Use of protocols in older intensive care unit patients: is standardization appropriate?

Increasing numbers of older adults are cared for in intensive care units (ICUs) across the country. These patients are disproportionately impacted by illnesses such as sepsis, ventilator-associated pneumonia, and infections. Their care and course of recovery are complicated by myriad factors, including their often-indistinct presentation of illness and issues related to pharmacotherapy. Increasingly, clinical practice guidelines are being used to facilitate the care of patients with select illnesses and presentations. However, these guidelines, protocols, or bundles, as they are known, generally have not been studied in an older population. This article describes the ventilator-associated pneumonia and sepsis bundles relative to the older critical care patient. Although an exhaustive discussion of every intervention within each bundle as it relates to older ICU patients is beyond the scope of this article, selected bundle parameters are presented, with examples of special considerations for the older ICU patient.