Community-acquired pneumonia in critically ill very old patients: a growing problem

Abstract

Very old (aged ≥80 years) adults constitute an increasing proportion of the global population. Currently, this subgroup of patients represents an important percentage of patients admitted to the intensive care unit. Community-acquired pneumonia (CAP) frequently affects very old adults. However, there are no specific recommendations for the management of critically ill very old CAP patients. Multiple morbidities, polypharmacy, immunosenescence and frailty contribute to an increased risk of pneumonia in this population. CAP in critically ill very old patients is associated with higher short- and long-term mortality; however, because of its uncommon presentation, diagnosis can be very difficult. Management of critically ill very old CAP patients should be guided by their baseline characteristics, clinical presentation and risk factors for multidrug-resistant pathogens. Hospitalisation in intermediate care may be a good option for critical ill very old CAP patients who do not require invasive procedures and for whom intensive care is questionable in terms of benefit.

Publication was funded by Ciber de Enfermedades Respiratorias (CibeRes CB06/06/0028) and the 2009 Support to Research Groups in Catalonia 911, IDIBAPS (CERCA Programme/Generalitat de Catalunya). C. Cillóniz is the recipient of a postdoctoral grant (Strategic Plan for Research and Innovation in Health-PERIS 2016–2020), SEPAR fellowship 2008 and the Fondo de Investigación Sanitaria (grant PI19/00207). Funding information for this article has been deposited with the Crossref Funder Registry