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Purpose <p>The heterogeneity of very old patients (age ≥ 80&#xa0;years) and the prevalence of complex geriatric syndromes in this cohort constitute major challenges for the classical methods of evidence-based medicine to inform clinical&#xa0;practice. The lack of robust guidance for the management of critical conditions in these patients contributes to considerable uncertainty among practitioners and unwarranted variations of care. The European Society of Intensive Care Medicine (ESICM) initiated a Delphi study to translate the empirical knowledge of experts in this field into consensus-based recommendations for clinical&#xa0;practice.</p> Methods <p>A multi-national group of specialists in intensive care, emergency, and geriatric medicine provided opinions on managing very old patients with critical conditions. Strong or moderate consensus was defined as having at least 90% or 80% of experts, respectively, expressing agreement or disagreement on the three highest or lowest levels of a 9-points Likert scale.</p> Results <p>Twenty-eight members of the expert steering group and 82 additional experts completed two&#xa0;Delphi rounds. After discussing the results, the steering group issued recommendations for 48 statements and 2 checklists for which consensus was achieved. In addition to determining fundamental principles, they include advice on goals of care and the decision-making about admission to and treatment of patients in intensive care and the management after discharge.</p> Conclusion <p>A multi-disciplinary group of experts achieved consensus on recommendations concerning intensive care for very old patients, which were approved and endorsed by ESICM. The implementation requires a careful analysis of available healthcare resources and should proceed in a stepwise fashion.</p>

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ESICM consensus-based recommendations for the management of very old patients in intensive care

  • 期刊论文

  • 发表日期：

    2025年2月17日

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  • Michael Beil,
  • Laura Alberto,
  • Richard S. Bourne,
  • Nathan E. Brummel,
  • Bas de Groot,
  • Dylan W. de Lange,
  • Paul Elbers,
  • Marielle Emmelot-Vonk,
  • Hans Flaatten,
  • Yonathan Freund,
  • Alessandro Galazzi,
  • Ana Garcia-Martinez,
  • Bertrand Guidet,
  • Iva Holmerova,
  • Jeremy M. Jacobs,
  • Gavin M. Joynt,
  • Susannah Leaver,
  • Marc Leone,
  • Bairbre McNicholas,
  • David McWilliams,
  • Victoria Metaxa,
  • Christian H. Nickel,
  • Daniele Poole,
  • Chiara Robba,
  • Kevin Roedl,
  • Marc Romain,
  • Anne-Françoise Rousseau,
  • Sigal Sviri,
  • Wojciech Szczeklik,
  • Helene Vallet,
  • James van Oppen,
  • Christian Jung

摘要

Purpose

The heterogeneity of very old patients (age ≥ 80 years) and the prevalence of complex geriatric syndromes in this cohort constitute major challenges for the classical methods of evidence-based medicine to inform clinical practice. The lack of robust guidance for the management of critical conditions in these patients contributes to considerable uncertainty among practitioners and unwarranted variations of care. The European Society of Intensive Care Medicine (ESICM) initiated a Delphi study to translate the empirical knowledge of experts in this field into consensus-based recommendations for clinical practice.

Methods

A multi-national group of specialists in intensive care, emergency, and geriatric medicine provided opinions on managing very old patients with critical conditions. Strong or moderate consensus was defined as having at least 90% or 80% of experts, respectively, expressing agreement or disagreement on the three highest or lowest levels of a 9-points Likert scale.

Results

Twenty-eight members of the expert steering group and 82 additional experts completed two Delphi rounds. After discussing the results, the steering group issued recommendations for 48 statements and 2 checklists for which consensus was achieved. In addition to determining fundamental principles, they include advice on goals of care and the decision-making about admission to and treatment of patients in intensive care and the management after discharge.

Conclusion

A multi-disciplinary group of experts achieved consensus on recommendations concerning intensive care for very old patients, which were approved and endorsed by ESICM. The implementation requires a careful analysis of available healthcare resources and should proceed in a stepwise fashion.