In-hospital and long-term prognosis of elderly patients requiring endotracheal intubation for life-threatening presentation of cardiogenic pulmonary edema

Objective: We studied the in-hospital course, long-term prognosis, and functional status of elderly patients with life-threatening cardiogenic pulmonary edema requiring mechanical ventilation. Design: Semiprospective evaluation. Setting: Twelve intensive care units and one emergency prehospital medical department in university hospitals. Patients: Patients, aged >75 yrs, with life-threatening cardiogenic pulmonary edema requiring invasive airway management during the prehospital phase between January 1994 and January 1999 were included, Intervention: None. Measurements and Main Results:A total of 79 patients were studied, of which 55 were included in the prospective phase and 24 during the retrospective phase. The age range was 75-99 yrs, with a mean age of 82.4 +/- 5,9, The male/female ratio was 35:44, The in-hospital mortality was 26,6%, The mean follow-up time for all 58 survivors was 23 months (range, 2-56 months), Among those discharged, survival at 1 yr was 69%, At 3 months after hospital discharge, 49 (87%) patients lived at home, 46 (82%) were able to bathe themselves, 35 (62%) could walk at least one block, and 34 (61%) could climb one flight of stairs, Conclusions: Mortality after severe pulmonary edema requiring endotracheal intubation in a very elderly cohort has a predictably high mortality, although not related directly to the degree of presenting respiratory compromise, However, approximately 50% of the overall cohort returned to relatively good functional status, despite advanced age and a severely compromised presentation. Aggressive airway management appears, therefore, justified in this select group of patients.