Utilization and outcomes of life-supporting interventions in older ICU patients in Japan: a nationwide registry study

Abstract

Purpose: The purpose of this study is to describe the implementation of life-supporting interventions and the short-term outcomes of older patients in ICUs in Japan.

Methods: All adult patients admitted to ICUs participating in the Japanese Intensive Care Patient Database (JIPAD) from April 1, 2015, to March 31, 2022, were eligible for inclusion. Information, including life-supporting interventions, was retrieved from the database. Patients were divided into six age groups. The primary outcome of interest was the proportion of receiving a composite of the following interventions: mechanical ventilation, continuous renal replacement therapy, and veno-venous or veno-arterial extracorporeal membrane oxygenation.

Results: Data of a total of 233,093 patients were analyzed. The median age was 71 years, with 18.2% of the patients in their 80s, 5303 patients in their 90s (2.3%), and 67 patients in their 100s. Many life-supporting interventions were provided to older patients. The proportion of patients older than 90 years who received the composite interventions decreased from 40.4% in 18-59 to 27.6% in 90-99. Non-invasive ventilation (NIV) use increased with age, resulting in a consistent proportion of patients receiving either NIV or mechanical ventilation until their 90s. ICU mortality for patients aged 80 years or older was 5.6%, and hospital mortality for this age group was 12.9%. Approximately half of the patients in their 80s and 60% of those older than 90 years did not return home.

Conclusion: Although life-supporting interventions tended to decrease with age, a considerable number of patients of advanced age still received these interventions.

Keywords: Intensive care units; Life-supporting interventions; Older patients; Resource utilization; Treatment limitation.