti E. Respiratory function in the elderly. Anesthesiol Clin North Am. 2000;18: 47-58.[CrossRef][Medline] [Order article via Infotrieve]
  • Behrendt CE. Acute respiratory failure in the United States. Chest. 2000;118: 1100-1105.[Abstract/Free Full Text]
  • Ely EW, Evans GW, Haponik EF. Mechanical ventilation in a cohort of elderly patients admitted to an intensive care unit. Ann Intern Med. 1999;131: 96-104.[Abstract/Free Full Text]
  • El Solh A, Bhat A, Gunen H, Berbary E. Extubation failure in the elderly. Respir Med. 2004;98: 661-668.[CrossRef][Medline] [Order article via Infotrieve]
  • El Solh A, Sikka P, Ramadan F, Davis J. Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med. 2001;163: 645-651.[Abstract/Free Full Text]
  • Hedlund J, Hansson LO, Ortqvist A. Short and long term prognosis for middle-aged and elderly patients hospitalized with community-acquired pneumonia: impact of nutritional and inflammatory factors. Scand J Infect Dis. 1995;27: 32-37.[Medline] [Order article via Infotrieve]
  • Swinburne A, Fedullo A, Bixby K, Lee DK, Wahl GW. Respiratory failure in the elderly. Analysis of outcome after treatment with mechanical ventilation. Arch Intern Med. 1993;153: 1657-1662.[Abstract]
  • Feinberg M, Knebl J, Tully J, Segall L. Aspiration and the elderly. Dysphagia. 1990;5: 61-71.[CrossRef][Medline] [Order article via Infotrieve]
  • Diamant NE. Physiology of esophageal motor function. Gastroenterol Clin North Am. 1989;18: 179-194.[Medline] [Order article via Infotrieve]
  • Connolly M, Crowley J, Charan N, Nielson C, Vestal R. Reduced subjective awareness of bronchoconstriction provoked by methacholine in the elderly asthmatic and normal subjects as measured on a simple awareness scale. Thorax. 1992;47: 410-413.[Abstract]
  • Vestal R, Wood A, Shand D. Reduced ß-adrenoreceptor sensitivity in the elderly. Clin Pharmacol Ther. 1979;26: 181-185.[Medline] [Order article via Infotrieve]
  • Pesau B, Falger S, Berger E, et al. Influence of age on outcome of mechanically ventilated patients in an intensive care unit. Crit Care Med. 1992;20: 489-492.[Medline] [Order article via Infotrieve]
  • Krieger BP, Ershowsky PF, Becker DA, Gazeroglu HB. Evaluation of conventional criteria for predicting successful weaning from mechanical ventilatory support in elderly patients. Crit Care Med. 1989;17: 858-861.[Medline] [Order article via Infotrieve]
  • Krieger B, Isber J, Breitenbucher A, Throop G, Ershowsky P. Serial measurements of the rapid shallow breathing index as a predictor of weaning outcome in elderly medical patients. Chest. 1997;112: 1029-1034.[Abstract/Free Full Text]
  • Brochard L, Isabey D, Piquet J, et al. Reversal of acute exacerbations of COPD by inspiratory assistance with a face mask. N Engl J Med. 1990;323: 1523-1530.[Abstract]
  • Plant P, Owen J, Elliot M. Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicenter randomized controlled trial. Lancet. 2000;355: 1931-1935.[CrossRef][Medline] [Order article via Infotrieve]
  • Martin T, Hovis J, Costantino J, et al. A randomized, prospective evaluation of positive pressure ventilation for acute respiratory failure. Am J Respir Crit Care Med. 2000;161: 807-813.[Abstract/Free Full Text]
  • Kramer N, Meyer T, Meharg J, Cece RD, Hill NS. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med. 1995;151: 1799-1806.[Abstract]
  • Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333: 817-822.[Abstract/Free Full Text]
  • Masip J, Betbese A, Paez J, et al. Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary edema: a randomized trial. Lancet. 2000;356: 2126-2132.[CrossRef][Medline] [Order article via Infotrieve]
  • Nava S, Carbone G, DiBattista N, et al. Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med. 2003;168: 1432-1437.[Abstract/Free Full Text]
  • Bersten A, Holt A, Vedig A, Skowronski GA, Baggoley CJ. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med. 1991;325: 1825-1830.[Abstract]
  • Rasanen J, Heikkila J, Downs J, Nikki P, Vaisanen I, Viitanen A. Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am J Cardiol. 1985;55: 296-300.[CrossRef][Medline] [Order article via Infotrieve]
  • Mehta S, Jay G, Woolard RH, et al. Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema. Crit Care Med. 1997;25: 620-628.[CrossRef][Medline] [Order article via Infotrieve]
  • Mehta S, Hill N. Noninvasive ventilation. Am J Respir Crit Care Med. 2001;163: 540-577.[Free Full Text]
  • Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Umberto Meduri G. Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med. 1999;160: 1585-1591.[Abstract/Free Full Text]
  • Hill N. Complications of noninvasive positive pressure ventilation. Respir Care. 1997;42: 432-435.
  • Antonelli M, Conti G, Moro M, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure. Intensive Care Med. 2001;27: 1718-1728.[CrossRef][Medline] [Order article via Infotrieve]
  • Gracey D, Hardy D, Naessens J, et al. The Mayo ventilator-dependent rehabilitation unit: a 5 year experience. Mayo Clin Proc. 1997;72: 13-19.[Medline] [Order article via Infotrieve]
  • Kurek C, Dewar D, Lambrinos J, et al. Clinical and economic outcome of mechanically ventilated patients in New York State during 1993: analysis of 6353 cases under diagnoses related group 483. Crit Care Med. 1997;25: 983-988.[CrossRef][Medline] [Order article via Infotrieve]
  • Dasgupta A, Rice R, Mascha E, et al. Four year experience with a unit for long-term ventilation at the Cleveland Clinic Foundation. Chest. 1999;116: 447-455.[Abstract/Free Full Text]
  • Black N, Jenkinson C, Hayes J, et al. Review of outcome measures used in adult critical care. Crit Care Med. 2001;29: 2119-2224.[CrossRef][Medline] [Order article via Infotrieve]
  • Fedullo A, Swinburne A. Relationship of patient age to cost and survival in a medical ICU. Crit Care Med. 1983;11: 155-159.[Medline] [Order article via Infotrieve]
  • Goldstein R, Campion E, Thibault G, Mulley AG, Skinner E. Functional outcomes following medical intensive care unit. Crit Care Med. 1986;14: 783-787.[Medline] [Order article via Infotrieve]
  • Wu A, Rubin H, Rosen M. Are elderly people less responsive to intensive care? J Am Geriatr Soc. 1990;38: 621-627.[Medline] [Order article via Infotrieve]
  • Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation. A 28 day international study. JAMA. 2002;287: 345-355.[Abstract/Free Full Text]
  • SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). JAMA. 1995;274: 1591-1598.[Abstract]
  • Uhlmann R, Pearlman R. Perceived quality of life and preferences for life-sustaining treatment in older adults. Arch Intern Med. 1991;151: 495-497.[Abstract]
  • Hakim RB, Teno J, Harrell F, et al. Factors associated with donot-resuscitate orders: patients’ preferences, prognoses and physicians’ judgments. Ann Intern Med. 1996;125: 284-293.[Abstract/Free Full Text]

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