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Hardcore ICU: Should we be admitting over 80's to the ICU?

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Hardcore ICU: Should we be admitting over 80's to the ICU? by Camilla Strom

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Hardcore ICU: Should we be admitting over 80's to the ICU?

  1. 1. Camilla Strøm, MD, PhD # dr_stroem camilla007@gmail.com SHOULD WE BE ADMITTING OVER 80’S TO THE ICU? #survivalmasters
  2. 2. THE SILVER TSUNAMI Modified from Luo Jie / China Daily
  3. 3. Chin-Yee Crit Care 2017 Non-survivor CAD 38,820 USD 29,340 EUR 26,260 COSTS
  4. 4. POPULATION 80+ Modified Hanson 2016
  5. 5. 1-YEAR MORTALITY 80+ COMMUNITY DWELLING Danmarks Statistik Venligst udlånt af Læge Stine Hanson Modified Hanson 2016
  6. 6. 1-YEAR MORTALITY 80+ ADMITTED TO HOSPITAL Data fra OUH, SVS Venligst udlånt af Læge Stine Hanson Modified Hanson 2016
  7. 7. 1-YEAR MORTALITY 80+ ADMITTED TO ICU Data fra OUH, SVS Venligst udlånt af Læge Stine Hanson Modified Hanson 2016
  8. 8. SO YOU’RE TELLING ME THERE IS! A CHANCE ?
  9. 9. ”AGE IS JUST A NUMBER” PHYSIOLOGICAL RESERVE SARCOPENIA IMMUNOSENESCENCE
  10. 10. Besidine 2008, Modified by Uptodate PHYSIOLOGICAL RESERVE
  11. 11. Bagshaw Crit Care 2008, Boumendil J Am Geriatr Soc 2005, Boumendil PLoS One 2012, Hamel Ann Intern Med 1999, Somme Intensive Care Med 2003
  12. 12. AGEISM
  13. 13. Garrouste-Orgeas Crit Care Med 2009, Heyland Intensive Care Med 2015, Le Guen Age Ageing 2016, Phillippart Intensive Care Med 2013 ASK
  14. 14. Carpenter 2014, Goldstein CGJ 2012, Pugh Crit Care 2014, Garrouste-Orgeas, Rooij 2005,Sprung Crit Care Med 2012 SOFA APACHE SAPS ISAR iADL CLINICAL FRAILTY SCALE CGA Bright TRST VEQ PHYSIOLOGY FUNCTION & FRAILTY FS
  15. 15. 2015 Becker Ann Intensive Care 2015
  16. 16. Becker Ann Intensive Care 2015 Becker Ann Intensive Care 2015
  17. 17. Bagshaw CMAJ 2014
  18. 18. Quality of life Andersen Crit Care 2017, Heyland 2015, Kaarlola Crit Care Med, Sacanella Crit Care 2011 Functional status Boumendil 2012, Heyland Intensive Care Med 2015, Sacanella Crit Care 2011 Geriatric Syndromes Sacanella Crit Care 2011
  19. 19. IN THE PIPELINE Frailty in the critically ill Wilhelmus 2016 Pugh, Prospero Flaaten, Clincialtrials.gov NCT03134807 Impact of guidelines for ICU admission Pugh, Prospero Flaaten, Clincialtrials.gov NCT03134807 ICE-CUBII study, Clinicaltrials.gov NCT01508819 Multimodal regimens Verceles, Clincialtrials.gov NCT02509520
  20. 20. SHOULD WE BE ADMITTING OVER 80’S TO THE ICU?
  21. 21. TAKE HOME  Know the limitations of the evidence  Know the limitations of your patient  Know your patient’s preferences  Set realistic goals  Re-evaluate  Get involved in Research!
  22. 22. #survivalmasters Camilla Strøm, MD, PhD # dr_stroem camilla007@gmail.com

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