The Health Services Research & Outcome (HSRO) section is led by Susannah Leaver.




Free live webinars are available for members & non members on the ESICM Media Library.



Patients > 80 years old have a high mortality. This study, which is performed in Europe among 301 different ICUs aims to develop and validate a mortality risk score for very old intensive care patients. The VIP2 study builds on the successful VIP1 study which was published in 2017. ICU recruitment took place from the fall of 2017 until fall of 2018 and is now closed.

Patient recruitment started between May 2018 and October 2018 and is still ongoing until May 2019 or until 20 patients have been included for the individual ICU (whichever comes first). The first results are expected no later than November 2019. More information can be found at

> Visit website


The TOXIC-EU study is a multi-center, international, observational study looking at the Outcome of Intoxicated Patients in Intensive Care Units. We want to include all consecutive patients admitted to the ICU with a (presumptive) diagnosis of intoxication or overdose during a 12 month period. There are no interventions. The primary outcome that this study wants to assess is the 30-day mortality. This study will identify major risk factors for poor outcome of intoxicated patients; look at the diagnostics used for intoxicated patients in distinct intoxication subpopulations and countries.

This study will evaluate treatments that are applied for intoxicated and validate the “ICU requirement score” in a large cohort of patients. At this moment the protocol is being drafted and we are welcoming intensivists who want to become the national coordinator of their country. As national coordinator you will be part of the steering group, you are in charge of applying for ethical approval for your country and you need to find collaborating ICUs in your country. If you are interested, you can send an email to


A Multicentre International One-Day Prevalence Study on Pressure Injuries in Intensive Care Units.

The objective of this study is to provide an up-to-date, global picture of the extent and patterns of pressure injuries in ICUs.

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Multinational, multicentre study of outcome of Very old ICU Patients. This study will address the ICU care of the very old, defined as patients ≥ 80 years, admitted to the ICU.

The project studied the frequency of ICU admission in the very old patients, the use of common ICU resources including ICU and hospital LOS in Europe.


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Competency-based Training in Intensive Care Medicine in Europe – Innovation Transfer. The CoBaTrICE project created an international competency-based programme for ICM.

More information:

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Sentinel Events Evaluation. SEE project is focused on the causes and measures of error prevention.

Results: Patient safety in intensive care: results from the multinational Sentinel Events Evaluation (SEE) study.

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Use of various ICU scoring systems

We have little insight into the extent to which such scoring systems are actually used in ICUs, and which type of systems are preferred.

This simple survey aimed to compile useful feedback about the use of ICU scoring in European ICUs and beyond.

Results coming soon.


The survey aimed to evaluate and compare the level of implementation of the European Working Time Directive amongst intensive care physicians working in countries across Europe, as well as their working conditions and job satisfaction.

WORKing time of DOCtors in the ICU (WorkDoc) survey.

Results coming soon.

Strategies to improve ICUs in resource-poor settings.

The aim of the study is to identify strategies to improve ICUs in resource-poor ICU settings and evaluate whether perceptions differ between ICU staff from the developed and developing world.

Publication: Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future.

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Survey about non-physician providers (physician assistants and nurse practitioners) on the ICU in Europe

Survey organised by Herman Kreeftenberg, HSRO section


Romano Bruno R, Wernly B, Flaatten H, Schölzel F, Kelm M, Jung C. Critical Care volume 23, Article number: 239 (2019)
The hospital frailty risk score is of limited value in intensive care unit patients.

Guidet B, Vallet H, Boddaert J, de Lange DW, Morandi A, Leblanc G, Artigas A, Flaatten H. Ann Intensive Care. 2018 Nov 26;8(1):114
Caring for the critically ill patients over 80: a narrative review.

Guidet B, Flaatten H, Boumendil A, Morandi A, Andersen FH, Artigas A, Bertolini G, Cecconi M, Christensen S, Faraldi L, Fjølner J, Jung C, Marsh B,Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Zafeiridis T, De Lange DW; VIP1 study group. Intensive Care Med. 2018 Jul;44(7):1027-1038.
Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit.

Guidet B, De Lange DW, Christensen S, Moreno R, Fjølner J, Dumas G, Flaatten, H. Acta Anaesthesiol Scand. 2018 Feb;62(2):207-219.
Attitudes of physicians towards the care of critically ill elderly patients – a European survey.

Fronczek J, Polok KJ, Nowak-Kózka I, et al. Anaesthesiol Intensive Ther. 2018
Frailty increases mortality among patients ≥80 years old treated in Polish ICUs.

Flaatten H, Oeyen S, deLange DW. Intensive Care Med. 2018 Aug;44(8):1344-1345.
Predicting outcomes in very old ICU patients: time to focus on the past?

Muessig JM, Nia AM, Masyuk M, et al. BMC Geriatr. 2018 Jul 13;18(1):162.
Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study.

POPPI Study – Conclusions
> Read this article review

Psychiatric symptoms after acute respiratory distress syndrome: a 5-year longitudinal study
> Read this article review

Is it dangerous to be admitted to an ICU during a weekend?
> Read this article review

Impact of Frailty on ICU & mortality in very elderly patients
> Read this article review

How to reduce physical and mental impairment post-ICU? Results from the RAPIT study
> Read this article review

Randomised trial on Condolence Letter for grief symptoms among ICU patients’ relatives
> Read this article review

Challenges in caring for critically ill, non-sedated, mechanically ventilated patients
> Read this article review