Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade*

Lerolle, Nicolas; Trinquart, Ludovic; Bornstain, Caroline; Tadié, Jean‐Marc; Imbert, Audrey; Diehl, Jean‐Luc; Fagon, Jean-Yves; Guérot, Emmanuel

doi:10.1097/ccm.0b013e3181b088ec

Cited by 141 publications

(110 citation statements)

References 24 publications

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“…This suggests more proactive end-of-life (EOL) decision policy for elderly patients. However, over time an increase in the intensity of treatment in VOPs has been documented and associated with a mortality improvement after adjustment for severity [10].…”

Section: Icu Interventions and Length Of Staymentioning

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

219

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: Icu Interventions and Length Of Staymentioning

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

219

196

View full text Add to dashboard Cite

show abstract

“…Intensity of ICU treatment [25] and use of medical resources [15,26] are also significant issues. Of all treatment days for the four age groups combined, both the percentages of ICU and hospital treatments days attributable to the very elderly patients increased annually.…”

Section: Discussionmentioning

confidence: 99%

Should Very Old Patients Be Admitted to the Intensive Care Units?

Kwon¹,

Song²

2017

Korean J Crit Care Med

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“…Prior studies have shown that chaplain-led spiritual care improves family satisfaction with end-of-life care in the ICU (23,24), but our study is the first to proactively and systematically engage mechanically ventilated ICU patients who are not necessarily dying. With technological advances, many critically ill patients now survive what were previously fatal illnesses (40,41), but survivors of mechanical ventilation are increasingly recognized to suffer from anxiety, depression, and posttraumatic stress disorder (42)(43)(44). Our finding that chaplain-led spiritual care potentially improves stress after the ICU and helps ICU survivors' ability to cope raises the possibility that chaplain-led picture-guided spiritual care with follow up may be able to help prevent or alleviate these psychiatric sequelae of critical illness.…”

Section: Original Researchmentioning

confidence: 99%

A Novel Picture Guide to Improve Spiritual Care and Reduce Anxiety in Mechanically Ventilated Adults in the Intensive Care Unit

et al. 2016

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Rationale: Hospital chaplains provide spiritual care that helps patients facing serious illness cope with their symptoms and prognosis, yet because mechanically ventilated patients cannot speak, spiritual care of these patients has been limited. Objectives:To determine the feasibility and measure the effects of chaplain-led picture-guided spiritual care for mechanically ventilated adults in the intensive care unit (ICU). Methods:We conducted a quasi-experimental study at a tertiary care hospital between March 2014 and July 2015. Fifty mechanically ventilated adults in medical or surgical ICUs without delirium or dementia received spiritual care by a hospital chaplain using an illustrated communication card to assess their spiritual affiliations, emotions, and needs and were followed until hospital discharge. Feasibility was assessed as the proportion of participants able to identify spiritual affiliations, emotions, and needs using the card. Among the first 25 participants, we performed semistructured interviews with 8 ICU survivors to identify how spiritual care helped them. For the subsequent 25 participants, we measured anxiety (on 100-mm visual analog scales [VAS]) immediately before and after the first chaplain visit, and we performed semistructured interviews with 18 ICU survivors with added measurements of pain and stress (on 6100-mm VAS). Measurements and Main Results:The mean (SD) age was 59 (616) years, median mechanical ventilation days was 19.5 (interquartile range, 7-29 d), and 15 (30%) died in-hospital. Using the card, 50 (100%) identified a spiritual affiliation, 47 (94%) identified one or more emotions, 45 (90%) rated their spiritual pain, and 36 (72%) selected a chaplain intervention. Anxiety after the first visit decreased 31% (mean score change, 220; 95% confidence interval, 233 to 27). Among 28 ICU survivors, 26 (93%) remembered the intervention and underwent semistructured interviews, of whom 81% felt more capable of dealing with their hospitalization and 0% felt worse. The 18 ICU survivors who underwent additional VAS testing during semistructured follow-up interviews reported a 49-point reduction in stress (95% confidence interval, 272 to 224) and no significant change in physical pain that they attributed to picture-guided spiritual care.Conclusions: Chaplain-led picture-guided spiritual care is feasible among mechanically ventilated adults and shows potential for reducing anxiety during and stress after an ICU admission.

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Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade*

Cited by 141 publications

References 24 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

Should Very Old Patients Be Admitted to the Intensive Care Units?

A Novel Picture Guide to Improve Spiritual Care and Reduce Anxiety in Mechanically Ventilated Adults in the Intensive Care Unit

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