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1. O que mudou entre os períodos de pico e de platô durante a primeira onda do SARS-CoV-2? Estudo multicêntrico português em unidades de cuidados intensivos

Author

Rui Antunes Pereira, Marta Sousa, José Pedro Cidade, Luís Melo, Diogo Lopes, Sara Ventura, Irene Aragão, Raul Miguel de Freitas Lima Neto, Elena Molinos, Ana Marques, Nelson Cardoso, Flávio Marino, Filipa Brás Monteiro, Ana Pinho Oliveira, Rogério C Silva, André Miguel Neto Real, Bruno Sarmento Banheiro, Renato Reis, Maria Adão-Serrano, Ana Cracium, Ana Valadas, João Miguel Ribeiro, Pedro Póvoa, Camila Tapadinhas, Vítor Mendes, Luís Coelho, Raquel Maia, Paulo Telles Freitas, Isabel Amorim Ferreira, Tiago Ramires, Luís Silva Val-Flores, Mariana Cascão, Rita Alves, Simão C Rodeia, Cleide Barrigoto, Rosa Cardiga, Maria João Ferreira da Silva, Bruno Vale, Tatiana Fonseca, Ana Lúcia Rios, João Camões, Danay Pérez, Susana Cabral, Maria Inês Ribeiro, João João Mendes, João Gouveia, and Susana Mendes Fernandes

Subjects
COVID-19, Infecções por coronavírus, SARS-CoV-2, Pandemia, Cuidados intensivos, Estado terminal, Corticosteroides, Síndrome do desconforto respiratório, Cânula, Resultados de cuidados críticos, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

RESUMO Objetivo: Analisar e comparar as características de pacientes críticos com a COVID-19, a abordagem clínica e os resultados entre os períodos de pico e de platô na primeira onda pandêmica em Portugal. Métodos: Este foi um estudo de coorte multicêntrico ambispectivo, que incluiu pacientes consecutivos com a forma grave da COVID-19 entre março e agosto de 2020 de 16 unidades de terapia intensiva portuguesas. Definiram-se as semanas 10 - 16 e 17 - 34 como os períodos de pico e platô. Resultados: Incluíram-se 541 pacientes adultos com mediana de idade de 65 [57 - 74] anos, a maioria do sexo masculino (71,2%). Não houve diferenças significativas na mediana de idade (p = 0,3), no Simplified Acute Physiology Score II (40 versus 39; p = 0,8), na pressão parcial de oxigênio/fração inspirada de oxigênio (139 versus 136; p = 0,6), na terapia com antibióticos na admissão (57% versus 64%; p = 0,2) ou na mortalidade aos 28 dias (24,4% versus 22,8%; p = 0,7) entre o período de pico e platô. Durante o período de pico, os pacientes tiveram menos comorbidades (1 [0 - 3] versus 2 [0 - 5]; p = 0,002); fizeram mais uso de vasopressores (47% versus 36%; p < 0,001) e ventilação mecânica invasiva na admissão (58,1% versus 49,2%; p < 0,001), e tiveram mais prescrição de hidroxicloroquina (59% versus 10%; p < 0,001), lopinavir/ritonavir (41% versus 10%; p < 0,001) e posição prona (45% versus 36%; p = 0,04). Entretanto, durante o platô, observou-se maior uso de cânulas nasais de alto fluxo (5% versus 16%; p < 0,001) na admissão, remdesivir (0,3% versus 15%; p < 0,001) e corticosteroides (29% versus 52%; p < 0,001), além de menor tempo de internação na unidade de terapia intensiva (12 versus 8 dias; p < 0,001). Conclusão: Houve mudanças significativas nas comorbidades dos pacientes, nos tratamentos da unidade de terapia intensiva e no tempo de internação entre os períodos de pico e platô na primeira onda da COVID-19.

Published
2023
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2. Provision of critical care for the elderly in Europe: a retrospective comparison of national healthcare frameworks in intensive care units

Author

Antonio Artigas, Nuno Catorze, Bernhard Wernly, Wojciech Szczeklik, Raimund Helbok, Pål Klepstad, Emmanuel Guerot, Tim Rahmel, Kelly Tiercelet, Louise Bell, Clare Bolger, Helder Filipe, Michael Reay, Jean-Pierre Quenot, Saad Nseir, Didier Thévenin, Maurizio Cecconi, Susan Dowling, Jason Cupitt, Willem Dieperink, Henning Ebelt, Philipp Eller, Patrick Meybohm, Rene Schmutz, Michael Joannidis, Sally Humphreys, Filippo Boroli, Gerardo Aguilar, Jørund Langørgen, Malte Kelm, Marcus Franz, Hans Flaatten, Christian Jung, Michael Beil, Susannah Leaver, Bertrand Guidet, Tom Dormans, Jonathan Ball, Patrick Morgan, Nick Spittle, Tom Lawton, Diederik Gommers, Antoine Romen, Camilla Brorsson, Ana Rita Santos, JANE EVANS, Ala Khaled, Hazem Ahmed, Madhu Balasubramaniam, Simon Dubler, Jean-Philippe Rigaud, Michael Schuster, Julien Maizel, Christophe Vinsonneau, Carole Boulanger, Jeremy Henning, Catia Cillóniz, Michael Spivey, Kiran Salaunkey, Raphael Romano Bruno, Stephan Binnebössel, Sviri Sigal, Peter Vernon van Heerden, Ariane Boumendil, Brian Marsh, Rui Moreno, Sandra Oeyen, Bernardo Bollen Pinto, Sten Mikael Walther, Joerg C Schefold, Jesper Fjølner, Tilemachos Zafeiridis, Dylan de Lange, Joke Nollet, Nikolaas de Neve, Pieter De Buysscher, Walter Swinnen, Marijana Mikačić, Anders Bastiansen, Andreas Husted, Bård E S Dahle, Christine Cramer, Christoffer Sølling, Dorthe Ørsnes, Jakob Edelberg Thomsen, Jonas Juul Pedersen, Mathilde Hummelmose Enevoldsen, Thomas Elkmann, Agnieszka Kubisz-Pudelko, Alan Pope, Amy Collins, Ashok S Raj, Christian Frey, Ciaran Hart, Dominic Spray, Georgina Randell, Ingeborg D Welters, Irina Grecu, Jenny Lord, Joanne Jones, Julie North, Laura Ortiz-Ruiz De Gordoa, Marcela Vizcaychipi, Maria Faulkner, McDonald Mupudzi, Megan Lea-Hagerty, Nicholas Love, Nigel White, Patricia Williams, Phillipa Wakefield, Rachel Savine, Reni Jacob, Richard Innes, Ritoo Kapoor, Steve Rose, Tarkeshwari Mane, Vongayi Ogbeide, Waqas Khaliq, Yolanda Baird, Arnaud Galbois, Cyril Charron, Guillaume Besch, Guillaume Savary, Hervé Mentec, Jean-Luc Chagnon, Jeremy Castaneray, Jérémy Rosman, Lucie Vettoretti, Maud Mousset Hovaere, Messika Messika, Michel Djibré, Nathalie Rolin, Philippe Burtin, Pierre Garcon, Xavier Valette, Christian Rabe, Eberhard Barth, Kristina Fuest, Michael Horacek, Sebastian Allgäuer, Stefan J Schaller, Stefan Schering, Stephan Steiner, Thorben Dieck, Tobias Graf, Anastasia Koutsikou, Aristeidis Vakalos, Bogdan Raitsiou, Elli Niki Flioni, Evangelia Neou, Fotios Tsimpoukas, Georgios Papathanakos, Giorgos Marinakis, Ioannis Koutsodimitropoulos, Kounougeri Aikaterini, Nikoletta Rovina, Stylliani Kourelea, Tasioudis Polychronis, Vasiiios Zidianakis, Vryza Konstantinia, Zoi Aidoni, Catherine Motherway, Chris Read, Ignacio Martin-Loeches, Andrea Neville Cracchiolo, Aristide Morigi, Italo Calamai, Stefania Brusa, Ahmed Elhadi, Ahmed Tarek, Wesal Ali Belkhair, Alexander D Cornet, Evavan Boven, Jasper Haringman, Lenneke Haas, Lettie van den Berg, Oscar Hoiting, Peter de Jager, Rik T Gerritsen, Alena Breidablik, Anita Slapgard, Anne-Karin Rime, Bente Jannestad, Britt Sjøbøe, Eva Rice, Finn H Andersen, Hans Frank Strietzel, Jan Peter Jensen, Kirsti Tøien, Kristian Strand, Michael Hahn, Aleksandra Biernacka, Anna Kluzik, Bartosz Kudlinski, Dariusz Maciejewski, Dorota Studzińska, Hubert Hymczak, Jan Stefaniak, Joanna Solek-Pastuszka, Joanna Zorska, Katarzyna Cwyl, Lukasz J Krzych, Maciej Zukowski, Małgorzata Lipińska-Gediga, Marek Pietruszko, Mariusz Piechota, Marta Serwa, Miroslaw Czuczwar, Mirosław Ziętkiewicz, Natalia Kozera, Paweł Nasiłowski, Paweł Sendur, Paweł Zatorski, Piotr Galkin, Ryszard Gawda, Urszula Kościuczuk, Waldemar Cyrankiewicz, Wojciech Gola, Alexandre Fernandes Pinto, Ana Margarida Fernandes, Cristina Sousa, Inês Barros, Isabel Amorim Ferreira, Jacobo Bacariza Blanco, João Teles Carvalho, Jose Maia, Nuno Candeias, Vladislav Belskiy, Africa Lores, Angela Prado Mira, David Perez-Torres, Emilio Maseda, Enver Rodriguez, Estefania Prol-Silva, Gaspar Eixarch, Gemma Gomà, Gonzalo Navarro Velasco, MariánIrazábal Jaimes, Mercedes Ibarz Villamayor, Noemí Llamas Fernández, Patricia Jimeno Cubero, Sonia López-Cuenca, Teresa Tomasa, Anders Sjöqvist, Fredrik Schiöler, Henrik Westberg, Jessica Nauska, Joakim Sivik, Johan Berkius, Karin Kleiven Thiringer, Lina DeGeer, Sten Walther, Leila Hergafi, Philippe Eckert, Ismail Yıldız, Ihor Yovenko, Yuriy Nalapko, and Richard Pugh

Subjects
Medicine
Abstract

Objectives In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between THS and SHI.Setting ICUs in 16 European countries.Participants In total, 7817 critically ill older (≥80 years) patients were included in this study, 4941 in THS and 2876 in the SHI systems.Primary and secondary outcomes measures We chose generalised estimation equations with robust standard errors to produce population average adjusted OR (aOR). We adjusted for patient-specific variables, health economic data, including gross domestic product (GDP) and human development index (HDI), and treatment strategies.Results In SHI systems, there were higher rates of frail patients (Clinical Frailty Scale>4; 46% vs 41%; p

Published
2021
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3. Native Valve Aspergillus Endocarditis in a Non-Neutropenic Immunocompromised Patient on Anti-TNF α Blockers Therapy

Author

Joana Azevedo Carvalho, Leonor Boavida, Isabel Amorim Ferreira, Bruno Grima, and José Delgado Alves

Subjects
invasive aspergillosis, Rheumatology, seronegative spondyloarthropathy, Cardiology, General Engineering, fungal endocarditis, Infectious Disease, autoimmune diseases, anti-tnf agents
Abstract

Invasive aspergillosis is a rare opportunistic infection mainly occurring in patients with a well-established risk such as neutropenia or conditions that lead to chronically impaired cellular immune responses. Systemic corticosteroids are a well-known risk factor for fungal infections. Recently, reports of invasive aspergillosis in patients treated with monoclonal biologic agents, such as tumor necrosis factor-alpha inhibitors, have been increasing. We present the case of a 47-year-old female patient with seronegative spondyloarthropathy treated with infliximab and corticosteroids. The patient presented classical symptoms of an acute lower respiratory infection, and she was treated with a β-lactam antibiotic. Infliximab administration was deferred until nine days after clinical recovery. Fourteen days after drug administration, she was admitted with a symptomatic subcortical hematoma in the left parietal region. There was a rapid neurological recovery, and there were no risk factors for haemorrhagic stroke detected. The chest X-ray revealed an oval mass with an air crescent sign, and the CT scan was suggestive of aspergilloma. Bronchoalveolar lavage cytology identified Aspergillus spp. Voriconazole was initiated and, after one month of treatment, the patient was readmitted with a left facial palsy associated with hemiparesis and dysarthria. Laboratory evaluation showed leukocytosis and elevated C-reactive protein. A severe right middle cerebral artery stroke was present on the brain CT scan. Transesophageal echocardiogram revealed large mitral valve vegetation, and the diagnosis of Aspergillus endocarditis with cerebral embolization was made. Fungal infections are challenging due to the diagnosis infrequency and paucisymptomatic natural history. Despite being crucial in the treatment of autoimmune diseases, immunosuppressive drugs increase the risk of fungal infection. It is extremely important to consider Aspergillus infection in immunosuppressed patients, and the need for prophylaxis in non-neutropenic patients with risk factors should be clarified.

Published
2021
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4. Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs

Author

Nigel White, Jenny Lord, Angela Prado Mira, Ala Khaled, Hubert Hymczak, Kristian Strand, Lenneke E M Haas, Mirosław Czuczwar, Lettie van den Berg, Pieter De Buysscher, Małgorzata Lipińska-Gediga, Simon Dubler, Michel Djibré, Ignacio Martin-Loeches, Georgina Randell, Diederik Gommers, Jose Maia, Patrick Meybohm, Wojciech Gola, Lina De Geer, Tom Lawton, Jonas Juul Pedersen, Isabel Amorim Ferreira, Kristina Fuest, Marcus Franz, McDonald Mupudzi, Kounougeri Aikaterini, Zoi Aidoni, Anastasia Koutsikou, Joakim Sivik, Hans Flaatten, Catia Cilloniz, Paweł Zatorski, Sally Humphreys, Henrik Westberg, Eva Rice, Peter de Jager, Helder Filipe, Stefania Brusa, Maria Faulkner, Jan Stefaniak, Cyril Charron, Nuno Candeias, Sten Walther, Nathalie Rolin, Muhammed Elhadi, Marta Serwa, Sebastian Allgäuer, Thomas Elkmann, Philipp Eller, Jean-Luc Chagnon, Gonzalo Navarro Velasco, Raimund Helbok, Catherine Motherway, Dorota Studzińska, Alan Pope, Ahmed Tarek, Cristina Sousa, Natalia Kozera, Michael Horacek, Camilla Brorsson, Tom Dormans, Nuno Catorze, Michael Joannidis, Andrea Neville Cracchiolo, Walter Swinnen, Oscar Hoiting, Africa Lores, Dominic Spray, Vladislav Belskiy, Marijana Mikačić, Rachel Savine, Tim Rahmel, Christoffer Sølling, Fredrik Schiöler, Henning Ebelt, Urszula Kościuczuk, Marek Pietruszko, Alexander D Cornet, Vasiiios Zidianakis, Bogdan Raitsiou, Ana Rita Santos, Nick Spittle Nick Spittle, Jan Peter Jensen, Alena Breidablik Alena Breidablik, Wojciech Szczeklik, Joerg C. Schefold, Karin Kleiven Thiringer, Alexandre Fernandes Pinto, Antoine Romen, Ingeborg D Welters, Nikolaas de Neve, Joanne Jones, Carole Boulanger, Ciaran Hart, Georgios Papathanakos, Jessica Nauska, Gaspar Eixarch, Pål Klepstad, Wesal Ali Belkhair, Ximena Watson, Brian Marsh, Emmanuel Guerot, Michael W. Schuster, Julie North, Bartosz Kudlinski, Alessandro Morandi, Stefan Schering, Fotios Tsimpoukas, Mercedes Ibarz, Ioannis Koutsodimitropoulos, Maurizio Cecconi, David Perez-Torres, Stephan Steiner, Agnieszka Kubisz-Pudelko, Johan Berkius, Phillipa Wakefield, Joanna Zorska, Anne-Karin Rime, Jacobo Bacariza Blanco, Reni Jacob, Guillaume Besch, Jane Evans, Mathilde Hummelmose Enevoldsen, Jasper Haringman, Xavier Valette, Pierre Garçon, Waldemar Cyrankiewicz, Megan Lea-Hagerty, Jason Cupitt, Yolanda Baird, Eberhard Barth, Stylliani Kourelea, Christine Cramer, Gerardo Aguilar, Christophe Vinsonneau, Maud Mousset Hovaere, Hans Frank Strietzel, Patricia Jimeno Cubero, René Schmutz, Aristide Morigi, Jonathan Ball, Raphael Romano Bruno, Kirsti Tøien, Ahmed Elhadi, Susan Dowling, Antonio Artigas, Aleksandra Biernacka, Clare Bolger, Italo Calamai, Dorthe Ørsnes, Giorgos Marinakis, Amy Collins, Leila Hergafi, Didier Thevenin, Michael Spivey, Bård E S Dahle, Willem Dieperink, Lucie Vettoretti, Vryza Konstantinia, Tasioudis Polychronis, Laura Ortiz-Ruiz De Gordoa, Julien Maizel, Louise Bell, Nicholas Love, Christian Frey, Joanna Solek-Pastuszka, Richard Pugh, Stefan J. Schaller, Hervé Mentec, Mercedes Ibarz Villamayor, Ritoo Kapoor, W. Khaliq, Gemma Gomà, Patrick Morgan, Finn H. Andersen, Madhu Balasubramaniam, Irina Grecu, Filippo Boroli, Saad Nseir, Mariusz Piechota, Ana M. Fernandes, Katarzyna Cwyl, Elli Niki Flioni, Jørund Langørgen, Kiran Salaunkey, Jean-Pierre Quenot, Philippe Burtin, Michael Reay, Ryszard Gawda, Ariane Boumendil, Anders Bastiansen, Hazem Ahmed, Evangelia Neou, Ihor Yovenko, Rik T Gerritsen, Bente Jannestad, Tarkeshwari Mane, Richard Innes, Kelly Tiercelet, Christian Jung, Rui Moreno, Maciej Zukowski, Dariusz Maciejewski, Dylan W. de Lange, Jeremy Henning, Paweł Nasiłowski, Estefania Prol-Silva, Tilemachos Zafeiridis, Lukasz J Krzych, Jérémy Rosman, Tobias Graf, Sonia López-Cuenca, Marcela Vizcaychipi, Jeremy Castaneray, Steve Rose, Vongayi Ogbeide, Arnaud Galbois, Yuriy Nalapko, Sandra Oeyen, Joke Nollet, Ismail Yıldız, Chris Read, Philippe Eckert, Ashok Raj, Anita Slapgard, Anna Kluzik, Mirosław Ziętkiewicz, Christian Rabe, Guillaume Savary, Noemí Llamas Fernández, João Teles Carvalho, Nikoletta Rovina, Jakob Edelberg Thomsen, Britt Sjøbøe, Andreas Husted, Jean-Philippe Rigaud, Bertrand Guidet, Piotr Galkin, Marián Irazábal Jaimes, Anders Sjöqvist, Paweł Sendur, Thorben Dieck, A. Vakalos, Enver Rodriguez, Jesper Fjølner, Eva van Boven, Inês Barros, Susannah Leaver, Patricia Williams, Messika Messika, Emilio Maseda, Michael Hahn, Teresa Tomasa, and Critical Care

Subjects
Aging, medicine.medical_specialty, intensive care units, 80 jaar en ouder, Comorbidity, frailty, elderly, law.invention, Sepsis, sepsis, 03 medical and health sciences, intensive care afdelingen, 0302 clinical medicine, law, Intensive care, kwetsbaarheid, sterfte, ouderen, medicine, 80 and over, Humans, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Prospective cohort study, business.industry, Mortality rate, Hazard ratio, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Intensive care unit, mortality, aged, Emergency medicine, SOFA score, Geriatrics and Gerontology, business, aged, 80 and over
Abstract

Background Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. Objective To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. Design Prospective cohort study. Setting 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. Subjects Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. Methods Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients’ characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. Results Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09–1.25, P 4): HR, 1.34 (95% CI, 1.18–1.51, P Conclusions There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

Published
2021

5. What Changed Between the Peak and the Plateau Periods of the First COVID-19 Pandemic Wave? A Multicentric Portuguese Cohort Study in Intensive Care

Author

Diogo Lopes, L. Coelho, Camila Tapadinhas, Paulo Telles-Freitas, Pedro Póvoa, João Camões, Ana Valadas, Maria Ferreira da Silva, R. A. Pereira, Danay Perez, Raul Neto, Susana Cabral, João Gouveia, Renato Reis, João João Mendes, Nelson Cardoso, E. Molinos, Rogério C. Silva, João M. Ribeiro, Ana Lúcia Rios, Isabel Amorim Ferreira, Sara Ventura, Bruno Miguel Faria Do Vale, Ana L. P. Marques, Maria Inês Ribeiro, Maria Adão-Serrano, Ana Pinho Oliveira, José Pedro Cidade, Filipa Brás Monteiro, Mariana Cascão, Cleide Barrigoto, Luís Daniel Rodrigues Melo, Rita Alves, Rosa Cardiga, Luís Val-Flores, Tiago Ramires, Bruno Sarmento Banheiro, Flávio Marino, Ana Raquel Maia, Marta M. Sousa, Vitor Mendes, Tatiana Fonseca, Simão C Rodeia, Ana Cracium, Irene Aragão, André Real, and Susana M. Fernandes

Subjects
Geography, Plateau, geography.geographical_feature_category, Coronavirus disease 2019 (COVID-19), Intensive care, Pandemic, language, Portuguese, language.human_language, Demography, Cohort study
Abstract

BackgroundThe COVID-19 pandemic represented a challenge for intensive care units (ICU) with overwhelming demand, heterogenous outcomes and clinical practices. To improve care a profound knowledge on severe COVID-19 patients during different time points is crucial. This data is still scarce. We aimed to analyze and compare COVID-19 patient demographics, clinical management, and outcomes between two periods from the first pandemic wave.MethodsWe performed a multicentric ambispective cohort study including severe COVID-19 patients between March and August 2020 from 16 Portuguese ICUs. A peak and a plateau period were defined, corresponding to weeks 10-16 and 17-34 of the first pandemic wave. All patients had SARS-CoV-2 pneumonia diagnosis and complete hospital follow-up.ResultsWe included 541 adult patients with a median age of 65 [57-74] years and mostly male (71.2%). Severe acute respiratory distress syndrome developed in 63.9% of cases. Overall, 28-day mortality rate was 23.7% with age and SAPSII (both p

Published
2021
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6. Management and outcomes in critically ill nonagenarian versus octogenarian patients

Author

Bruno, Raphael Romano, Wernly, Bernhard, Kelm, Malte, Boumendil, Ariane, Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Finazzi, Stefano, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Lichtenauer, Michael, Muessig, Johanna M., Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agvald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Leaver, Susannah, Boulanger, Carole, Walther, Sten, Schefold, Joerg C., Joannidis, Michael, Nalapko, Yuriy, Elhadi, Muhammed, Fjølner, Jesper, Zafeiridis, Tilemachos, De Lange, Dylan W., Guidet, Bertrand, Flaatten, Hans, Jung, Christian, Eller, Philipp, Helbok, Raimund, Schmutz, René, Nollet, Joke, de Neve, Nikolaas, Buysscher, Pieter De, Swinnen, Walter, Mikačić, Marijana, Bastiansen, Anders, Husted, Andreas, Dahle, Bård E.S., Cramer, Christine, Sølling, Christoffer, Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), Karolinska Institutet [Stockholm], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), the Handmaids of Charity Nursing Home / Casa di Cura Ancelle della Carità [Cremona, Italia], NTNU [Ålesund], Hospital Universitari Parc Taulí [Sabadell, Spain] (HUPT), CIBER de Epidemiología y Salud Pública (CIBERESP), RCCS–Istituto di Ricerche Farmacologiche 'Mario Negri [Bergamo, Italy], Clinical Research Center for Rare Diseases 'Aldo e Cele Daccò' [Bergamo, Italy], Humanitas University [Milan] (Hunimed), Aarhus University Hospital, ASST Great Metropolitan Niguarda / ASST Grande Ospedale Metropolitano Niguarda [Milan, Italia], Mater Misericordiae University Hospital (The Mater Hospital), NOVA Medical School - Faculdade de Ciências Médicas (NMS), Universidade Nova de Lisboa = NOVA University Lisbon (NOVA), Ghent University Hospital, Karolinska University Hospital [Stockholm], Geneva University Hospitals and Geneva University, Utrecht University [Utrecht], Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Cardinal Schwarzenberg Hospital [Pongau, Austria] (CSH), St George’s University Hospitals, Royal Devon and Exeter NHS Foundation Trust [UK], Linköping university hospital, University of Bern, Innsbruck Medical University = Medizinische Universität Innsbruck (IMU), European Wellness International [Luhansk, Ukraine] (EWI), Alkhums Hospital [Tripoli, Libya] (AH), University Hospital of Larissa, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), University of Bergen (UiB), Haukeland University Hospital, VIP2 study group: Michael Joannidis, Philipp Eller, Raimund Helbok, René Schmutz, Joke Nollet, Nikolaas de Neve, Pieter De Buysscher, Sandra Oeyen, Walter Swinnen, Marijana Mikačić, Anders Bastiansen, Andreas Husted, Bård E S Dahle, Christine Cramer, Christoffer Sølling, Dorthe Ørsnes, Jakob Edelberg Thomsen, Jonas Juul Pedersen, Mathilde Hummelmose Enevoldsen, Thomas Elkmann, Agnieszka Kubisz-Pudelko, Alan Pope, Amy Collins, Ashok S Raj, Carole Boulanger, Christian Frey, Ciaran Hart, Clare Bolger, Dominic Spray, Georgina Randell, Helder Filipe, Ingeborg D Welters, Irina Grecu, Jane Evans, Jason Cupitt, Jenny Lord, Jeremy Henning, Joanne Jones, Jonathan Ball, Julie North, Kiran Salaunkey, Laura Ortiz-Ruiz De Gordoa, Louise Bell, Madhu Balasubramaniam, Marcela Vizcaychipi, Maria Faulkner, Mc Donald Mupudzi, Megan Lea-Hagerty, Michael Reay, Michael Spivey, Nicholas Love, Nick Spittle Nick Spittle, Nigel White, Patricia Williams, Patrick Morgan, Phillipa Wakefield, Rachel Savine, Reni Jacob, Richard Innes, Ritoo Kapoor, Sally Humphreys, Steve Rose, Susan Dowling, Susannah Leaver, Tarkeshwari Mane, Tom Lawton, Vongayi Ogbeide, Waqas Khaliq, Yolanda Baird, Antoine Romen, Arnaud Galbois, Bertrand Guidet, Christophe Vinsonneau, Cyril Charron, Didier Thevenin, Emmanuel Guerot, Guillaume Besch, Guillaume Savary, Hervé Mentec, Jean-Luc Chagnon, Jean-Philippe Rigaud, Jean-Pierre Quenot, Jeremy Castanera, Jérémy Rosman, Julien Maizel, Kelly Tiercelet, Lucie Vettoretti, Maud Mousset Hovaere, Messika Messika, Michel Djibré, Nathalie Rolin, Philippe Burtin, Pierre Garcon, Saad Nseir, Xavier Valette, Christian Rabe, Eberhard Barth, Henning Ebelt, Kristina Fuest, Marcus Franz, Michael Horacek, Michael Schuster, Patrick Meybohm, Raphael Romano Bruno, Sebastian Allgäuer, Simon Dubler, Stefan J Schaller, Stefan Schering, Stephan Steiner, Thorben Dieck, Tim Rahmel, Tobias Graf, Anastasia Koutsikou, Aristeidis Vakalos, Bogdan Raitsiou, Elli Niki Flioni, Evangelia Neou, Fotios Tsimpoukas, Georgios Papathanakos, Giorgos Marinakis, Ioannis Koutsodimitropoulos, Kounougeri Aikaterini, Nikoletta Rovina, Stylliani Kourelea, Polychronis Tasioudis, Vasiiios Zidianakis, Vryza Konstantinia, Zoi Aidoni, Brian Marsh, Catherine Motherway, Chris Read, Ignacio Martin-Loeches, Andrea Neville Cracchiolo, Aristide Morigi, Italo Calamai, Stefania Brusa, Ahmed Elhadi, Ahmed Tarek, Ala Khaled, Hazem Ahmed, Wesal Ali Belkhair, Alexander D Cornet, Diederik Gommers, Dylan W De Lange, Eva van Boven, Jasper Haringman, Lenneke Haas, Lettie van den Berg, Oscar Hoiting, Peter de Jager, Rik T Gerritsen, Tom Dormans, Willem Dieperink, Alena Breidablik Alena Breidablik, Anita Slapgard, Anne-Karin Rime, Bente Jannestad, Britt Sjøbøe, Eva Rice, Finn H Andersen, Hans Frank Strietzel, Jan Peter Jensen, Jørund Langørgen, Kirsti Tøien, Kristian Strand, Michael Hahn, Pål Klepstad, Aleksandra Biernacka, Anna Kluzik, Bartosz Kudlinski, Dariusz Maciejewski, Dorota Studzińska, Hubert Hymczak, Jan Stefaniak, Joanna Solek-Pastuszka, Joanna Zorska, Katarzyna Cwyl, Lukasz J Krzych, Maciej Zukowski, Małgorzata Lipińska-Gediga, Marek Pietruszko, Mariusz Piechota, Marta Serwa, Miroslaw Czuczwar, Mirosław Ziętkiewicz, Natalia Kozera, Paweł Nasiłowski, Paweł Sendur, Paweł Zatorski, Piotr Galkin, Ryszard Gawda, Urszula Kościuczuk, Waldemar Cyrankiewicz, Wojciech Gola, Alexandre Fernandes Pinto, Ana Margarida Fernandes, Ana Rita Santos, Cristina Sousa, Inês Barros, Isabel Amorim Ferreira, Jacobo Bacariza Blanco, João Teles Carvalho, Jose Maia, Nuno Candeias, Nuno Catorze, Vladislav Belskiy, Africa Lores, Angela Prado Mira, Catia Cilloniz, David Perez-Torres, Emilio Maseda, Enver Rodriguez, Estefania Prol-Silva, Gaspar Eixarch, Gemma Gomà, Gerardo Aguilar, Gonzalo Navarro Velasco, Marián Irazábal Jaimes, Mercedes Ibarz Villamayor, Noemí Llamas Fernández, Patricia Jimeno Cubero, Sonia López-Cuenca, Teresa Tomasa, Anders Sjöqvist, Camilla Brorsson, Fredrik Schiöler, Henrik Westberg, Jessica Nauska, Joakim Sivik, Johan Berkius, Karin Kleiven Thiringer, Lina De Geer, Sten Walther, Filippo Boroli, Joerg C Schefold, Leila Hergafi, Philippe Eckert, Ismail Yıldız, Ihor Yovenko, Yuriy Nalapko, Richard Pugh, Malbec, Odile, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Mater Misericordiae University Hospital [Dublin] (The Mater Hospital), Jagiellonian University Medical College / Uniwersytet Jagielloński Collegium Medicum [Krakow, Poland], Innsbruck Medical University [Austria] (IMU), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), and Intensive Care

Subjects
Aged, 80 and over, Octogenarians, Critical Care, Frailty, Omvårdnad, Research, Critical Illness, [SDV]Life Sciences [q-bio], 610 Medicine & health, Nursing, Cohort Studies, Hospitalization, [SDV] Life Sciences [q-bio], Critical Illness/therapy, Nonagenarians, Humans, Intensive care medicine, Geriatrics and Gerontology, Outcome
Abstract

Funding Information: This study was endorsed by the ESICM. Free support for running the electronic database and was granted from the dep. of Epidemiology, University of Aarhus, Denmark. Financial support for creation of the e-CRF and maintenance of the database was possible from a grant (open project support) by Western Health region in Norway) 2018 who also funded the participating Norwegian ICUs. DRC Ile de France and URC Est helped conducting VIP2 in France. Open Access funding enabled and organized by Projekt DEAL. Publisher Copyright: © 2021, The Author(s). Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80–89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90–1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered– together with illness severity and pre-existing functional capacity - to effectively guide triage decisions. Trial registration: NCT03134807 and NCT03370692. publishersversion published

Published
2021
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