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Older adults comprise 48% of the critically ill population in intensive care units and will continue to represent a substantial proportion of patients requiring intensive care for decades to come. Aging both decreases the reserve capacity of vital organs and increases the risk of concurrent illnesses that challenge the respiratory system, such as pneumonia, renal failure, or heart diseases. Because respiratory failure is one of the leading causes of death in intensive care units, implementation of strategies to prevent the need for reintubation should be considered early in the course of respiratory decompensation. For those who require mechanical ventilation, protocols to identify patients who are ready to wean should facilitate liberation from respiratory support and reduce complications of mechanical ventilation. Finally, allocation of potentially limited health care resources necessitates knowing about the risk—benefit of mechanical ventilation and other treatment for respiratory failure in this population.