B Guidet1,2,3, D W De Lange4, S Christensen5, R Moreno6, J Fjølner5, G Dumas1,2, H Flaatten7. 1. Hôpital Saint-Antoine, Service de Réanimation Médicale, Assistance Publique - Hôpitaux de Paris, Paris, France. 2. UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, Paris, France. 3. UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Paris, France. 4. Department of Intensive Care Medicine, University Medical Center, Utrecht, The Netherlands. 5. Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark. 6. Unidade de Cuidados Intensivos Neurocríticos, Hospital de São José, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. 7. Department of Clinical Medicine, University of Bergen, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
Abstract
BACKGROUND: Very elderly patients are one of the fastest growing population in ICUs worldwide. There are lots of controversies regarding admission, discharge of critically ill elderly patients, and also on treatment intensity during the ICU stay. As a consequence, practices vary considerably from one ICU to another. In that perspective, we collected opinions of experienced ICU physicians across Europe on statements focusing on patients older than 80. METHODS: We sent an online questionnaire to the coordinator ICU physician of all participating ICUs of an recent European, observational study of Very old critically Ill Patients (VIP1 study). This questionnaire contained 12 statements about admission, triage, treatment and discharge of patients older than 80. RESULTS: We received answers from 162 ICUs (52% of VIP1-study) spanning 20 different European countries. There were major disagreements between ICUs. Responders disagree that: there is clear evidence that ICU admission is beneficial (37%); seeking relatives' opinion is mandatory (17%); written triage guidelines must be available either at the hospital or ICU level (20%); level of care should be reduced (25%); a consultation of a geriatrician should be sought (34%) and a geriatrician should be part of the post-ICU trail (11%). The percentage of disagreement varies between statements and European regions. CONCLUSION: There are major differences in the attitude of European ICU physicians on the admission, triage and treatment policies of patients older than 80 emphasizing the lack of consensus and poor level of evidence for most of the statements and outlining the need for future interventional studies.
BACKGROUND: Very elderly patients are one of the fastest growing population in ICUs worldwide. There are lots of controversies regarding admission, discharge of critically ill elderly patients, and also on treatment intensity during the ICU stay. As a consequence, practices vary considerably from one ICU to another. In that perspective, we collected opinions of experienced ICU physicians across Europe on statements focusing on patients older than 80. METHODS: We sent an online questionnaire to the coordinator ICU physician of all participating ICUs of an recent European, observational study of Very old critically Ill Patients (VIP1 study). This questionnaire contained 12 statements about admission, triage, treatment and discharge of patients older than 80. RESULTS: We received answers from 162 ICUs (52% of VIP1-study) spanning 20 different European countries. There were major disagreements between ICUs. Responders disagree that: there is clear evidence that ICU admission is beneficial (37%); seeking relatives' opinion is mandatory (17%); written triage guidelines must be available either at the hospital or ICU level (20%); level of care should be reduced (25%); a consultation of a geriatrician should be sought (34%) and a geriatrician should be part of the post-ICU trail (11%). The percentage of disagreement varies between statements and European regions. CONCLUSION: There are major differences in the attitude of European ICU physicians on the admission, triage and treatment policies of patients older than 80 emphasizing the lack of consensus and poor level of evidence for most of the statements and outlining the need for future interventional studies.
Authors: Bernhard Wernly; Hans Flaatten; Michael Beil; Jesper Fjølner; Raphael Romano Bruno; Antonio Artigas; Bernardo Bollen Pinto; Joerg C Schefold; Malte Kelm; Sviri Sigal; Peter Vernon van Heerden; Wojciech Szczeklik; Muhammed Elhadi; Michael Joannidis; Richard Rezar; Sandra Oeyen; Georg Wolff; Brian Marsh; Finn H Andersen; Rui Moreno; Sarah Wernly; Susannah Leaver; Ariane Boumendil; Dylan W De Lange; Bertrand Guidet; Stefan Perings; Christian Jung Journal: Sci Rep Date: 2022-10-19 Impact factor: 4.996
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: Pierrick Le Borgne; Quentin Maestraggi; Sophie Couraud; François Lefebvre; Jean-Etienne Herbrecht; Alexandra Boivin; Baptiste Michard; Vincent Castelain; Georges Kaltenbach; Pascal Bilbault; Francis Schneider Journal: PLoS One Date: 2018-06-01 Impact factor: 3.240
Authors: Bertrand Guidet; Helene Vallet; Jacques Boddaert; Dylan W de Lange; Alessandro Morandi; Guillaume Leblanc; Antonio Artigas; Hans Flaatten Journal: Ann Intensive Care Date: 2018-11-26 Impact factor: 6.925
Authors: Ignacio Martin-Loeches; Maria Consuelo Guia; Maria Sole Vallecoccia; David Suarez; Mercedes Ibarz; Marian Irazabal; Ricard Ferrer; Antonio Artigas Journal: Ann Intensive Care Date: 2019-02-04 Impact factor: 6.925
Authors: Dylan W de Lange; Sylvia Brinkman; 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 Agvald Öhman; Bernardo Bollen Pinto; Anne Marie G A de Smet; Ivo W Soliman; Wojciech Szczeklik; Andreas Valentin; Ximena Watson; Tilemachos Zafeiridis; Bertrand Guidet Journal: J Am Geriatr Soc Date: 2019-04-12 Impact factor: 5.562