Acute respiratory failure in the elderly: Diagnosis and prognosis

Emergency Department, CHU Pitié-Salpétriêre, 47-83 boulevard de l'hopital, 75013 Paris, Université Pierre et Marie Curie-Paris 6, France.
Age and Ageing (Impact Factor: 3.64). 06/2008; 37(3):251-7. DOI: 10.1093/ageing/afn060
Source: PubMed


Acute respiratory failure (ARF) in patients over 65 years is common in emergency departments (EDs) and is one of the key symptoms
of congestive heart failure (CHF) and respiratory disorders. Searches were conducted in MEDLINE for published studies in the
English language between January 1980 and August 2007, using ‘acute dyspnea’, ‘acute respiratory failure (ARF)’, ‘heart failure’,
‘pneumonia’, ‘pulmonary embolism (PE)’ keywords and selecting articles concerning patients aged 65 or over. The age-related
structural changes of the respiratory system, their consequences in clinical assessment and the pathophysiology of ARF are
reviewed. CHF is the most common cause of ARF in the elderly. Inappropriate diagnosis that is frequent and inappropriate treatments
in ED are associated with adverse outcomes. B-type natriuretic peptides (BNPs) help to determine an accurate diagnosis of
CHF. We should consider non-invasive ventilation (NIV) in elderly patients hospitalised with CHF or acidotic chronic obstructive
pulmonary disease (COPD) who do not improve with medical treatment. Further studies on ARF in elderly patients are warranted.

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Available from: Samuel Delerme, May 03, 2015
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    • "Parmi les causes de dyspnée, l'insuffisance cardiaque aiguë tient une place remarquable par sa fréquence et sa sévérité. Elle est la première cause d'hospitalisation des sujets âgés depuis les urgences [21] et la mortalité hospitalière s'élève à 25 % au-delà de 70 ans [22]. Ce diagnostic est souvent difficile chez les patients âgés, souffrant de bronchopneumopathie chronique obstructive (BPCO) ou en présence de sibilants . "
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    ABSTRACT: L’utilisation des biomarqueurs a considérablement modifié l’approche diagnostique des pathologies cardiovasculaires et infectieuses en médecine d’urgence. L’utilisation de stratégies combinées incluant des biomarqueurs a sensiblement amélioré la qualité de la prise en charge des patients souffrant de pathologies courantes. Le besoin de nouveaux outils plus fiables et plus performants a permis l’émergence d’une recherche clinique intense autour de cette thématique. Cette revue n’a pas pour objet l’exhaustivité, mais détaille les situations d’urgence où les biomarqueurs sont plus fréquemment utiles, ainsi que les actuels écueils et limites à leur bonne utilisation.
    La Presse Médicale 01/2013; 43(1). DOI:10.1016/j.lpm.2012.04.032 · 1.08 Impact Factor
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    • "Prompt diagnosis of HF may lead to earlier and more appropriate therapy [4]. However, it is difficult to identify HF among dyspnea patients because physical examinations and radiologic approaches often provide limited value for diagnosing HF, especially in the elderly [2] [4]. This difficulty has been partly alleviated by testing for B-type natriuretic peptide (BNP) or the N-terminal peptide of its precursor, proBNP (NT-proBNP), as biomarkers for HF [5,6]. "
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    • "Delirium is commonly diagnosed among patients suffering from COPD and acute respiratory failure. It is known that chronic hypoxia–hypercapnia is associated with development of delirium.[2829] The most possible explanation is the fact that hypercapnia leads to acidosis, and carbon dioxide narcosis, which might represent delirium.[3031] "
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    International journal of preventive medicine 06/2012; 3(6):420-7.
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