Search

Your search keyword '"Beil, Michael"' showing total 12 results
Start Over Author "Beil, Michael" Topic critical care medicine
12 results on '"Beil, Michael"'

1. Prognosticating the outcome of intensive care in older patients—a narrative review.

Author

Beil, Michael, Moreno, Rui, Fronczek, Jakub, Kogan, Yuri, Moreno, Rui Paulo Jorge, Flaatten, Hans, Guidet, Bertrand, de Lange, Dylan, Leaver, Susannah, Nachshon, Akiva, van Heerden, Peter Vernon, Joskowicz, Leo, Sviri, Sigal, Jung, Christian, and Szczeklik, Wojciech

Subjects
*ELDER care, *PREDICTION models, *FUNCTIONAL assessment, *UNCERTAINTY, *TREATMENT effectiveness, *DECISION making, *CONFIDENCE, *SEVERITY of illness index, *DISEASES, *INTENSIVE care units, *QUALITY of life, *MACHINE learning, *CRITICAL care medicine, *PATIENTS' attitudes, *OVERALL survival, *HEALTH care rationing
Abstract

Prognosis determines major decisions regarding treatment for critically ill patients. Statistical models have been developed to predict the probability of survival and other outcomes of intensive care. Although they were trained on the characteristics of large patient cohorts, they often do not represent very old patients (age ≥ 80 years) appropriately. Moreover, the heterogeneity within this particular group impairs the utility of statistical predictions for informing decision-making in very old individuals. In addition to these methodological problems, the diversity of cultural attitudes, available resources as well as variations of legal and professional norms limit the generalisability of prediction models, especially in patients with complex multi-morbidity and pre-existing functional impairments. Thus, current approaches to prognosticating outcomes in very old patients are imperfect and can generate substantial uncertainty about optimal trajectories of critical care in the individual. This article presents the state of the art and new approaches to predicting outcomes of intensive care for these patients. Special emphasis has been given to the integration of predictions into the decision-making for individual patients. This requires quantification of prognostic uncertainty and a careful alignment of decisions with the preferences of patients, who might prioritise functional outcomes over survival. Since the performance of outcome predictions for the individual patient may improve over time, time-limited trials in intensive care may be an appropriate way to increase the confidence in decisions about life-sustaining treatment. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

2. Critical care beyond organ support: the importance of geriatric rehabilitation.

Author

Jacobs, Jeremy M., Rahamim, Ana, Beil, Michael, Guidet, Bertrand, Vallet, Helene, Flaatten, Hans, Leaver, Susannah K., de Lange, Dylan, Szczeklik, Wojciech, Jung, Christian, and Sviri, Sigal

Subjects
ELDER care, PHYSICAL therapy, FRAIL elderly, FATIGUE (Physiology), ORGAN donation, FUNCTIONAL status, POLYPHARMACY, ANXIETY, AGITATION (Psychology), GERIATRIC rehabilitation, OCCUPATIONAL therapy, MUSCLE weakness, MOTIVATION (Psychology), COGNITION disorders, QUALITY of life, PAIN, DELIRIUM, CRITICAL care medicine, SARCOPENIA
Abstract

Very old critically ill patients pose a growing challenge for intensive care. Critical illness and the burden of treatment in the intensive care unit (ICU) can lead to a long-lasting decline of functional and cognitive abilities, especially in very old patients. Multi-complexity and increased vulnerability to stress in these patients may lead to new and worsening disabilities, requiring careful assessment, prevention and rehabilitation. The potential for rehabilitation, which is crucial for optimal functional outcomes, requires a systematic, multi-disciplinary approach and careful long-term planning during and following ICU care. We describe this process and provide recommendations and checklists for comprehensive and timely assessments in the context of transitioning patients from ICU to post-ICU and acute hospital care, and review the barriers to the provision of good functional outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

3. The trajectory of very old critically ill patients.

Author

Guidet, Bertrand, Vallet, Helene, Flaatten, Hans, Joynt, Gavin, Bagshaw, Sean M., Leaver, Susannah K., Beil, Michael, Du, Bin, Forte, Daniel N., Angus, Derek C., Sviri, Sigal, de Lange, Dylan, Herridge, Margaret S., and Jung, Christian

Subjects
CRITICALLY ill, MEDICAL personnel, INTENSIVE care units, DOCUMENTATION, CRITICALLY ill patient care, HOSPITAL admission & discharge, CRITICAL care medicine
Abstract

The demographic shift, together with financial constraint, justify a re-evaluation of the trajectory of care of very old critically ill patients (VIP), defined as older than 80 years. We must avoid over- as well as under-utilisation of critical care interventions in this patient group and ensure the inclusion of health care professionals, the patient and their caregivers in the decision process. This new integrative approach mobilises expertise at each step of the process beginning prior to intensive care unit (ICU) admission and extending to long-term follow-up. In this review, several international experts have contributed to provide recommendations that can be universally applied. Our aim is to define a minimum core dataset of information to be shared and discussed prior to ICU admission and to facilitate the shared-decision-making process with the patient and their caregivers, throughout the patient journey. Documentation of uncertainty may contribute to a tailored level of care and ultimately to discussions around possible limitations of life sustaining treatments. The goal of ICU care is not only to avoid death, but more importantly to maintain an acceptable quality of life and functional autonomy after hospital discharge. Societal consideration is important to highlight, together with alternatives to ICU admission. We discuss challenges for the future and potential areas of research. In summary, this review provides a state-of-the-art current overview and aims to outline future directions to address the challenges in the treatment of VIP. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

4. Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study.

Author

Mayerhöfer, Timo, Klein, Sebastian, Wernly, Bernhard, Flaatten, Hans, Guidet, Bertrand, De Lange, Dylan W., Fjølner, Jesper, Leaver, Susannah, Beil, Michael, Sviri, Sigal, Bruno, Raphael Romano, Artigas, Antonio, van Heerden, Peter Vernon, Pinto, Bernardo Bollen, Schefold, Joerg C., Moreno, Rui, Cecconi, Maurizio, Szczeklik, Wojciech, Jung, Christian, and Joannidis, Michael

Subjects
DIABETES risk factors, RESEARCH, INTENSIVE care units, HYPERTENSION, COVID-19, SCIENTIFIC observation, CRITICALLY ill, TIME, LOG-rank test, AGE distribution, DIABETES, PATIENTS, TREATMENT effectiveness, RISK assessment, COMPARATIVE studies, KIDNEY diseases, SEX distribution, RESEARCH funding, KAPLAN-Meier estimator, DESCRIPTIVE statistics, CRITICAL care medicine, STATISTICAL models, DATA analysis software, LONGITUDINAL method, COMORBIDITY, HEART failure, VENTILATION, OLD age
Abstract

Background: Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age. Methods: This multicentre international prospective cohort study was performed in 151 ICUs across 26 countries. We included patients ≥ 70 years of age with a confirmed SARS-CoV-2 infection admitted to the intensive care unit from 19th March 2020 through 15th July 2021. Patients were categorized into two groups according to the presence of diabetes mellitus. Primary outcome was 90-day mortality. Kaplan–Meier overall survival curves until day 90 were analysed and compared using the log-rank test. Mixed-effect Weibull regression models were computed to investigate the influence of diabetes mellitus on 90-day mortality. Results: This study included 3420 patients with a median age of 76 years were included. Among these, 37.3% (n = 1277) had a history of diabetes mellitus. Patients with diabetes showed higher rates of frailty (32% vs. 18%) and several comorbidities including chronic heart failure (20% vs. 11%), hypertension (79% vs. 59%) and chronic kidney disease (25% vs. 11%), but not of pulmonary comorbidities (22% vs. 22%). The 90-day mortality was significantly higher in patients with diabetes than those without diabetes (64% vs. 56%, p < 0.001). The association of diabetes and 90-day mortality remained significant (HR 1.18 [1.06–1.31], p = 0.003) after adjustment for age, sex, SOFA-score and other comorbidities in a Weibull regression analysis. Conclusion: Diabetes mellitus was a relevant risk factor for 90-day mortality in old critically ill patients with COVID-19. Study registration: NCT04321265, registered March 19th, 2020. [ABSTRACT FROM AUTHOR]

Published
2023
Full Text
View/download PDF

5. Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study

Author

Fronczek, Jakub, Polok, Kamil, de Lange, Dylan W., Jung, Christian, Beil, Michael, Rhodes, Andrew, Fjølner, Jesper, Górka, Jacek, Andersen, Finn H., Artigas, Antonio, Cecconi, Maurizio, Christensen, Steffen, Joannidis, Michael, Leaver, Susannah, Marsh, Brian, Morandi, Alessandro, Moreno, Rui, Oeyen, Sandra, Agvald-Öhman, Christina, Bollen Pinto, Bernardo, Schefold, Joerg C., Valentin, Andreas, Walther, Sten, Watson, Ximena, Zafeiridis, Tilemachos, Sviri, Sigal, van Heerden, Peter Vernon, Flaatten, Hans, Guidet, Bertrand, Szczeklik, Wojciech, Schmutz, R., Wimmer, F., Eller, P., Joannidis, M., De Buysscher, P., De Neve, N., Oeyen, S., Swinnen, W., Bollen Pinto, B., Abraham, P., Hergafi, L., Schefold, J. C., Biskup, E., Piza, P., Taliadoros, I., Fjølner, J., Dey, N., Sølling, C., Rasmussen, B. S., Christensen, S., Forceville, X., Besch, G., Mentec, H., Michel, P., Mateu, P., Vettoretti, L., Bourenne, J., Marin, N., Guillot, M., Aissaoui, N., Goulenok, C., Thieulot-Rolin, N., Messika, J., Lamhaut, L., Guidet, B., Charron, C., Lauten, A., Sacher, A. L., Brenner, T., Franz, M., Bloos, F., Ebelt, H., Schaller, S. J., Fuest, K., Rabe, C., Dieck, T., Steiner, S., Graf, T., Nia, A. M., Jung, C., Janosi, R. A., Meybohm, P., Simon, P., Utzolino, S., Rahmel, T., Barth, E., Schuster, M., Aidoni, Z., Aloizos, S., Tasioudis, P., Lampiri, K., Zisopoulou, V., Ravani, I., Pagaki, E., Antoniou, A., Katsoulas, T. A., Kounougeri, A., Marinakis, G., Tsimpoukas, F., Spyropoulou, A., Zygoulis, P., Kyparissi, A., Gupta, M., Gurjar, M., Maji, I. M., Hayes, I., Marsh, B., Kelly, Y., Westbrook, A., Fitzpatrick, G., Maheshwari, D., Motherway, C., Negri, G., Spadaro, S., Nattino, G., Pedeferri, M., Boscolo, A., Rossi, S., Calicchio, G., Cubattoli, L., Di Lascio, G., Barbagallo, M., Berruto, F., Codazzi, D., Bottazzi, A., Fumagalli, P., Negro, G., Lupi, G., Savelli, F., Vulcano, G. A., Fumagalli, R., Marudi, A., Lefons, U., Lembo, R., Babini, M., Paggioro, A., Parrini, V., Zaccaria, M., Clementi, S., Gigliuto, C., Facondini, F., Pastorini, S., Munaron, S., Calamai, I., Bocchi, A., Adorni, A., Bocci, M. G., Cortegiani, A., Casalicchio, T., Mellea, S., Graziani, E., Barattini, M., Brizio, E., Rossi, M., Hahn, M., Flaatten, H., Kemmerer, N., Strietzel, H. F., Dybwik, K., Legernaes, T., Klepstad, P., Olaussen, E. B., Olsen, K. I., Brresen, O. M., Bjorsvik, G., Andersen, F. H., Maini, S., Fehrle, L., Czuczwar, M., Krawczyk, P., Ziętkiewicz, M., Nowak, Ł. R., Kotfis, K., Cwyl, K., Gajdosz, R., Biernawska, J., Bohatyrewicz, R., Gawda, R., Grudzień, P., Nasiłowski, P., Popek, N., Cyrankiewicz, W., Wawrzyniak, K., Wnuk, M., Maciejewski, D., Studzińska, D., Żukowski, M., Bernas, S., Piechota, M., Szczeklik, W., Nowak-Kózka, I., Fronczek, J., Serwa, M., Machała, W., Stefaniak, J., Wujtewicz, M., Maciejewski, P., Szymkowiak, M., Adamik, B., Polok, K., Górka, J., Catorze, N., Branco, M. C., Barros, N., Barros, I., Krystopchuk, A., Honrado, T., Sousa, C., Munoz, F., Rebelo, M., Gomes, R., Nunes, J., Dias, C., Fernandes, A. M., Petrisor, C., Constantin, B., Belskiy, V., Boskholov, B., Rodriguez, E., Aguilar, G., Masdeu, G., Jaimes, M. I., Mira, A. P., Bodi, M. A., Mendoza, J. A. B., López-Cuenca, S., Guzman, M. H., Rico-Feijoo, J., Ibarz, M., Alvarez, J. Trenado, Kawati, R., Sivik, J., Nauska, J., Smole, D., Parenmark, F., Lyrén, J., Rockstroh, K., Rydén, S., Spångfors, M., Strinnholm, M., Walther, S., De Geer, L., Nordlund, P., Pålsson, S., Zetterquist, H., Nilsson, A., Thiringer, K., Jungner, M., Bark, B., Nordling, B., Sköld, H., Brorsson, C., Persson, S., Bergström, A., Berkius, J., Holmström, J., van Dijk, I., van Lelyveld-Haas, L. E. M., Jansen, T., Nooteboom, F., van der Voort, P. H. J., de Lange, D., Dieperink, W., de Waard, M. C., de Smet, A. G. E., Bormans, L., Dormans, T., Dempsey, G., Mathew, S. J., Raj, A. S., Grecu, I., Cupitt, J., Lawton, T., Clark, R., Popescu, M., Spittle, N., Faulkner, M., Cowton, A., Williams, P., Elloway, E., Reay, M., Chukkambotla, S., Kumar, R., Al-Subaie, N., Kent, L., Tamm, T., Kajtor, I., Burns, K., Pugh, R., Ostermann, M., Kam, E., Bowyer, H., Smith, N., Templeton, M., Henning, J., Goffin, K., Kapoor, R., Laha, S., Chilton, P., Khaliq, W., Crayford, A., Coetzee, S., Tait, M., Stoker, W., Gimenez, M., Pope, A., Camsooksai, J., Pogson, D., Quigley, K., Ritzema, J., Hormis, A., Boulanger, C., Balasubramaniam, M., Vamplew, L., Burt, K., Martin, D., Craig, J., Prowle, J., Doyle, N., Shelton, J., Scott, C., Donnison, P., Shelton, S., Frey, C., Ryan, C., Spray, D., Barnes, V., Barnes, K., Ridgway, S., Saha, R., Clark, T., Wood, J., Bolger, C., Bassford, C., Lewandowski, J., Zhao, X., Humphreys, S., Dowling, S., Richardson, N., Burtenshaw, A., Stevenson, C., Wilcock, D., Nalapko, Y., Helbok, R., Nollet, J., de Neve, N., Mikačić, M., Bastiansen, A., Husted, A., Dahle, B. E. S., Cramer, C., Ørsnes, D., Thomsen, J. Edelberg, Pedersen, J. J., Enevoldsen, M. Hummelmose, Elkmann, T., Kubisz-Pudelko, A., Collins, A., Hart, C., Randell, G., Filipe, H., Welters, I. D., Evans, J., Lord, J., Jones, J., Ball, J., North, J., Salaunkey, K., De Gordoa, L. Ortiz-Ruiz, Bell, L., Vizcaychipi, M., Mupudzi, M., Lea-Hagerty, M., Spivey, M., Love, N., White, N., Morgan, P., Wakefield, P., Savine, R., Jacob, R., Innes, R., Rose, S., Leaver, S., Mane, T., Ogbeide, V., Baird, Y., Romen, A., Galbois, A., Vinsonneau, C., Thevenin, D., Guerot, E., Savary, G., Chagnon, J. L., Rigaud, J. P., Quenot, J. P., Castaneray, J., Rosman, J., Maizel, J., Tiercelet, K., Hovaere, M. M., Messika, M., Djibré, M., Rolin, N., Burtin, P., Garcon, P., Nseir, S., Valette, X., Horacek, M., Bruno, R. Romano, Allgäuer, S., Dubler, S., Schering, S., Koutsikou, A., Vakalos, A., Raitsiou, B., Flioni, E. N., Neou, E., Papathanakos, G., Koutsodimitropoulos, I., Aikaterini, K., Rovina, N., Kourelea, S., Polychronis, T., Zidianakis, V., Konstantinia, V., Read, C., Martin-Loeches, I., Cracchiolo, A. Neville, Morigi, A., Brusa, S., Elhadi, A., Tarek, A., Khaled, A., Ahmed, H., Belkhair, W. Ali, Cornet, A. D., Gommers, D., van Boven, E., Haringman, J., Haas, L., van den Berg, L., Hoiting, O., de Jager, P., Gerritsen, R. T., Breidablik, A., Slapgard, A., Rime, A. K., Jannestad, B., Sjøbøe, B., Rice, E., Jensen, J. P., Langørgen, J., Tøien, K., Strand, K., Biernacka, A., Kluzik, A., Kudlinski, B., Hymczak, H., Solek-Pastuszka, J., Zorska, J., Krzych, Ł. J., Zukowski, M., Lipińska-Gediga, M., Pietruszko, M., Kozera, N., Sendur, P., Zatorski, P., Galkin, P., Kościuczuk, U., Gola, W., Pinto, A. F., Santos, A. R., Ferreira, I. A., Blanco, J. B., Carvalho, J. T., Maia, J., Candeias, N., Lores, A., Cilloniz, C., Perez-Torres, D., Maseda, E., Prol-Silva, E., Eixarch, G., Gomà, G., Velasco, G. Navarro, Jaimes, M. Irazábal, Villamayor, M. Ibarz, Fernández, N. Llamas, Cubero, P. Jimeno, Tomasa, T., Sjöqvist, A., Schiöler, F., Westberg, H., Thiringer, K. Kleiven, Boroli, F., Eckert, P., Yıldız, I., Yovenko, I., for the VIP1, [missing], VIP2 study group, [missing], Fronczek, Jakub, Polok, Kamil, de Lange, Dylan W, Jung, Christian, Beil, Michael, Rhodes, Andrew, Fjølner, Jesper, Górka, Jacek, Andersen, Finn H, Artigas, Antonio, Cecconi, Maurizio, Christensen, Steffen, Joannidis, Michael, Leaver, Susannah, Marsh, Brian, Morandi, Alessandro, Moreno, Rui, Oeyen, Sandra, Agvald-Öhman, Christina, Bollen Pinto, Bernardo, Schefold, Joerg C, Valentin, Andrea, Walther, Sten, Watson, Ximena, Zafeiridis, Tilemacho, Sviri, Sigal, van Heerden, Peter Vernon, Flaatten, Han, Guidet, Bertrand, Szczeklik, Wojciech, R Schmutz, F Wimmer, P Eller, M Joannidis, P De Buysscher, N De Neve, S Oeyen, W Swinnen, B Bollen Pinto, P Abraham, L Hergafi, J C Schefold, E Biskup, P Piza, I Taliadoros, J Fjølner, N Dey, C Sølling, B S Rasmussen, S Christensen, X Forceville, G Besch, H Mentec, P Michel, P Mateu, P Michel, L Vettoretti, J Bourenne, N Marin, M Guillot, N Aissaoui, C Goulenok, N Thieulot-Rolin, J Messika, L Lamhaut, B Guidet, C Charron, A Lauten, A L Sacher, T Brenner, M Franz, F Bloos, H Ebelt, S J Schaller, K Fuest, C Rabe, T Dieck, S Steiner, T Graf, A M Nia, C Jung, R A Janosi, P Meybohm, P Simon, S Utzolino, T Rahmel, E Barth, C Jung, M Schuster, Z Aidoni, S Aloizos, P Tasioudis, K Lampiri, V Zisopoulou, I Ravani, E Pagaki, A Antoniou, T A Katsoulas, A Kounougeri, G Marinakis, F Tsimpoukas, A Spyropoulou, P Zygoulis, A Kyparissi, M Gupta, M Gurjar, I M Maji, I Hayes, B Marsh, Y Kelly, A Westbrook, G Fitzpatrick, D Maheshwari, C Motherway, G Negri, S Spadaro, G Nattino, M Pedeferri, A Boscolo, S Rossi, G Calicchio, L Cubattoli, G Di Lascio, M Barbagallo, F Berruto, D Codazzi, A Bottazzi, P Fumagalli, G Negro, G Lupi, F Savelli, G A Vulcano, R Fumagalli, A Marudi, U Lefons, R Lembo, M Babini, A Paggioro, V Parrini, M Zaccaria, S Clementi, C Gigliuto, F Facondini, S Pastorini, S Munaron, I Calamai, A Bocchi, A Adorni, M G Bocci, A Cortegiani, T Casalicchio, S Mellea, E Graziani, M Barattini, E Brizio, M Rossi, M Hahn, H Flaatten, N Kemmerer, H F Strietzel, K Dybwik, T Legernaes, P Klepstad, E B Olaussen, K I Olsen, O M Brresen, G Bjorsvik, F H Andersen, S Maini, L Fehrle, M Czuczwar, P Krawczyk, M Ziętkiewicz, Ł R Nowak, K Kotfis, K Cwyl, R Gajdosz, J Biernawska, R Bohatyrewicz, R Gawda, P Grudzień, P Nasiłowski, N Popek, W Cyrankiewicz, K Wawrzyniak, M Wnuk, D Maciejewski, D Studzińska, M Żukowski, S Bernas, M Piechota, W Szczeklik, I Nowak-Kózka, J Fronczek, M Serwa, W Machała, J Stefaniak, M Wujtewicz, P Maciejewski, M Szymkowiak, B Adamik, K Polok, J Górka, N Catorze, M C Branco, N Barros, I Barros, A Krystopchuk, T Honrado, C Sousa, F Munoz, M Rebelo, R Gomes, J Nunes, C Dias, A M Fernandes, C Petrisor, B Constantin, V Belskiy, B Boskholov, E Rodriguez, G Aguilar, G Masdeu, M I Jaimes, A P Mira, M A Bodi, J A B Mendoza, S López-Cuenca, M H Guzman, J Rico-Feijoo, M Ibarz, J Trenado Alvarez, R Kawati, J Sivik, J Nauska, D Smole, F Parenmark, J Lyrén, K Rockstroh, S Rydén, M Spångfors, M Strinnholm, S Walther, L De Geer, P Nordlund, S Pålsson, H Zetterquist, A Nilsson, K Thiringer, M Jungner, B Bark, B Nordling, H Sköld, C Brorsson, S Persson, A Bergström, J Berkius, J Holmström, I van Dijk, L E M van Lelyveld-Haas, T Jansen, F Nooteboom, P H J van der Voort, D de Lange, W Dieperink, M C de Waard, A G E de Smet, L Bormans, T Dormans, G Dempsey, S J Mathew, A S Raj, I Grecu, J Cupitt, T Lawton, R Clark, M Popescu, N Spittle, M Faulkner, A Cowton, P Williams, E Elloway, M Reay, S Chukkambotla, R Kumar, N Al-Subaie, L Kent, T Tamm, I Kajtor, K Burns, R Pugh, M Ostermann, E Kam, H Bowyer, N Smith, M Templeton, J Henning, K Goffin, R Kapoor, S Laha, P Chilton, W Khaliq, A Crayford, S Coetzee, M Tait, W Stoker, M Gimenez, A Pope, J Camsooksai, D Pogson, K Quigley, J Ritzema, A Hormis, C Boulanger, M Balasubramaniam, L Vamplew, K Burt, D Martin, I Grecu, J Craig, J Prowle, N Doyle, J Shelton, C Scott, P Donnison, S Shelton, C Frey, C Ryan, D Spray, C Ryan, V Barnes, K Barnes, S Ridgway, R Saha, L Kent, T Clark, J Wood, C Bolger, C Bassford, A Cowton, J Lewandowski, X Zhao, S Humphreys, S Dowling, N Richardson, A Burtenshaw, C Stevenson, D Wilcock, Y Nalapko, M Joannidis, P Eller, R Helbok, R Schmutz, J Nollet, N de Neve, P De Buysscher, S Oeyen, W Swinnen, M Mikačić, A Bastiansen, A Husted, B E S Dahle, C Cramer, C Sølling, D Ørsnes, J Edelberg Thomsen, J J Pedersen, M Hummelmose Enevoldsen, T Elkmann, A Kubisz-Pudelko, A Pope, A Collins, A S Raj, C Boulanger, C Frey, C Hart, C Bolger, D Spray, G Randell, H Filipe, I D Welters, I Grecu, J Evans, J Cupitt, J Lord, J Henning, J Jones, J Ball, J North, K Salaunkey, L Ortiz-Ruiz De Gordoa, L Bell, M Balasubramaniam, M Vizcaychipi, M Faulkner, M Mupudzi, M Lea-Hagerty, M Reay, M Spivey, N Love, N Spittle, N White, P Williams, P Morgan, P Wakefield, R Savine, R Jacob, R Innes, R Kapoor, S Humphreys, S Rose, S Dowling, S Leaver, T Mane, T Lawton, V Ogbeide, W Khaliq, Y Baird, A Romen, A Galbois, B Guidet, C Vinsonneau, C Charron, D Thevenin, E Guerot, G Besch, G Savary, H Mentec, J L Chagnon, J P Rigaud, J P Quenot, J Castaneray, J Rosman, J Maizel, K Tiercelet, L Vettoretti, M M Hovaere, M Messika, M Djibré, N Rolin, P Burtin, P Garcon, S Nseir, X Valette, C Rabe, E Barth, H Ebelt, K Fuest, M Franz, M Horacek, M Schuster, P Meybohm, R Romano Bruno, S Allgäuer, S Dubler, S J Schaller, S Schering, S Steiner, T Dieck, T Rahmel, T Graf, A Koutsikou, A Vakalos, B Raitsiou, E N Flioni, E Neou, F Tsimpoukas, G Papathanakos, G Marinakis, I Koutsodimitropoulos, K Aikaterini, N Rovina, S Kourelea, T Polychronis, V Zidianakis, V Konstantinia, Z Aidoni, B Marsh, C Motherway, C Read, I Martin-Loeches, A Neville Cracchiolo, A Morigi, I Calamai, S Brusa, A Elhadi, A Tarek, A Khaled, H Ahmed, W Ali Belkhair, A D Cornet, D Gommers, D de Lange, E van Boven, J Haringman, L Haas, L van den Berg, O Hoiting, P de Jager, R T Gerritsen, T Dormans, W Dieperink, A Breidablik, A Slapgard, A K Rime, B Jannestad, B Sjøbøe, E Rice, F H Andersen, H F Strietzel, J P Jensen, J Langørgen, K Tøien, K Strand, M Hahn, P Klepstad, A Biernacka, A Kluzik, B Kudlinski, D Maciejewski, D Studzińska, H Hymczak, J Stefaniak, J Solek-Pastuszka, J Zorska, K Cwyl, Ł J Krzych, M Zukowski, M Lipińska-Gediga, M Pietruszko, M Piechota, M Serwa, M Czuczwar, M Ziętkiewicz, N Kozera, P Nasiłowski, P Sendur, P Zatorski, P Galkin, R Gawda, U Kościuczuk, W Cyrankiewicz, W Gola, A F Pinto, A M Fernandes, A R Santos, C Sousa, I Barros, I A Ferreira, J B Blanco, J T Carvalho, J Maia, N Candeias, N Catorze, V Belskiy, A Lores, A P Mira, C Cilloniz, D Perez-Torres, E Maseda, E Rodriguez, E Prol-Silva, G Eixarch, G Gomà, G Aguilar, G Navarro Velasco, M Irazábal Jaimes, M Ibarz Villamayor, N Llamas Fernández, P Jimeno Cubero, S López-Cuenca, T Tomasa, A Sjöqvist, C Brorsson, F Schiöler, H Westberg, J Nauska, J Sivik, J Berkius, K Kleiven Thiringer, L De Geer, S Walther, F Boroli, J C Schefold, L Hergafi, P Eckert, I Yıldız, I Yovenko, Y Nalapko, R Pugh, and Critical Care

Subjects
Male, Short term mortality, Critical Care and Intensive Care Medicine, Cohort Studies, 0302 clinical medicine, kwetsbaarheid, Medicine and Health Sciences, 80 and over, Medicine, 610 Medicine & health, Prospective cohort study, Correlation of Data, 11 Medical and Health Sciences, Aged, 80 and over, OUTCOMES, Intensive care units, Frailty, VIP1, Aged,&nbsp, Medical emergencies. Critical care. Intensive care. First aid, Scale (social sciences), Female, prospectief onderzoek, Life Sciences & Biomedicine, CRITICALLY-ILL PATIENTS, Study groups, medicine.medical_specialty, Anestesi och intensivvård, 80 jaar en ouder, INTENSIVE-CARE, BED AVAILABILITY, NO, 03 medical and health sciences, Critical Care Medicine, Intensive care, sterfte, General & Internal Medicine, Humans, Aged, Prospective studies, Mortality, In patient, ddc:610, Intensive Care Units, Logistic Models, Prospective Studies, Science & Technology, Anesthesiology and Intensive Care, business.industry, RC86-88.9, Research, 030208 emergency & critical care medicine, ADULTS, Aged, 80 and over, Emergency & Critical Care Medicine, 030228 respiratory system, intensivecareafdelingen, Critical illness, Emergency medicine, VIP2 study group, &nbsp, CRITICAL ILLNESS, business
Abstract

Background The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient’s age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results The median age in the sample of 7487 consecutive patients was 84 years (IQR 81–87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p p Conclusion Knowledge about a patient’s frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Published
2021

6. Odds ratios versus risk ratios in intensive care research: Using frailty in intensive care as a case study.

Author

Wernly, Bernhard, Beil, Michael, Guidet, Bertrand, Flaatten, Hans, and Jung, Christian

Subjects
RISK assessment, ELDER care, FRAIL elderly, MULTIPLE regression analysis, SEX distribution, HOSPITAL mortality, EVALUATION of medical care, DISEASE prevalence, AGE distribution, DIAGNOSIS, POPULATION geography, DESCRIPTIVE statistics, ODDS ratio, LONGITUDINAL method, INTENSIVE care units, HOSPITAL care of older people, CONFIDENCE intervals, CRITICAL care medicine, OLD age
Abstract

The article explores the comparative implications of odds ratios (ORs) and risk ratios (RRs) in assessing frailty's impact on intensive care unit (ICU) mortality and 30-day mortality. Topics discussed include the higher numerical values of ORs versus RRs, the influence of outcome prevalence on these ratios' divergence, and recommendations for prioritizing RRs to enhance clinical decision-making in intensive care settings.

Published
2024
Full Text
View/download PDF

7. Frailty in intensive care medicine must be measured, interpreted and taken into account!

Author

Jung, Christian, Guidet, Bertrand, Flaatten, Hans, the VIP study group, Fjølner, Jesper, Bruno, Raphael Romano, Kelm, Malte, Beil, Michael, Sigal, Sviri, Szczeklik, Wojciech, Leaver, Susannah, and De Lange, Dylan W.

Subjects
FRAILTY, CRITICAL care medicine
Abstract

An early paper about frailty in the intensive care unit (ICU) context was published in 2014 [[2]] and frailty has since attained considerable attraction and has been found to be closely related to an adverse outcome after ICU admissions [[3]]. 2021; 11: 22. 10.1186/s13613-021-00815-7 12 Bruno RR, Wernly B, Flaatten H, Scholzel F, Kelm M, Jung C. The hospital frailty risk score is of limited value in intensive care unit patients. 1 Frailty assessment in the ICU In summary, frailty should be evaluated in clinical practice in old ICU patients. In that study 42% of acutely admitted patients developed increased frailty measured with the Clinical Frailty Scale (CFS) after one year, but many patients (35%) also had also reduced frailty. [Extracted from the article]

Published
2023
Full Text
View/download PDF

8. Who gets the ventilator? A multicentre survey of intensivists' opinions of triage during the first wave of the COVID‐19 pandemic.

Author

Fjølner, Jesper, Haaland, Øystein Ariandsen, Jung, Christian, de Lange, Dylan W., Szczeklik, Wojciech, Leaver, Susannah, Guidet, Bertrand, Sviri, Sigal, Van Heerden, Peter Vernon, Beil, Michael, Hartog, Christiane S., and Flaatten, Hans

Subjects
COVID-19 pandemic, MEDICAL triage, LIKERT scale, CRITICAL care medicine, WORK experience (Employment)
Abstract

Background: The COVID‐19 pandemic has caused a shortage of intensive care resources. Intensivists' opinion of triage and ventilator allocation during the COVID‐19 pandemic is not well described. Methods: This was a survey concerning patient numbers, bed capacity, triage guidelines, and three virtual cases involving ventilator allocations. Physicians from 400 ICUs in a research network were invited to participate. Preferences were assessed with a five‐point Likert scale. Additionally, age, gender, work experience, geography, and religion were recorded. Results: Of 437 responders 31% were female. The mean age was 44.4 (SD 11.1) with a mean ICU experience of 13.7 (SD 10.5) years. Respondents were mostly European (88%). Sixty‐six percent had triage guidelines available. Younger patients and caretakers of children were favoured for ventilator allocation although this was less clear if this involved withdrawal of the ventilator from another patient. Decisions did not differ with ICU experience, gender, religion, or guideline availability. Consultation of colleagues or an ethical committee decreased with age and male gender. Conclusion: Intensivists appeared to prioritise younger patients for ventilator allocation. The tendency to consult colleagues about triage decreased with age and male gender. Many found such tasks to be not purely medical and that authorities should assume responsibility for triage during resource scarcity. [ABSTRACT FROM AUTHOR]

Published
2022
Full Text
View/download PDF

9. Elderly Patients in the Intensive Care Unit.

Author

Flaatten, Hans, Beil, Michael, and Guidet, Bertrand

Subjects
*INTENSIVE care patients, *OLDER patients, *OLDER people, *INTENSIVE care units, *CRITICAL care medicine
Abstract

Very old intensive care unit (ICU) patients, aged ≥ 80 years, are by no mean newcomers, but during the last decades their impact on ICU admissions has grown in parallel with the increase in the number of elderly persons in the community. Hence, from being a "rarity," they have now become common and constitute one of the largest subgroups within intensive care, and may easily be the largest group in 20 years and make up 30 to 40% of all ICU admissions. Obviously, they are not admitted because they are old but because they are with various diseases and problems like any other ICU patient. However, their age and the presence of common geriatric syndromes such as frailty, cognitive decline, reduced activity of daily life, and several comorbid conditions makes this group particularly challenging, with a high mortality rate. In this review, we will highlight aspects of current and future epidemiology and current knowledge on outcomes, and describe the effects of the aforementioned geriatric syndromes. The major challenge for the coming decades will be the question of whom to treat and the quest for better triage criteria not based on age alone. Challenges with the level of care during the ICU stay will also be discussed. A stronger relationship with geriatricians should be promoted to create a better and more holistic care and aftercare for survivors. [ABSTRACT FROM AUTHOR]

Published
2021
Full Text
View/download PDF

10. Frailty as a Prognostic Indicator in Intensive Care.

Author

Jung, Christian, Romano Bruno, Raphael, Wernly, Bernhard, Wolff, Georg, Beil, Michael, and Kelm, Malte

Subjects
CRITICAL care medicine, INTENSIVE care patients, INTENSIVE care units, INTER-observer reliability
Abstract

Background: The percentage of patients in intensive care who are 80 years old or older is continually increasing. Such patients already made up more than 20% of all patients in intensive care in Germany in the years 2007-2011. Meanwhile, effective treatments that support the organs of the body and keep severely ill patients alive are also being continually developed and refined. Frailty is a key prognostic parameter. The scientifically based assessment of frailty can be highly useful in intensive care medicine with regard to consented decision-making, individualized prognostication, treatment planning, and aftercare. Methods: Pertinent publications were retrieved by a selective search in the PubMed database. On the basis of the literature assessment, a variety of screening instruments were used to assess frailty and its significance for very old, critically ill patients in German intensive care units. Results: Only a small number of screening instruments are suitable for routine use in German intensive care units. The scores vary in diagnostic precision. The Clinical Frailty Scale (CFS) enables highly accurate prognostication; it considers the patient in relation to his or her social environment, and to the reference population. Categorization is achieved by means of pictograms that are supplemented with brief written descriptions. The CFS can be used prospectively and is easy to learn. Its interrater reliability is high (weighted Cohen's κ: 0.85 [0.84; 0.87]), and it has been validated for routine use in intensive care units in Germany. Conclusion: None of the available scores enable perfect prognostication. In Germany, frailty in intensive-care patients is currently best assessed on a simple visual scale (CFS). [ABSTRACT FROM AUTHOR]

Published
2020
Full Text
View/download PDF

11. Ethical considerations about artificial intelligence for prognostication in intensive care.

Author

Beil, Michael, Proft, Ingo, van Heerden, Daniel, Sviri, Sigal, and van Heerden, Peter Vernon

Subjects
*ARTIFICIAL intelligence, *CRITICAL care medicine, *MEDICAL ethics, *PATIENT autonomy, *MACHINE learning
Abstract

Background: Prognosticating the course of diseases to inform decision-making is a key component of intensive care medicine. For several applications in medicine, new methods from the field of artificial intelligence (AI) and machine learning have already outperformed conventional prediction models. Due to their technical characteristics, these methods will present new ethical challenges to the intensivist. Results: In addition to the standards of data stewardship in medicine, the selection of datasets and algorithms to create AI prognostication models must involve extensive scrutiny to avoid biases and, consequently, injustice against individuals or groups of patients. Assessment of these models for compliance with the ethical principles of beneficence and non-maleficence should also include quantification of predictive uncertainty. Respect for patients' autonomy during decision-making requires transparency of the data processing by AI models to explain the predictions derived from these models. Moreover, a system of continuous oversight can help to maintain public trust in this technology. Based on these considerations as well as recent guidelines, we propose a pathway to an ethical implementation of AI-based prognostication. It includes a checklist for new AI models that deals with medical and technical topics as well as patient- and system-centered issues. Conclusion: AI models for prognostication will become valuable tools in intensive care. However, they require technical refinement and a careful implementation according to the standards of medical ethics. [ABSTRACT FROM AUTHOR]

Published
2019
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results