Evaluating the clinical and cost-effectiveness of permissive hypotension in critically ill patients aged 65 years or over with vasodilatory hypotension: Protocol for the 65 randomised clinical trial

Abstract

Vasodilatory shock is common in critically ill patients and vasopressors are a mainstay of therapy. A meta-analysis suggested that use of a higher, as opposed to a lower, mean arterial pressure target to guide titration of vasopressor therapy, could be associated with a higher risk of death in older critically ill patients. The 65 trial is a pragmatic, multi-centre, parallel-group, open-label, randomised clinical trial of permissive hypotension (a mean arterial pressure target of 60 -65 mmHg during vasopressor therapy) versus usual care in critically ill patients aged 65 years or over with vasodilatory hypotension. The trial is conducted in 2600 patients from 65 United Kingdom adult, general critical care units. The primary outcome is all-cause mortality at 90 days. An economic evaluation is embedded. The 65 trial received favourable ethical opinion from the South Central - Oxford C Research Ethics Committee and approval from the Health Research Authority. The results will be presented at national and international conferences and published in peer-reviewed medical journals. Trial registration: ISRCTN10580502

Long term outcomes in the critically ill: Investigating the association between frailty and survival. LONG a SWARM regional observational study

“…Four hundred and fiftythree patients were admitted with a medical diagnosis (81%) whilst 107 patients were admitted following emergency gastro-intestinal or vascular surgery (19%). The median APACHE 2 and ICNARC scores were 15 (11,20) and 20 (14,26). Three hundred and eighteen patients were not-frail (56.8%, estimated CFS between 1 and 3), whilst 112 were vulnerable (20%, estimated CFS of 4) and 130 patients were frail (23.2%, estimated CFS between 5 and 7).…”

“…(1) Frequency tables and Kaplan-Meier estimation of survival function for whole cohort and specific pre-identified sub-cohorts. These were Rockwood et al Clinical Frailty Score ('frailty') group 19 (not-frail defined as a CFS of one to three, vulnerable defined as a CFS of four and frail defined as a CFS of five or more; vulnerable patients were categorised separately to not-frail or frail patients due to a hypothesised difference in survival), age group (ages 18-64, 65-79 and over 80) 26,27 and invasive organ support groups (received advanced respiratory, cardiovascular or renal support).…”