LIVES 2016: ICU admission in the elderly

elderly

Session on ICU admissions in the elderly. A few RCTs completed but awaiting further data as discussed. Good review below:

Review on the Elderly and ICU

Very old ICU Patients = VIPs

Long term survival important. 1 year mortality >80 is especially bad in AKI patients. Cardiothoracic seem to do much better

Hospital mortality of approx 40% in Dutch octogenarians. But decreasing since 2007

Predicting outcome in >80 difficult – frailty index or simpler frailty scale

Summary here: http://lifeinthefastlane.com/ccc/frailty/

VIP-1 study – looks at all octogenarians after ICU admission. Recruiting now!

Factors impossible to know – Rui Moreno

Dramatic change in number of elderly in general population 1850 – 1990

Need fast decisions but need time to decide whether patient responding to treatment

45% of prognosis already present at time of ICU admission e.g. age, prior disease, genetic background

Acute physiological disturbance only accounts for 35% of prognosis

William Osler: “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has”

ICE-CUB 2 study – Bertrand Guidet

Planning RCTs investigating admissions of the eldery to ICU – firstly, how to select which patients to admit? ncbi.nlm.nih.gov/pubmed/19866508

ICE-CUB-1 study. No beneficial effect on admission to ICU for patients >80 archinte.jamanetwork.com/article.aspx?a…

2016 ICE-CUB-2 study recruting. Lowered inclusion age to <75. ADL >4, nil active cancer, preserved nutritional status

Primary endpoint for ICE-CUB2 study = 6 month mortality. Right length? Or is that too short term in this group and to show overall benefit

Results embargoed but coming soon!