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Despite technological advances, the mortality rate for critically ill oldest old patients remains high. The intensive caring should be able to combine technology and a deep humanity considering that the patients are living the last part of their lives. In addition to the traditional goals of ICU of reducing morbidity and mortality, of maintaining organ functions and restoring health, caring for seriously oldest old patients should take into account their end-of-life preferences, the advance or proxy directives if available, the prognosis, the communication, their life expectancy and the impact of multimorbidity. The aim of this review was to focus on all these aspects with an emphasis on some intensive procedures such as mechanical ventilation, noninvasive mechanical ventilation, cardiopulmonary resuscitation, renal replacement therapy, hemodynamic support, evaluation of delirium and malnutrition in this heterogeneous frail ICU population.

Twenty-five patients affected by chronic lower limb obliterating arteriopathy with critical ischemia in one limb were treated with PGE1 for 4 weeks and then followed-up for one year. On day 14 of treatment three groups of patients were selected on the basis of clinical symptoms and instrumental tests; patients were subdivided into Responders, Partial Responders and Non-Responders. The results obtained were satisfactory in view of the fact that the selection into three groups enabled Partial Responders to be reclassified, in some cases by repeating the treatment cycle.

Even though with increasing age it becomes progressively more difficult to distinguish between physiologic and pathologic changes and also considering the marked rise in the number of asymptomatic forms, the senile heart appears to be characterized by functional peculiarities rather than by specific organic alterations. Reduced contractility and myocardial compliance lead to the diminished effort adaptation characteristic for old age; to this must be added the degenerative changes of systemic vessels adding up to increased aortic impedance. Aging of the heart is not a clinical entity and therefore on no account requires therapeutic intervention provided investigation of each individual case has ascertained the absence of asymptomatic pathology. The sole possibility apt to delay the onset of overt pathology is physical exercise according to an individually tailored program.