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.

Download full-text


Available from: Samuel Delerme, May 03, 2015
  • Source
    • "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 . "
    [Show abstract] [Hide abstract]
    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.
    Preview · Article · Jan 2013 · La Presse Médicale
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To evaluate the diagnostic performance of the mid-regional portion of the pro-atrial natriuretic peptide (MR-proANP) for heart failure (HF) in dyspnea patients. Design and methods: We performed a systematic review of English-language studies published during the past three decades. The performance characteristics (diagnostic sensitivity, specificity, and other measures of accuracy) were pooled and examined by random-effects models. Results: Five studies met the inclusion criteria, which included 1153 patients with HF and 1904 non-HF patients. The summary estimates for MR-proANP in HF diagnosis had a diagnostic sensitivity of 0.90 (95% confidence interval (CI), 0.88-0.92), a specificity of 0.68 (95% CI, 0.66-0.70), and a diagnostic odds ratio (DOR) of 22.89 (95% CI, 12.54-41.77). The area under the curve (AUC) and Q value for the summary receiver operating characteristic (sROC) curves were 0.88 and 0.81, respectively. Conclusion: MR-proANP showed a high diagnostic accuracy for HF in dyspnea patients.
    Full-text · Article · Sep 2012 · Clinical biochemistry
  • Source
    • "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] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Postoperative delirium (POD) is one of the important complications of cardiac surgery and it is assumed to provoke inflammatory responses. Theoretically, anti-inflammatory effects of dexamethasone can have an influence on the incidence and outcomes of POD. The aim of our study was to assess POD predictors and outcomes of dexamethasone administration after cardiac surgery. Patients' mental status was examined by mini-mental status examination and psychiatric interviewing to diagnose delirium. Subsequently, authors analyzed the patient variables for identification of predictors and outcomes of POD. Between 196 patients who met the inclusion criteria, 34 (17.34%) patients were delirious. History of chronic renal failure, obstructive pulmonary disease, smoking, and addiction strongly predicted development of POD. Other predictors were intra-aortic balloon pump insertion, transfusion of packed cells, and atrial fibrillation rhythm. In our study, the administration of dexamethasone significantly reduced the risk for POD. Furthermore, delirium was associated with longer intensive care unit (ICU) stay. Our study reports the predictors of POD, which patients commonly facing them in cardiac surgery ICU. Appropriate management and prevention of these predictors, especially modifiable ones, can decrease the incident of POD and improves cognitive outcomes of cardiac surgeries.
    Full-text · Article · Jun 2012 · International journal of preventive medicine
Show more