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It is well recognised that critically ill elderly patient have a higher mortality and therefore the beneficial effect of intensive care unit (ICU) admission variable ICU use among this population have let to significant difference in uptake.
Guidet and colleagues performed a cluster, randomised trial of admission versus standard care in 3036 elderly patients aged 75 years and above. In their multicentre randomised trail, suitable patients were allocated to routine or non-routine admission as per the following:
- Primarily 6 months
- Secondarily ICU admission rate, in-hospital death, functional status and quality of life.
- Disappointingly there was no difference seen in any of the outcome measures, even after adjustment for differences in illness severity and patients admitted to ICU had an INCREASED risk of death at six months despite an increase ICU admission rates.
- Functional status and physical quality of life at six months did not differ significantly.
What does this mean?
- As our ICU population changes it may be that a systematic approach which admits all elderly patients has no effect upon outcome.
- Further international trials are needed before we know whether this is applicable to other populations.