Tachypnea in response to hypoxemia decreases with age in older patients

Aim To investigate if tachypneic response to hypoxia is decreased in older patients. Methods We included all patients ≥65 years of age attending 52 Spanish emergency departments (EDs) for whom peripheral arterial oxygen saturation (SatO2) measured by pulsioxymetry and respiratory rate (RR) were regi...

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Published in:	Geriatrics & gerontology international Vol. 24; no. 11; pp. 1120 - 1129
Main Authors:	Burillo, Guillermo, Montero‐Pérez, Francisco Javier, Piñera, Pascual, Blázquez, Beatriz Escudero, Quesada, Sílvia Flores, Vaswani‐Bulchand, Aarati, Collado, Jésica Mansilla, Martos, Rocío Muñoz, López, Antonio Real, García, Jorge Pedraza, Trian, Esperanza Muñoz, Castillo, Juan González, Miró, Òscar, Castillo, Juan, Fernández, Cesáreo, Lamberechts, Jorge García, García, Paula Queizán, Salado, Parla. España. Ángel Iván Diaz, Ungerer, Osvaldo Jorge Troiano, Eiroa‐Hernández, Patricia, Rodríguez‐Cabrera, Montserrat, Gómez, Marta Isabel Gómez, Leal, Cristóbal Rodríguez, Díaz‐Guerra, María Luisa Pérez, Mir, Sira Aguiló, González, Francesc Xavier Alemany, Molinas, Claudia Lorena Amarilla, Lázaro, Leticia Serrano, Soria, Javier Millán, Rodrigo, Adriana Gil, Benito, Mónica Veguillas, Martínez, María Caballero, Jacob, Javier, Fuentes, Elena, Guillen, Lara, Méndez, Coral Suero, Álvarez, Rocío Lorenzo, Mota, Manuel Salido, Sánchez, Mario Lozano, Ramírez, Paula Pedraza, Borja Quero Espinosa, F., Triano, Esperanza Muñoz, Baena, Sierra Bretones, Gil, Ana Isabel Castuera, Romero, Melisa San Julian, Pulfer, María Dolores, Herranz, Juan Fernández, Cubillas, Amanda Ibisate, González, Rocio Hernando, Vela, Marta Iglesias, Madrigal, Alberto Alvarez, Arranz, Esperanza Marín, Aroca, Sara Sánchez, Gallardo, Elena Ramírez, Bataller, Ana Palací, Zorita, Julia Martínez‐Ibarreta, Criado, Beatriz Mañero, Gárate, Raquel Torres, Motto, Eva Quero, Garcia, Nuria Tomas, Martínez, Laura Bernal, Fernández, Marina Carrión, Franco, Belén Morales, Ferrer, Ester Soy, Cho, Jeong‐Uh Hong, Salvatierra, Iciar González, Diamanti, María, Martín, Sara Gayoso, Álvarez, María Esther Fernández, Ballard, Margarita Puiggali, Gómez y Gómez, Bárbara, Gutiérrez, OlgaTrejo, Carrete, Carlos Romero, Mar Sousa, Ricardo Juárez González, Molina, Laura, Juan, María Martínez, Hoffman, María José Blanco, Salgado, Fátima Fernández, García, Gema Gómez, García, Esther Pérez, Del Valle, Pedro Rivas, Diez, María Amparo Berenguer, Moreno, María Teresa Sánchez, Campos, Raquel Benavent, Soler, Alejandro Cortés, Vera, María Teresa Maza, Dacosta, Paz Balado, Rupérez, Inmaculada García, Garcinuño, Pablo González, Ramos, José Ramón Oliva, Marchena, Maria José, Piquero, Eugenia Prieto, Cortizo, Isabel Lobo, Torres, Jennifer Turcios, Patiño, Jesús Santianes
Format:	Journal Article
Language:	English
Published:	Kyoto, Japan John Wiley & Sons Australia, Ltd 01-11-2024 Blackwell Publishing Ltd
Subjects:	Aging emergency department Emergency medical care geriatrics hypoxemia Hypoxia Observational studies older Older people tachypnea geriatrics hypoxemia older tachypnea emergency department
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Summary:	Aim To investigate if tachypneic response to hypoxia is decreased in older patients. Methods We included all patients ≥65 years of age attending 52 Spanish emergency departments (EDs) for whom peripheral arterial oxygen saturation (SatO2) measured by pulsioxymetry and respiratory rate (RR) were registered at ED arrival. We assessed the relationship between SatO2 and RR in different models, and with the best‐fitting model, we independently analyzed this relationship in four subgroups according to patient age (65–69, 70–79, 80–89, and ≥90 years). Five sensitivity analyses using different subsets of patients were carried out to check for the consistency of the results. Results We included 7126 patients, with medians for SatO2 and RR of 97% (interquartile range [IQR]: 94–98) and 15 bpm (IQR: 15–16), respectively. We found significant associations (P < 0.001) between SatO2 and RR in every model tested (P < 0.001 for all), with the quadratic model obtaining the best fit (R2: 0.098) over those obtained with linear (R2: 0.096) and logarithmic (R2: 0.092) models. The same was observed in sensitivity analyses, with R2 for quadratic models ranging from 0.069 in patients with low comorbidity and 0.102 in patients breathing room air. The mean RR for 100% SatO2 was 15 bpm and increased as SatO2 decreased, although with a progressive slowing of the slope, with a mean RR of 27 at 50% SatO2. We detected a decreased RR response to increasing hypoxemia according to age and, while the RR curve was higher and with a progressively steepening slope in the 972 patients aged 65–69 (mean RR of 42 bpm with 50% SatO2), a progressive slowing of slope was observed in the 2693 patients aged 70–79 (mean RR of 28 with 50% SatO2), the 2582 aged 80–89 (mean RR of 25) and the 879 aged ≥90 (mean RR of 23). Sensitivity analyses provided very similar results. Conclusion Tachypneic response to hypoxemia in older patients decreases as age advances, regardless of the reason leading to hypoxemia. Geriatr Gerontol Int 2024; 24: 1120–1129. Tachypneic response to hypoxemia tends to decrease in older patients as age advances, regardless of the reason leading to hypoxemia. Consequently, emergency physicians should take this conclusion into consideration when evaluating older patients in emergency departments.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1444-1586 1447-0594 1447-0594
DOI:	10.1111/ggi.14965