Bertrand Guidet1, Eric Hodgson2, Charles Feldman3, Fathima Paruk4, Jeffrey Lipman5, Younsuck Koh6, Jean Louis Vincent7, Elie Azoulay8, Charles L Sprung9. 1. Assistance Publique, Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, F-75012, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France. Electronic address: bertrand.guidet@sat.aphp.fr. 2. Department of Anaesthesia & Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, eThekwini-Durban, South Africa. 3. Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 4. Department of Anaesthesiology, University of the Witwatersrand, Johannesburg, South Africa. 5. Department of Anaesthesiology and Critical Care, The University of Queensland School of Medicine: Department of Intensive Care Medicine l Royal Brisbane and Women's Hospital, Herston, QLD 4029. 6. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Univ. of Ulsan College of Medicine, 388-1 Pungnap Dong Songpa Ku, Seoul, 138-736, Korea. 7. Dept of Intensive Care, Université Libre de Bruxelles, Erasme Univ Hospital. 8. AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France. 9. General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, PO Box 12000, Jerusalem, Israel 91120.
Abstract
INTRODUCTION: Life-sustaining treatment (LST) limitation for elderly patients is highly controversial. In that context, it is useful to evaluate the attitudes to LST in the elderly among experienced intensive care unit (ICU) physicians with different backgrounds and cultures. METHODS: A panel of 22 international ICU physicians from 13 countries responded to a questionnaire related to withholding (WH) and withdrawing (WD) LST in elderly patients using a semi-Likert scale. RESULTS: Most experts disagree or strongly disagree (77%) that age should be used as the sole criterion for WH or WD LST, and almost all disagree (91%) that there should be a specific age for such decision making. However, the vast majority (91%) acknowledge that age should be an important consideration in conjunction with other factors. Disagreement for consideration of prioritizing the young over the old in normal ICU operations was reported in 68%, whereas in an emergency triage situation, disagreement dropped to 18%. CONCLUSIONS: There is a consensus among ICU physicians that age cannot be the sole criterion on which health care decisions should be made. In that perspective, it is important to provide data showing that outcome differences between elderly and nonelderly patients are partly related to decisions to forgo LSTs.
INTRODUCTION: Life-sustaining treatment (LST) limitation for elderly patients is highly controversial. In that context, it is useful to evaluate the attitudes to LST in the elderly among experienced intensive care unit (ICU) physicians with different backgrounds and cultures. METHODS: A panel of 22 international ICU physicians from 13 countries responded to a questionnaire related to withholding (WH) and withdrawing (WD) LST in elderly patients using a semi-Likert scale. RESULTS: Most experts disagree or strongly disagree (77%) that age should be used as the sole criterion for WH or WD LST, and almost all disagree (91%) that there should be a specific age for such decision making. However, the vast majority (91%) acknowledge that age should be an important consideration in conjunction with other factors. Disagreement for consideration of prioritizing the young over the old in normal ICU operations was reported in 68%, whereas in an emergency triage situation, disagreement dropped to 18%. CONCLUSIONS: There is a consensus among ICU physicians that age cannot be the sole criterion on which health care decisions should be made. In that perspective, it is important to provide data showing that outcome differences between elderly and nonelderly patients are partly related to decisions to forgo LSTs.
Authors: Hans Flaatten; Dylan W De Lange; Alessandro Morandi; Finn H Andersen; Antonio Artigas; Guido Bertolini; Ariane Boumendil; Maurizio Cecconi; Steffen Christensen; Loredana Faraldi; Jesper Fjølner; Christian Jung; Brian Marsh; Rui Moreno; Sandra Oeyen; Christina Agwald Öhman; Bernardo Bollen Pinto; Ivo W Soliman; Wojciech Szczeklik; Andreas Valentin; Ximena Watson; Tilemachos Zaferidis; Bertrand Guidet Journal: Intensive Care Med Date: 2017-09-21 Impact factor: 17.440
Authors: Bertrand Guidet; Hans Flaatten; Ariane Boumendil; Alessandro Morandi; Finn H Andersen; Antonio Artigas; Guido Bertolini; Maurizio Cecconi; Steffen Christensen; Loredana Faraldi; Jesper Fjølner; Christian Jung; Brian Marsh; Rui Moreno; Sandra Oeyen; Christina Agwald Öhman; Bernardo Bollen Pinto; Ivo W Soliman; Wojciech Szczeklik; Andreas Valentin; Ximena Watson; Tilemachos Zafeiridis; Dylan W De Lange Journal: Intensive Care Med Date: 2018-05-17 Impact factor: 17.440
Authors: Seung Hun Lee; Tae Won Lee; Sunmi Ju; Jung-Wan Yoo; Seung Jun Lee; Yu Ji Cho; Yi Yeong Jeong; Jong Deog Lee; Ho Cheol Kim Journal: Korean J Intern Med Date: 2017-06-26 Impact factor: 2.884
Authors: Ernest van Veen; Mathieu van der Jagt; Giuseppe Citerio; Nino Stocchetti; Diederik Gommers; Alex Burdorf; David K Menon; Andrew I R Maas; Erwin J O Kompanje; Hester F Lingsma Journal: Intensive Care Med Date: 2021-08-05 Impact factor: 17.440