ICU challenges: elderly patient
DOI:
https://doi.org/10.30445/rear.v11i2.725Keywords:
Intensive Care, elderly patient, Fragility Index, Admission ICU, Reanimation ICUAbstract
Due to the limitations of available resources and the divergence in the final result of very elderly patients (age> 80 years), these are evaluated to assess the prognosis and benefit before proceeding to their admission to the ICU. According to studies on population, a high increase in elderly patients requiring intensive care is foreseeable in the near future. Admission decisions should be oriented according to the prognosis determined by frailty and comorbidity, but with a more functional approach. Being the fragility index a more significant independent predictor than age, the severity of the disease and even comorbidity. Fragility is multidimensional, but it implies cognitive and physical characteristics that intervene in a decision-making process in order to admit elderly patients in the ICU.
The ICE-CUB 1 study and the recent ICE-CUB 2 study reaffirm the same results and imply that it is necessary to evaluate the possible benefits and harms of the admission in the ICU of very elderly patients. The present article that I request an evaluation for is meant to be a guide for that decision-making process in these patients.
References
- Ihra GC, Lehberger J, Hochrieser H, Bauer P, Schmutz R, Metnitz B, Metnitz PG. Development of demographics and outcome of very old critically ill patients admitted to intensive care units. Intensive Care Med 2012; 38:620–626.
- Boumendil A, Angus DC, Guitonneau AL, et al ICE-CUB study group. Variability of intensive care admission decisions for the very elderly. PLoS One. 2012;7(4):e34387.
- Guidet B, Leblanc G, Simon T, et al. Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France: A Randomized Clinical Trial. JAMA. 2017;318(15):1450-1459.
- Le Borgne P, Maestraggi Q, Couraud S, et al. Critically ill elderly patients (≥ 90 years): Clinical characteristics, outcome and financial implications. Lazzeri C, ed. PLoS ONE. 2018;13(6):e0198360.
- Flaatten H, de Lange W.D. Artigas A, et al .The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Medicine. 2017; 43 (9):1319–1328. |
- Gordo E y Martin P. Fragilidad en Anestesia y Cirugía. ¿Qué deberías saber de tu paciente anciano vulnerable? https://anestesiar.org/2017/fragilidad-en-anestesia-y-cirugia-que-deberias-saber-de-tu-paciente-anciano-vulnerable/?utm_source=blogsterapp&utm_medium=twitter
- Flaatten, H., De Lange, D.W., Morandi, A. et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med. 2017; 43: 1820-1828.
- Rockwood K, Song X, MacKnight C, Bergman H, Hogan D.B., McDowell I and Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173 (5): 489-495.
- Heyland DK, Garland A, Bagshaw SM, et al. Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study. Intensive Care Med. 2015; 41:1911–1920.
- L.E.M.Haas L.S.van Dillen D.W.de Lange D.van Dijk M.E.Hamaker. Outcome of very old patients admitted to the ICU for sepsis: A systematic review. European Geriatric Medicine. 2017; 8(5-6): 446-453.
- Outcomes of elderly critically ill medical and surgical patients: a multicentre cohort study. Ball, I.M., Bagshaw, S.M., Burns, K.E.A. et al. Can J Anesth/J Can Anesth 2017; 64: 260-269.
- Angus DC. Admitting Elderly Patients to the Intensive Care Unit—Is it the Right Decision?. JAMA. 2017;318(15):1443–1444.
- Zeng A, Song X, Dong J, et al. Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2015;70(12):1586-1594. doi:10.1093/gerona/glv084.
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