The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II

Sprung, Charles L.; Artigas, Antonio; Kesecioğlu, Jozef; Pezzi, Annalisa; Wiis, J.; Pirracchio, Romain; Baras, Mario; Edbrooke, D. L.; Pesenti, Antonio; Bakker, Jan; Hargreaves, Chris; Gurman, Gabriel M.; Cohen, Simon; Lippert, Anne; Payen, Didier; Corbella, Davide; Iapichino, G.

doi:10.1097/ccm.0b013e318232d6b0

Cited by 187 publications

(156 citation statements)

References 15 publications

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“…These may include VOPs, those with chronic diseases or active malignant diseases. In the large Eldicus study the elderly patients (greater than 75 years old) were found to have more ICU rejections than younger ones (less than 75 years old) despite having a greater mortality benefit [3]. On the other hand, in a prospective French study, no survival benefit was found in VOPs who were admitted versus rejected patients [4].…”

Section: Triagementioning

confidence: 96%

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The status of intensive care medicine research and a future agenda for very old patients in the ICU

Flaatten¹,

Lange²,

Artigas³

et al. 2017

Intensive Care Med

212

196

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The "very old intensive care patients" (abbreviated to VOPs; greater than 80 years old) are probably the fastest expanding subgroup of all intensive care unit (ICU) patients. Up until recently most ICU physicians have been reluctant to admit these VOPs. The general consensus was that there was little survival to gain and the incremental life expectancy of ICU admission was considered too small. Several publications have questioned this belief, but others have confirmed the poor long-term mortality rates in VOPs. More appropriate triage (resource limitation enforced decisions), admission decisions based on shared decision-making and improved prediction models are also needed for this particular patient group. Here, an expert panel proposes a research agenda for VOPs for the coming years.

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Section: Triagementioning

confidence: 96%

“…As already discussed, there is a short-term mortality benefit of ICU admission of VOPs [3,32]. However, 1-year mortality appears equally poor in both admitted and refused very elderly patients [33].…”

Section: Long-term Sequelaementioning

confidence: 99%

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Flaatten¹,

Lange²,

Artigas³

et al. 2017

Intensive Care Med

212

196

View full text Add to dashboard Cite

show abstract

“…In addition, we observed that too old patients with irreversible medical conditions were receiving advanced life care treatment notwithstanding higher ICU mortality [25]. Several studies pointed out that ICU refusal rates increase according to patient age, underlying disease, prior cognitive impairment, dependency status, and medical criteria [25][26][27][28].…”

Section: Discussionmentioning

confidence: 96%

“…Several studies pointed out that ICU refusal rates increase according to patient age, underlying disease, prior cognitive impairment, dependency status, and medical criteria [25][26][27][28]. Our ICU has an open model and the decision to admitted patients comes mainly from the external assistant physician and family, limiting our power to explore the recommendation.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Poor Prognostic Patients Admitted to the Intensive Care Unit on Family Member's Emotional Disorders

Fumis¹,

Martins²,

Schettino³

2016

Intensive & Crit Care

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Background: Having a loved one admitted to the ICU is an extraordinarily stressful event, principally with poor prognosis and when death may occur. Aim:To evaluate the impact of poor prognosis patients admitted in the ICU on their family member's emotional disorders. Design and setting:Prospective study conducted in a 22-bed mixed ICU in a tertiary hospital in Sao Paulo, Brazil. Family members completed the Hospital Anxiety and Depression Scale 48 hours post-admission. Family members answered the HADS, the Impact of Event Scale by phone at 30-days and 90-days after ICU discharge.Results: 95/575 patients admitted at the ICU were defined as poor prognostic patients. Poor prognostic patients required more mechanical ventilation (50.0% vs. 32.9%, p=0.002), tracheotomy (11.6% vs. 5.0%, p=0.014), vasopressors (54.7% vs. 36.8%, p=0.001), remained longer under mechanical ventilation (7 [3-15] vs. 3 [2-6] days, p=0.030) and stay longer at ICU (8 [5-18] vs. 4 [3-8], p<0.001) when compared with non-poor prognosis patients. They also had high mortality at ICU (32.6%), 30-days (60.0%) and 90-days (73.5%) and we also observed an intense emotional suffering among their respective family members during and after ICU discharge. Conclusion:Family members of poor prognosis patients admitted to the ICU were more likely to suffer with symptoms of anxiety, depression and post traumatic distress. Their loved ones needed more aggressive treatments during ICU and had higher mortality in a short time.

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“…Prospective, observational study of triage decisions, performed in 11 ICUs in 7 European countries showed that elderly patients have more ICU rejections and higher mortality than younger ones. On the other hand, differences between mortality of accepted versus rejected patients were greatest for older patients indicating that the benefit of ICU admission appears to be greater for the elderly [16,17]. Despite the fact that age is an important and independent predictor of mortality, it cannot be used as the main admission criterion, as the severity of an acute medical condition is much more strongly associated with mortality [18].…”

mentioning

confidence: 99%

The relativity of age or geriatric medicine at the crossroads

Voga

Kovačić

2016

Wien Klin Wochenschr

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The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II

Cited by 187 publications

References 15 publications

The status of intensive care medicine research and a future agenda for very old patients in the ICU

The status of intensive care medicine research and a future agenda for very old patients in the ICU

The Impact of Poor Prognostic Patients Admitted to the Intensive Care Unit on Family Member's Emotional Disorders

The relativity of age or geriatric medicine at the crossroads

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