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201 results on '"Sviri, S."'

4. The Clinical Frailty Scale for mortality prediction of old acutely admitted intensive care patients: a meta-analysis of individual patient-level data.

Author

Bruno, R.R., Wernly, B., Bagshaw, S.M., Boogaard, M. van den, Darvall, J.N., Geer, L. De, Gopegui Miguelena, P.R. de, Heyland, D.K., Hewitt, D., Hope, A.A., Langlais, E., Maguet, P. Le, Montgomery, C.L., Papageorgiou, D., Seguin, P., Geense, W.W., Silva-Obregón, J.A., Wolff, G., Polzin, A., Dannenberg, L., Kelm, M., Flaatten, H., Beil, M., Franz, M., Sviri, S., Leaver, S., Guidet, B., Boumendil, A., Jung, C., Bruno, R.R., Wernly, B., Bagshaw, S.M., Boogaard, M. van den, Darvall, J.N., Geer, L. De, Gopegui Miguelena, P.R. de, Heyland, D.K., Hewitt, D., Hope, A.A., Langlais, E., Maguet, P. Le, Montgomery, C.L., Papageorgiou, D., Seguin, P., Geense, W.W., Silva-Obregón, J.A., Wolff, G., Polzin, A., Dannenberg, L., Kelm, M., Flaatten, H., Beil, M., Franz, M., Sviri, S., Leaver, S., Guidet, B., Boumendil, A., and Jung, C.

Abstract

Contains fulltext : 292531.pdf (Publisher’s version ) (Open Access), BACKGROUND: This large-scale analysis pools individual data about the Clinical Frailty Scale (CFS) to predict outcome in the intensive care unit (ICU). METHODS: A systematic search identified all clinical trials that used the CFS in the ICU (PubMed searched until 24th June 2020). All patients who were electively admitted were excluded. The primary outcome was ICU mortality. Regression models were estimated on the complete data set, and for missing data, multiple imputations were utilised. Cox models were adjusted for age, sex, and illness acuity score (SOFA, SAPS II or APACHE II). RESULTS: 12 studies from 30 countries with anonymised individualised patient data were included (n = 23,989 patients). In the univariate analysis for all patients, being frail (CFS ≥ 5) was associated with an increased risk of ICU mortality, but not after adjustment. In older patients (≥ 65 years) there was an independent association with ICU mortality both in the complete case analysis (HR 1.34 (95% CI 1.25-1.44), p < 0.0001) and in the multiple imputation analysis (HR 1.35 (95% CI 1.26-1.45), p < 0.0001, adjusted for SOFA). In older patients, being vulnerable (CFS 4) alone did not significantly differ from being frail. After adjustment, a CFS of 4-5, 6, and ≥ 7 was associated with a significantly worse outcome compared to CFS of 1-3. CONCLUSIONS: Being frail is associated with a significantly increased risk for ICU mortality in older patients, while being vulnerable alone did not significantly differ. New Frailty categories might reflect its "continuum" better and predict ICU outcome more accurately. TRIAL REGISTRATION: Open Science Framework (OSF: https://osf.io/8buwk/ ).

Published
2023

7. 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, J, Polok, K, de Lange, D, Jung, C, Beil, M, Rhodes, A, Fjolner, J, Gorka, J, Andersen, F, Artigas, A, Cecconi, M, Christensen, S, Joannidis, M, Leaver, S, Marsh, B, Morandi, A, Moreno, R, Oeyen, S, Agvald-Ohman, C, Bollen Pinto, B, Schefold, J, Valentin, A, Walther, S, Watson, X, Zafeiridis, T, Sviri, S, van Heerden, P, Flaatten, H, Guidet, B, Szczeklik, W, Schmutz, R, Wimmer, F, Eller, P, De Buysscher, P, De Neve, N, Swinnen, W, Abraham, P, Hergafi, L, Biskup, E, Piza, P, Taliadoros, I, Dey, N, Solling, C, Rasmussen, B, 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, Charron, C, Lauten, A, Sacher, A, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, S, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, A, Janosi, R, 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, Kounougeri, A, Marinakis, G, Tsimpoukas, F, Spyropoulou, A, Zygoulis, P, Kyparissi, A, Gupta, M, Gurjar, M, Maji, I, Hayes, I, 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, 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, Cortegiani, A, Casalicchio, T, Mellea, S, Graziani, E, Barattini, M, Brizio, E, Rossi, M, Hahn, M, Kemmerer, N, Strietzel, H, Dybwik, K, Legernaes, T, Klepstad, P, Olaussen, E, Olsen, K, Brresen, O, Bjorsvik, G, Maini, S, Fehrle, L, Czuczwar, M, Krawczyk, P, Zietkiewicz, M, Nowak, L, Kotfis, K, Cwyl, K, Gajdosz, R, Biernawska, J, Bohatyrewicz, R, Gawda, R, Grudzien, P, Nasilowski, P, Popek, N, Cyrankiewicz, W, Wawrzyniak, K, Wnuk, M, Maciejewski, D, Studzinska, D, Zukowski, M, Bernas, S, Piechota, M, Nowak-Kozka, I, Serwa, M, Machala, W, Stefaniak, J, Wujtewicz, M, Maciejewski, P, Szymkowiak, M, Adamik, B, Catorze, N, Branco, M, Barros, N, Barros, I, Krystopchuk, A, Honrado, T, Sousa, C, Munoz, F, Rebelo, M, Gomes, R, Nunes, J, Dias, C, Fernandes, A, Petrisor, C, Constantin, B, Belskiy, V, Boskholov, B, Rodriguez, E, Aguilar, G, Masdeu, G, Jaimes, M, Mira, A, Bodi, M, Mendoza, J, Lopez-Cuenca, S, Guzman, M, Rico-Feijoo, J, Ibarz, M, Alvarez, J, Kawati, R, Sivik, J, Nauska, J, Smole, D, Parenmark, F, Lyren, J, Rockstroh, K, Ryden, S, Spangfors, M, Strinnholm, M, De Geer, L, Nordlund, P, Palsson, S, Zetterquist, H, Nilsson, A, Thiringer, K, Jungner, M, Bark, B, Nordling, B, Skold, H, Brorsson, C, Persson, S, Bergstrom, A, Berkius, J, Holmstrom, J, van Dijk, I, van Lelyveld-Haas, L, Jansen, T, Nooteboom, F, van der Voort, P, Dieperink, W, de Waard, M, de Smet, A, Bormans, L, Dormans, T, Dempsey, G, Mathew, S, Raj, A, 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, Mikacic, M, Bastiansen, A, Husted, A, Dahle, B, Cramer, C, Orsnes, D, Thomsen, J, Pedersen, J, Enevoldsen, M, Elkmann, T, Kubisz-Pudelko, A, Collins, A, Hart, C, Randell, G, Filipe, H, Welters, I, Evans, J, Lord, J, Jones, J, Ball, J, North, J, Salaunkey, K, De Gordoa, L, 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, Mane, T, Ogbeide, V, Baird, Y, Romen, A, Galbois, A, Vinsonneau, C, Thevenin, D, Guerot, E, Savary, G, Chagnon, J, Rigaud, J, Quenot, J, Castaneray, J, Rosman, J, Maizel, J, Tiercelet, K, Hovaere, M, Messika, M, Djibre, M, Rolin, N, Burtin, P, Garcon, P, Nseir, S, Valette, X, Horacek, M, Bruno, R, Allgauer, S, Dubler, S, Schering, S, Koutsikou, A, Vakalos, A, Raitsiou, B, Flioni, E, 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, Morigi, A, Brusa, S, Elhadi, A, Tarek, A, Khaled, A, Ahmed, H, Belkhair, W, Cornet, A, Gommers, D, van Boven, E, Haringman, J, Haas, L, van den Berg, L, Hoiting, O, de Jager, P, Gerritsen, R, Breidablik, A, Slapgard, A, Rime, A, Jannestad, B, Sjoboe, B, Rice, E, Jensen, J, Langorgen, J, Toien, K, Strand, K, Biernacka, A, Kluzik, A, Kudlinski, B, Hymczak, H, Solek-Pastuszka, J, Zorska, J, Krzych, L, Lipinska-Gediga, M, Pietruszko, M, Kozera, N, Sendur, P, Zatorski, P, Galkin, P, Kosciuczuk, U, Gola, W, Pinto, A, Santos, A, Ferreira, I, Blanco, J, Carvalho, J, Maia, J, Candeias, N, Lores, A, Cilloniz, C, Perez-Torres, D, Maseda, E, Prol-Silva, E, Eixarch, G, Goma, G, Velasco, G, Villamayor, M, Fernandez, N, Cubero, P, Tomasa, T, Sjoqvist, A, Schioler, F, Westberg, H, Boroli, F, Eckert, P, Yildiz, I, Yovenko, I, Fronczek J., Polok K., de Lange D. W., Jung C., Beil M., Rhodes A., Fjolner J., Gorka J., Andersen F. H., Artigas A., Cecconi M., Christensen S., Joannidis M., Leaver S., Marsh B., Morandi A., Moreno R., Oeyen S., Agvald-Ohman C., Bollen Pinto B., Schefold J. C., Valentin A., Walther S., Watson X., Zafeiridis T., Sviri S., van Heerden P. V., Flaatten H., Guidet B., Szczeklik W., Schmutz R., Wimmer F., Eller P., De Buysscher P., De Neve N., Swinnen W., Abraham P., Hergafi L., Biskup E., Piza P., Taliadoros I., Dey N., Solling C., Rasmussen B. 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., 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., 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., 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., Kemmerer N., Strietzel H. F., Dybwik K., Legernaes T., Klepstad P., Olaussen E. B., Olsen K. I., Brresen O. M., Bjorsvik G., Maini S., Fehrle L., Czuczwar M., Krawczyk P., Zietkiewicz M., Nowak L. R., Kotfis K., Cwyl K., Gajdosz R., Biernawska J., Bohatyrewicz R., Gawda R., Grudzien P., Nasilowski P., Popek N., Cyrankiewicz W., Wawrzyniak K., Wnuk M., Maciejewski D., Studzinska D., Zukowski M., Bernas S., Piechota M., Nowak-Kozka I., Serwa M., Machala W., Stefaniak J., Wujtewicz M., Maciejewski P., Szymkowiak M., Adamik B., 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., Lopez-Cuenca S., Guzman M. H., Rico-Feijoo J., Ibarz M., Alvarez J. T., Kawati R., Sivik J., Nauska J., Smole D., Parenmark F., Lyren J., Rockstroh K., Ryden S., Spangfors M., Strinnholm M., De Geer L., Nordlund P., Palsson S., Zetterquist H., Nilsson A., Thiringer K., Jungner M., Bark B., Nordling B., Skold H., Brorsson C., Persson S., Bergstrom A., Berkius J., Holmstrom 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., Mikacic M., Bastiansen A., Husted A., Dahle B. E. S., Cramer C., Orsnes D., Thomsen J. E., Pedersen J. J., Enevoldsen M. H., 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. O. -R., 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., 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., Djibre M., Rolin N., Burtin P., Garcon P., Nseir S., Valette X., Horacek M., Bruno R. R., Allgauer 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. N., Morigi A., Brusa S., Elhadi A., Tarek A., Khaled A., Ahmed H., Belkhair W. A., 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., Sjoboe B., Rice E., Jensen J. P., Langorgen J., Toien K., Strand K., Biernacka A., Kluzik A., Kudlinski B., Hymczak H., Solek-Pastuszka J., Zorska J., Krzych L. J., Lipinska-Gediga M., Pietruszko M., Kozera N., Sendur P., Zatorski P., Galkin P., Kosciuczuk 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., Goma G., Velasco G. N., Villamayor M. I., Fernandez N. L., Cubero P. J., Tomasa T., Sjoqvist A., Schioler F., Westberg H., Thiringer K. K., Boroli F., Eckert P., Yildiz I., Yovenko I., Fronczek, J, Polok, K, de Lange, D, Jung, C, Beil, M, Rhodes, A, Fjolner, J, Gorka, J, Andersen, F, Artigas, A, Cecconi, M, Christensen, S, Joannidis, M, Leaver, S, Marsh, B, Morandi, A, Moreno, R, Oeyen, S, Agvald-Ohman, C, Bollen Pinto, B, Schefold, J, Valentin, A, Walther, S, Watson, X, Zafeiridis, T, Sviri, S, van Heerden, P, Flaatten, H, Guidet, B, Szczeklik, W, Schmutz, R, Wimmer, F, Eller, P, De Buysscher, P, De Neve, N, Swinnen, W, Abraham, P, Hergafi, L, Biskup, E, Piza, P, Taliadoros, I, Dey, N, Solling, C, Rasmussen, B, 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, Charron, C, Lauten, A, Sacher, A, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, S, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, A, Janosi, R, 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, Kounougeri, A, Marinakis, G, Tsimpoukas, F, Spyropoulou, A, Zygoulis, P, Kyparissi, A, Gupta, M, Gurjar, M, Maji, I, Hayes, I, 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, 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, Cortegiani, A, Casalicchio, T, Mellea, S, Graziani, E, Barattini, M, Brizio, E, Rossi, M, Hahn, M, Kemmerer, N, Strietzel, H, Dybwik, K, Legernaes, T, Klepstad, P, Olaussen, E, Olsen, K, Brresen, O, Bjorsvik, G, Maini, S, Fehrle, L, Czuczwar, M, Krawczyk, P, Zietkiewicz, M, Nowak, L, Kotfis, K, Cwyl, K, Gajdosz, R, Biernawska, J, Bohatyrewicz, R, Gawda, R, Grudzien, P, Nasilowski, P, Popek, N, Cyrankiewicz, W, Wawrzyniak, K, Wnuk, M, Maciejewski, D, Studzinska, D, Zukowski, M, Bernas, S, Piechota, M, Nowak-Kozka, I, Serwa, M, Machala, W, Stefaniak, J, Wujtewicz, M, Maciejewski, P, Szymkowiak, M, Adamik, B, Catorze, N, Branco, M, Barros, N, Barros, I, Krystopchuk, A, Honrado, T, Sousa, C, Munoz, F, Rebelo, M, Gomes, R, Nunes, J, Dias, C, Fernandes, A, Petrisor, C, Constantin, B, Belskiy, V, Boskholov, B, Rodriguez, E, Aguilar, G, Masdeu, G, Jaimes, M, Mira, A, Bodi, M, Mendoza, J, Lopez-Cuenca, S, Guzman, M, Rico-Feijoo, J, Ibarz, M, Alvarez, J, Kawati, R, Sivik, J, Nauska, J, Smole, D, Parenmark, F, Lyren, J, Rockstroh, K, Ryden, S, Spangfors, M, Strinnholm, M, De Geer, L, Nordlund, P, Palsson, S, Zetterquist, H, Nilsson, A, Thiringer, K, Jungner, M, Bark, B, Nordling, B, Skold, H, Brorsson, C, Persson, S, Bergstrom, A, Berkius, J, Holmstrom, J, van Dijk, I, van Lelyveld-Haas, L, Jansen, T, Nooteboom, F, van der Voort, P, Dieperink, W, de Waard, M, de Smet, A, Bormans, L, Dormans, T, Dempsey, G, Mathew, S, Raj, A, 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, Mikacic, M, Bastiansen, A, Husted, A, Dahle, B, Cramer, C, Orsnes, D, Thomsen, J, Pedersen, J, Enevoldsen, M, Elkmann, T, Kubisz-Pudelko, A, Collins, A, Hart, C, Randell, G, Filipe, H, Welters, I, Evans, J, Lord, J, Jones, J, Ball, J, North, J, Salaunkey, K, De Gordoa, L, 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, Mane, T, Ogbeide, V, Baird, Y, Romen, A, Galbois, A, Vinsonneau, C, Thevenin, D, Guerot, E, Savary, G, Chagnon, J, Rigaud, J, Quenot, J, Castaneray, J, Rosman, J, Maizel, J, Tiercelet, K, Hovaere, M, Messika, M, Djibre, M, Rolin, N, Burtin, P, Garcon, P, Nseir, S, Valette, X, Horacek, M, Bruno, R, Allgauer, S, Dubler, S, Schering, S, Koutsikou, A, Vakalos, A, Raitsiou, B, Flioni, E, 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, Morigi, A, Brusa, S, Elhadi, A, Tarek, A, Khaled, A, Ahmed, H, Belkhair, W, Cornet, A, Gommers, D, van Boven, E, Haringman, J, Haas, L, van den Berg, L, Hoiting, O, de Jager, P, Gerritsen, R, Breidablik, A, Slapgard, A, Rime, A, Jannestad, B, Sjoboe, B, Rice, E, Jensen, J, Langorgen, J, Toien, K, Strand, K, Biernacka, A, Kluzik, A, Kudlinski, B, Hymczak, H, Solek-Pastuszka, J, Zorska, J, Krzych, L, Lipinska-Gediga, M, Pietruszko, M, Kozera, N, Sendur, P, Zatorski, P, Galkin, P, Kosciuczuk, U, Gola, W, Pinto, A, Santos, A, Ferreira, I, Blanco, J, Carvalho, J, Maia, J, Candeias, N, Lores, A, Cilloniz, C, Perez-Torres, D, Maseda, E, Prol-Silva, E, Eixarch, G, Goma, G, Velasco, G, Villamayor, M, Fernandez, N, Cubero, P, Tomasa, T, Sjoqvist, A, Schioler, F, Westberg, H, Boroli, F, Eckert, P, Yildiz, I, Yovenko, I, Fronczek J., Polok K., de Lange D. W., Jung C., Beil M., Rhodes A., Fjolner J., Gorka J., Andersen F. H., Artigas A., Cecconi M., Christensen S., Joannidis M., Leaver S., Marsh B., Morandi A., Moreno R., Oeyen S., Agvald-Ohman C., Bollen Pinto B., Schefold J. C., Valentin A., Walther S., Watson X., Zafeiridis T., Sviri S., van Heerden P. V., Flaatten H., Guidet B., Szczeklik W., Schmutz R., Wimmer F., Eller P., De Buysscher P., De Neve N., Swinnen W., Abraham P., Hergafi L., Biskup E., Piza P., Taliadoros I., Dey N., Solling C., Rasmussen B. 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., 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., 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., 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., Kemmerer N., Strietzel H. F., Dybwik K., Legernaes T., Klepstad P., Olaussen E. B., Olsen K. I., Brresen O. M., Bjorsvik G., Maini S., Fehrle L., Czuczwar M., Krawczyk P., Zietkiewicz M., Nowak L. R., Kotfis K., Cwyl K., Gajdosz R., Biernawska J., Bohatyrewicz R., Gawda R., Grudzien P., Nasilowski P., Popek N., Cyrankiewicz W., Wawrzyniak K., Wnuk M., Maciejewski D., Studzinska D., Zukowski M., Bernas S., Piechota M., Nowak-Kozka I., Serwa M., Machala W., Stefaniak J., Wujtewicz M., Maciejewski P., Szymkowiak M., Adamik B., 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., Lopez-Cuenca S., Guzman M. H., Rico-Feijoo J., Ibarz M., Alvarez J. T., Kawati R., Sivik J., Nauska J., Smole D., Parenmark F., Lyren J., Rockstroh K., Ryden S., Spangfors M., Strinnholm M., De Geer L., Nordlund P., Palsson S., Zetterquist H., Nilsson A., Thiringer K., Jungner M., Bark B., Nordling B., Skold H., Brorsson C., Persson S., Bergstrom A., Berkius J., Holmstrom 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., Mikacic M., Bastiansen A., Husted A., Dahle B. E. S., Cramer C., Orsnes D., Thomsen J. E., Pedersen J. J., Enevoldsen M. H., 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. O. -R., 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., 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., Djibre M., Rolin N., Burtin P., Garcon P., Nseir S., Valette X., Horacek M., Bruno R. R., Allgauer 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. N., Morigi A., Brusa S., Elhadi A., Tarek A., Khaled A., Ahmed H., Belkhair W. A., 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., Sjoboe B., Rice E., Jensen J. P., Langorgen J., Toien K., Strand K., Biernacka A., Kluzik A., Kudlinski B., Hymczak H., Solek-Pastuszka J., Zorska J., Krzych L. J., Lipinska-Gediga M., Pietruszko M., Kozera N., Sendur P., Zatorski P., Galkin P., Kosciuczuk 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., Goma G., Velasco G. N., Villamayor M. I., Fernandez N. L., Cubero P. J., Tomasa T., Sjoqvist A., Schioler F., Westberg H., Thiringer K. K., Boroli F., Eckert P., Yildiz I., and Yovenko I.

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 < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). 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

9. The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19

Author

Bruno, R.R., Wernly, B., Flaatten, H., Fjølner, J., Artigas, A., Baldia, P.H., Binneboessel, S., Pinto, B. Bollen, Schefold, J.C., Wolff, G., Kelm, M., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Kondili, E., Marsh, B., Wollborn, J., Andersen, F.H., Moreno, R., Leaver, S., Boumendil, A., Lange, D.W. de, Zegers, M., Guidet, B., Jung, C., Bruno, R.R., Wernly, B., Flaatten, H., Fjølner, J., Artigas, A., Baldia, P.H., Binneboessel, S., Pinto, B. Bollen, Schefold, J.C., Wolff, G., Kelm, M., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Kondili, E., Marsh, B., Wollborn, J., Andersen, F.H., Moreno, R., Leaver, S., Boumendil, A., Lange, D.W. de, Zegers, M., Guidet, B., and Jung, C.

Abstract

Contains fulltext : 282926.pdf (Publisher’s version ) (Open Access), PURPOSE: Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. METHODS: The COVIP study is a prospective international observational study that recruited ICU patients ≥ 70 years admitted with COVID-19 (NCT04321265). Several parameters including ADL (ADL; 0 = disability, 6 = no disability), Clinical Frailty Scale (CFS), SOFA score, intensive care treatment, ICU- and 3-month survival were recorded. A mixed-effects Weibull proportional hazard regression analyses for 3-month mortality adjusted for multiple confounders. RESULTS: This pre-specified analysis included 2359 patients with a documented ADL and CFS. Most patients evidenced independence in their daily living before hospital admission (80% with ADL = 6). Patients with no frailty and no disability showed the lowest, patients with frailty (CFS ≥ 5) and disability (ADL < 6) the highest 3-month mortality (52 vs. 78%, p < 0.001). ADL was independently associated with 3-month mortality (ADL as a continuous variable: aHR 0.88 (95% CI 0.82-0.94, p < 0.001). Being "disable" resulted in a significant increased risk for 3-month mortality (aHR 1.53 (95% CI 1.19-1.97, p 0.001) even after adjustment for multiple confounders. CONCLUSION: Baseline Activities of Daily Living (ADL) on admission provides additional information for outcome prediction, although most critically ill old intensive care patients suffering from COVID-19 had no restriction in their ADL prior to ICU admission. Combining frailty and disability identifies a subgroup with particularly high mortality. TRIAL REGISTRATION NUMBER: NCT04321265.

Published
2022

10. Health-related quality of life in older patients surviving ICU treatment for COVID-19: results from an international observational study of patients older than 70 years

Author

Soliman, I.W., Leaver, S., Flaatten, H., Fjølner, J., Wernly, B., Bruno, R.R., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Wollborn, J., Banzo, M.J. Arche, Fuest, K., Marsh, B., Andersen, F.H., Moreno, R., Boumendil, A., Guidet, B., Zegers, M., Jung, C., Lange, D.W. de, Soliman, I.W., Leaver, S., Flaatten, H., Fjølner, J., Wernly, B., Bruno, R.R., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Elhadi, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Wollborn, J., Banzo, M.J. Arche, Fuest, K., Marsh, B., Andersen, F.H., Moreno, R., Boumendil, A., Guidet, B., Zegers, M., Jung, C., and Lange, D.W. de

Abstract

Contains fulltext : 252215.pdf (Publisher’s version ) (Open Access), BACKGROUND: health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. OBJECTIVE: to quantify HRQoL in order to identify areas of interventions. DESIGN: prospective observation study. SETTING: admissions to European ICUs between March 2020 and February 2021. SUBJECTS: patients aged 70 years or older admitted with COVID-19 disease. METHODS: collected determinants include SOFA-score, Clinical Frailty Scale (CFS), number and timing of ICU procedures and limitation of care, Katz Activities of Daily Living (ADL) dependence score. HRQoL was assessed at 3 months after ICU admission with the Euro-QoL-5D-5L questionnaire. An outcome of ≥4 on any of Euro-QoL-5D-5L domains was considered unfavourable. RESULTS: in total 3,140 patients from 14 European countries were included in this study. Three months after inclusion, 1,224 patients (39.0%) were alive and the EQ-5D-5L from was obtained. The CFS was associated with an increased odds ratio for an unfavourable HRQoL outcome after 3 months; OR 1.15 (95% confidence interval (CI): 0.71-1.87) for CFS 2 to OR 4.33 (95% CI: 1.57-11.9) for CFS ≧ 7. The Katz ADL was not statistically significantly associated with HRQoL after 3 months. CONCLUSIONS: in critically ill old intensive care patients suffering from COVID-19, the CFS is associated with the subjectively perceived quality of life. The CFS on admission can be used to inform patients and relatives on the risk of an unfavourable qualitative outcome if such patients survive.

Published
2022

11. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years-a prospective multicentre cohort study

Author

Polok, K., Fronczek, J., Artigas, A., Flaatten, H., Guidet, B., Lange, D.W. de, Fjølner, J., Leaver, S., Beil, M., Sviri, S., Bruno, R.R., Wernly, B., Pinto, B. Bollen, Schefold, J.C., Studzińska, D., Joannidis, M., Oeyen, S., Marsh, B., Andersen, F.H., Moreno, R., Cecconi, M., Zegers, M., Jung, C., Szczeklik, W., Polok, K., Fronczek, J., Artigas, A., Flaatten, H., Guidet, B., Lange, D.W. de, Fjølner, J., Leaver, S., Beil, M., Sviri, S., Bruno, R.R., Wernly, B., Pinto, B. Bollen, Schefold, J.C., Studzińska, D., Joannidis, M., Oeyen, S., Marsh, B., Andersen, F.H., Moreno, R., Cecconi, M., Zegers, M., Jung, C., and Szczeklik, W.

Abstract

Contains fulltext : 283094.pdf (Publisher’s version ) (Open Access), BACKGROUND: Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. METHODS: This is a substudy of COVIP study-an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. RESULTS: Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36-5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06-2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI - 2.27 to - 0.46 days) compared to primary IMV group (n = 1876). CONCLUSIONS: Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial Registration NCT04321265 , registered 19 March 2020, https://clinicaltrials.gov .

Published
2022

16. The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Author

Jung, C., Flaatten, H., Fjølner, J., Bruno, R.R., Wernly, B., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Wolff, G., Kelm, M., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Czuczwar, M., Elhadi, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Marsh, B., Andersen, F.H., Moreno, R., Cecconi, M., Leaver, S., Boumendil, A., Zegers, M., Lange, D.W. de, and Guidet, B.

Subjects
Male, COVID-19 / mortality, Letter, Critical Care, Frail Elderly, HSJ UCI, Frailty / mortality, Critical Care and Intensive Care Medicine, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Elderly, Medicine and Health Sciences, Humans, Prospective Studies, Outcome, Aged, Aged, 80 and over, Pandemia, Frailty, RC86-88.9, COVID-19, Frail Elderly / statistics & numerical data, Medical emergencies. Critical care. Intensive care. First aid, Prognosis, Survival Analysis, COVID-19 / therapy, Female
Abstract

Contains fulltext : 238691.pdf (Publisher’s version ) (Open Access) BACKGROUND: The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. METHODS: A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. RESULTS: The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p

Published
2021

17. Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe

Author

Jung, C., Fjølner, J., Bruno, R.R., Wernly, B., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Wolff, G., Kelm, M., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Czuczwar, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Andersen, F.H., Moreno, R., Leaver, S., Boumendil, A., Lange, D.W. de, Zegers, M., Guidet, B., Flaatten, H., Jung, C., Fjølner, J., Bruno, R.R., Wernly, B., Artigas, A., Pinto, B. Bollen, Schefold, J.C., Wolff, G., Kelm, M., Beil, M., Sviri, S., Heerden, P.V. van, Szczeklik, W., Czuczwar, M., Joannidis, M., Oeyen, S., Zafeiridis, T., Andersen, F.H., Moreno, R., Leaver, S., Boumendil, A., Lange, D.W. de, Zegers, M., Guidet, B., and Flaatten, H.

Abstract

Contains fulltext : 238632.pdf (Publisher’s version ) (Open Access), BACKGROUND: The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe. METHODS: This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265). RESULTS: In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO(2)/FiO(2) ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%). CONCLUSION: An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients. TRIAL REGISTRATION NUMBER: NCT04321265 , registered March 19th, 2020.

Published
2021

27. A prospective comparison of the efficacy and safety of fully closed-loop control ventilation (Intellivent-ASV) with conventional ASV and SIMV modes.

Author

Abutbul, A., Sviri, S., Zbedat, W., Linton, D. M., and van Heerden, P. V.

Subjects
*OBSTRUCTIVE lung disease treatment, *PNEUMONIA treatment, *ADULT respiratory distress syndrome treatment, *ACTIVE oxygen in the body, *ARTIFICIAL respiration, *COMPARATIVE studies, *PROBABILITY theory, *PULMONARY gas exchange, *RESPIRATORY therapy, *SAFETY, *RESPIRATORY mechanics, *DESCRIPTIVE statistics, *POSITIVE end-expiratory pressure
Abstract

Background. Intellivent-adaptive support ventilation (ASV) is a closed-loop, fully automatic method of mechanical ventilation. This advanced mode of ventilation adjusts ventilation and oxygenation parameters according to patient weight, lung function (as assessed by the ventilator) and continuous input of end-tidal carbon dioxide and oxygen saturation. Our study compares the efficacy of this new mode with ASV and synchronised intermittent mandatory ventilation (SIMV) modes. Methods. We conducted a within-group comparison of three modes of ventilation, ASV, Intellivent-ASV and SIMV, using a Hamilton S1 ventilator (Hamilton Medical, Switzerland). Subjects were ventilated for 2 hours on each mode, and at the end of each 2-hour period, parameters of ventilation and haemodynamics were measured. Results. Twenty subjects participated in this study. Their mean age was 67.3 years (range 22 - 82 years). The most common diagnosis at presentation was pneumonia (55%), followed by chronic obstructive pulmonary disease (16%) and acute respiratory distress syndrome (11%). Mean (standard deviation) levels of positive end-expiratory pressure (PEEP) were significantly higher in the Intellivent-ASV group (7.6 (5) v. 5.1 (2) and 5.2 (2) cm H2O in the ASV and SIMV groups, respectively (p<0.005). Fractional inspired concentration of oxygen (FiO2) was significantly lower in the Intellivent-ASV group (0.35 (0.7)) v. 0.41 (0.6) and 0.41 (0.6) for the ASV and SIMV groups, respectively (p<0.005). The mean spontaneous breathing rate in the Intellivent-ASV group was 8.6 (7.5) breaths per minute (b/min), significantly higher than in the ASV group (2.9 (5.7) b/min) and the SIMV group (2.4 (4.5) b/min) (p=0.002), while there was no difference in the total respiratory rate between the groups. There was no significant difference in haemodynamic parameters between the different ventilation modes. ASV tended to produce lower partial pressure of carbon dioxide (PCO2) levels than SIMV and Intellivent-ASV (p<0.05). Conclusions. Intellivent-ASV provided a significant reduction in the FiO2 with higher PEEP levels, but without haemodynamic detriment. Intellivent-ASV encouraged significantly more spontaneous breathing, which may translate to faster weaning. Further studies to examine this effect are warranted. [ABSTRACT FROM AUTHOR]

Published
2014
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34. 37th International Symposium on Intensive Care and Emergency Medicine (part 3 of 3)

Author

Von Seth, M., Hillered, L., Otterbeck, A., Hanslin, K., Larsson, A., Sjölin, J., Lipcsey, M., Cove, ME, Chew, N. S., Vu, L. H., Lim, R. Z., Puthucheary, Z., Wilske, F., Skorup, P., Tano, E., Derese, I., Thiessen, S., Derde, S., Dufour, T., Pauwels, L., Bekhuis, Y., Van den Berghe, G., Vanhorebeek, I., Khan, M., Dwivedi, D., Zhou, J., Prat, A., Seidah, N. G., Liaw, P. C., Fox-Robichaud, A. E., Correa, T., Pereira, J, Takala, J, Jakob, S, Maudsdotter, L., Castegren, M., Sjölin, J, Xue, M., Xu, J. Y., Liu, L., Huang, Y. Z., Guo, F. M., Yang, Y., Qiu, H. B., Kuzovlev, A., Moroz, V., Goloubev, A., Myazin, A., Chumachenko, A., Pisarev, V., Takeyama, N., Tsuda, M., Kanou, H., Aoki, R., Kajita, Y., Hashiba, M., Terashima, T., Tomino, A., Davies, R., O’Dea, K. P., Soni, S., Ward, J. K., O’Callaghan, D. J., Takata, M., Gordon, A. C., Wilson, J., Zhao, Y., Singer, M., Spencer, J., Shankar-Hari, M., Genga, K. Roveran, Lo, C., Cirstea, M. S., Walley, K. R., Russell, J. A., Linder, A., Boyd, J. H., Sedlag, A., Riedel, C., Georgieff, M., Barth, E., Bracht, H., Essig, A., Henne-Bruns, D., Gebhard, F., Orend, K., Halatsch, M., Weiss, M., Chase, M., Freinkman, E., Uber, A., Liu, X., Cocchi, M. N., Donnino, M. W., Peetermans, M., Liesenborghs, L., Claes, J., Vanassche, T., Hoylaerts, M., Jacquemin, M., Vanhoorelbeke, K., De Meyer, S., Verhamme, P., Vögeli, A., Ottiger, M., Meier, M., Steuer, C., Bernasconi, L., Huber, A., Christ-Crain, M., Henzen, C., Hoess, C., Thomann, R., Zimmerli, W., Müller, B., Schütz, P., Hoppensteadt, D., Walborn, A., Rondina, M., Tsuruta, K., Fareed, J., Tachyla, S., Ikeda, T., Ono, S., Ueno, T., Suda, S., Nagura, T., Damiani, E., Domizi, R., Scorcella, C., Tondi, S., Pierantozzi, S., Ciucani, S., Mininno, N., Adrario, E., Pelaia, P., Donati, A., Andersen, M. Schou, Lu, S., Lopez, G, Lassen, AT, Ghiran, I., Shapiro, N. I., Trahtemberg, U., Sviri, S., Beil, M., Agur, Z., Van Heerden, P., Jahaj, E., Vassiliou, A., Mastora, Z., Orfanos, S. E., Kotanidou, A., Wirz, Y., Sager, R., Amin, D., Amin, A., Haubitz, S., Hausfater, P., Kutz, A., Mueller, B., Schuetz, P., Sager, R. S., Wirz, Y. W., Amin, D. A., Amin, A. A., Hausfater, P. H., Huber, A. H., Mueller, B, Schuetz, P, Gottin, L., Dell’amore, C., Stringari, G., Cogo, G., Ceolagraziadei, M., Sommavilla, M., Soldani, F., Polati, E., Baumgartner, T., Zurauskaité, G., Gupta, S., Devendra, A., Mandaci, D., Eren, G., Ozturk, F., Emir, N., Hergunsel, O., Azaiez, S., Khedher, S., Maaoui, A., Salem, M., Chernevskaya, E., Beloborodova, N., Bedova, A., Sarshor, Y. U., Pautova, A., Gusarov, V., Öveges, N., László, I., Forgács, M., Kiss, T., Hankovszky, P., Palágyi, P., Bebes, A., Gubán, B., Földesi, I., Araczki, Á., Telkes, M., Ondrik, Z., Helyes, Z., Kemény, Á., Molnár, Z., Spanuth, E., Ebelt, H., Ivandic, B., Thomae, R., Werdan, K., El-Shafie, M., Taema, K., El-Hallag, M., Kandeel, A., Tayeh, O., Eldesouky, M., Omara, A., Winkler, M. S., Holzmann, M., Nierhaus, A., Mudersbach, E., Schwedhelm, E., Daum, G., Kluge, S., Zoellner, C., Greiwe, G., Sawari, H., Kubitz, J., Jung, R., Reichenspurner, H., Groznik, M., Ihan, A., Andersen, L. W., Holmberg, M. J., Wulff, A., Balci, C., Haliloglu, M., Bilgili, B., Bilgin, H., Kasapoglu, U., Sayan, I., Süzer, M., Mulazımoglu, L., Cinel, I., Patel, V., Shah, S., Parulekar, P., Minton, C., Patel, J., Ejimofo, C., Choi, H., Costa, R., Caruso, P., Nassar, P., Fu, J., Jin, J., Xu, Y., Kong, J., Wu, D., Yaguchi, A., Klonis, A., Ganguly, S., Kollef, M., Burnham, C., Fuller, B., Mavrommati, A., Chatzilia, D., Salla, E., Papadaki, E., Kamariotis, S., Christodoulatos, S., Stylianakis, A., Alamanos, G., Simoes, M., Trigo, E., Silva, N., Martins, P., Pimentel, J., Baily, D., Curran, L. A., Ahmadnia, E., Patel, B. V., Adukauskiene, D., Cyziute, J, Adukauskaite, A., Pentiokiniene, D., Righetti, F., Colombaroli, E., Castellano, G., Man, M., Shum, H. P., Chan, Y. H., Chan, K. C., Yan, W. W., Lee, R. A., Lau, S. K., Dilokpattanamongkol, P., Thirapakpoomanunt, P., Anakkamaetee, R., Montakantikul, P., Tangsujaritvijit, V., Sinha, S., Pati, J., Sahu, S., Valanciene, D., Dambrauskiene, A., Hernandez, K., Lopez, T., Saca, D., Bello, M., Mahmood, W., Hamed, K., Al Badi, N., AlThawadi, S., Al Hosaini, S., Salahuddin, N., Cilloniz, C. C., Ceccato, A. C., Bassi, G. L. Li, Ferrer, M. F., Gabarrus, A. G., Ranzani, O. R., Jose, A. S. San, Vidal, C. G. Garcia, de la Bella Casa, J. P. Puig, Blasi, F. B., Torres, AT, Ciginskiene, A., Simoliuniene, R., Giuliano, G., Triunfio, D., Sozio, E., Taddei, E., Brogi, E., Sbrana, F., Ripoli, A., Bertolino, G., Tascini, C., Forfori, F., Fleischmann, C., Goldfarb, D., Schlattmann, P., Schlapbach, L., Kissoon, N., Baykara, N., Akalin, H., Arslantas, M. Kemal, Gavrilovic, S. G., Vukoja, M. V., Hache, M. H., Kashyap, R. K., Dong, Y. D., Gajic, O. G., Ranzani, O., Harrison, D., Rabello, L., Rowan, K., Salluh, J., Soares, M., Markota, A. M., Fluher, J. F., Kogler, D. K., Borovšak, Z. B., Sinkovic, A. S., Siddiqui, Z, Aggarwal, P., Iqbal, O., Lewis, M., Wasmund, R., Abro, S., Raghuvir, S., Barie, P. S., Fineberg, D., Radford, A., Casazza, A., Vilardo, A., Bellazzi, E., Boschi, R., Ciprandi, D., Gigliuto, C., Preda, R., Vanzino, R., Vetere, M., Carnevale, L., Kyriazopoulou, E., Pistiki, A., Routsi, C., Tsangaris, I., Giamarellos-Bourboulis, E., Pnevmatikos, I., Vlachogiannis, G., Antoniadou, E., Mandragos, K., Armaganidis, A., Allan, P., Oehmen, R., Luo, J., Ellis, C., Latham, P., Newman, J., Pritchett, C., Pandya, D., Cripps, A., Harris, S., Jadav, M., Langford, R., Ko, B., Park, H., Beumer, C. M., Koch, R., Beuningen, D. V., Oudelashof, A. M., Vd Veerdonk, F. L., Kolwijck, E., VanderHoeven, J. G., Bergmans, D. C., Hoedemaekers, C., Brandt, J. B., Golej, J., Burda, G., Mostafa, G., Schneider, A., Vargha, R., Hermon, M., Levin, P., Broyer, C, Assous, M., Wiener-Well, Y., Dahan, M., Benenson, S., Ben-Chetrit, E, Faux, A., Sherazi, R., Sethi, A., Saha, S., Kiselevskiy, M., Gromova, E., Loginov, S., Tchikileva, I., Dolzhikova, Y., Krotenko, N., Vlasenko, R., Anisimova, N., Spadaro, S., Fogagnolo, A., Remelli, F., Alvisi, V., Romanello, A., Marangoni, E., Volta, C., Degrassi, A., Mearelli, F., Casarsa, C., Fiotti, N., Biolo, G., Cariqueo, M., Luengo, C., Galvez, R., Romero, C., Cornejo, R., Llanos, O., Estuardo, N., Alarcon, P., Magazi, B., Khan, S., Pasipanodya, J., Eriksson, M., Strandberg, G., Lipsey, M., Rajput, Z., Hiscock, F., Karadag, T., Uwagwu, J., Jain, S., Molokhia, A., Barrasa, H., Soraluce, A., Uson, E., Rodriguez, A., Isla, A., Martin, A., Fernández, B., Fonseca, F., Sánchez-Izquierdo, J. A., Maynar, F. J., Kaffarnik, M., Alraish, R., Frey, O., Roehr, A., Stockmann, M., Wicha, S., Shortridge, D., Castanheira, M., Sader, H. S., Streit, J. M., Flamm, R. K., Falsetta, K., Lam, T., Reidt, S., Jancik, J., Kinoshita, T., Yoshimura, J., Yamakawa, K., Fujimi, S., Torres, A., Zakynthinos, S., Mandragos, C., Ramirez, P., De la Torre-Prados, M., Dale, G., Wach, A., Beni, L., Hooftman, L., Zwingelstein, C., François, B., Colin, G., Dequin, P. F., Laterre, P. F., Perez, A., Welte, R., Lorenz, I., Eller, P., Joannidis, M., Bellmann, R., Lim, S., Chana, S., Patel, S., Higuera, J., Cabestrero, D., Rey, L., Narváez, G., Blandino, A., Aroca, M., Saéz, S., De Pablo, R, Albert, C. Nadège, Langouche, L., Goossens, C., Peersman, N., Vermeersch, P., Vander Perre, S., Holst, J., Wouters, P., Uber, A. U., Holmberg, M., Konanki, V., McNaughton, M., Zhang, J., Demirkiran, O., Byelyalov, A., Guerrero, J., Cariqueo, M, Rossini, N., Falanga, U., Monaldi, V., Cole, O., Scawn, N., Balciunas, M., Blascovics, I., Vuylsteke, A., Salaunkey, K., Omar, A., Salama, A., Allam, M., Alkhulaifi, A., Verstraete, S., Van Puffelen, E., Ingels, C., Verbruggen, S., Joosten, K., Hanot, J., Guerra, G., Vlasselaers, D., Lin, J., Haines, R., Zolfaghari, P., Hewson, R., Offiah, C., Prowle, J., Buter, H., Veenstra, J. A., Koopmans, M., Boerma, E. C., Taha, A., Shafie, A., Hallaj, S., Gharaibeh, D., Hon, H., Bizrane, M., El Khattate, A. A., Madani, N., Abouqal, R., Belayachi, J., Kongpolprom, N., Sanguanwong, N., Sanaie, S., Mahmoodpoor, A., Hamishehkar, H., Biderman, P., Avitzur, Y., Solomon, S., Iakobishvili, Z., Carmi, U., Gorfil, D, Singer, P., Paisley, C., Patrick-Heselton, J., Mogk, M., Humphreys, J., Welters, I., Casarotta, E., Bolognini, S., Moskowitz, A., Patel, P., Grossestreuer, A., Malinverni, S., Goedeme, D., Mols, P., Langlois, P. L., Szwec, C., D’Aragon, F., Heyland, D. K., Manzanares, W., Langlois, P., Aramendi, I., Heyland, D., Stankovic, N., Nadler, J., Sanchez, L., Wolfe, R., Donnino, M., Cocchi, M., Atalan, H. K., Gucyetmez, B., Kavlak, M. E., Aslan, S., Kargi, A., Yazici, S., Donmez, R., Polat, K. Y., Piechota, M, Piechota, A., Misztal, M., Bernas, S., Pietraszek-Grzywaczewska, I., Saleh, M., Hamdy, A., Elhallag, M., Atar, F., Kundakci, A., Gedik, E., Sahinturk, H., Zeyneloglu, P., Pirat, A., Popescu, M., Tomescu, D., Van Gassel, R., Baggerman, M., Schaap, F., Bol, M., Nicolaes, G., Beurskens, D., Damink, S. Olde, Van de Poll, M., Horibe, M., Sasaki, M., Sanui, M., Iwasaki, E., Sawano, H., Goto, T., Ikeura, T., Hamada, T., Oda, T., Mayumi, T., Kanai, T., Kjøsen, G., Horneland, R., Rydenfelt, K., Aandahl, E., Tønnessen, T., Haugaa, H., Lockett, P., Evans, L., Somerset, L., Ker-Reid, F., Laver, S., Courtney, E., Dalton, S., Georgiou, A., Robinson, K., Haas, B., Bartlett, K., Bigwood, M., Hanley, R., Morgan, P., Marouli, D., Chatzimichali, A., Kolyvaki, S., Panteli, A., Diamantaki, E., Pediaditis, E., Sirogianni, P., Ginos, P., Kondili, E., Georgopoulos, D., Askitopoulou, H., Zampieri, F. G., Liborio, A. B., Besen, B. A., Cavalcanti, A. B., Dominedò, C., Dell’Anna, A. M., Monayer, A., Grieco, D. L., Barelli, R., Cutuli, S. L., Maddalena, A. Ionescu, Picconi, E., Sonnino, C., Sandroni, C., Antonelli, M., Tuzuner, F., Cakar, N., Jacob, M., Sahu, S, Singh, Y. P., Mehta, Y., Yang, K. Y., Kuo, S., Rai, V., Cheng, T., Ertmer, C., Czempik, P, Hutchings, S., Watts, S., Wilson, C., Burton, C., Kirkman, E., Drennan, D., O’Prey, A., MacKay, A., Forrest, R., Oglinda, A., Ciobanu, G., Casian, M., Oglinda, C., Lun, C. T., Yuen, H. J., Ng, G., Leung, A., So, S. O., Chan, H. S., Lai, K. Y., Sanguanwit, P., Charoensuk, W., Phakdeekitcharoen, B., Batres-Baires, G., Kammerzell, I., Lahmer, T., Mayr, U., Schmid, R., Huber, W., Bomberg, H., Klingele, M., Groesdonk, H., Piechota, M., Mirkiewicz, K., Pérez, A. González, Silva, J., Ramos, A., Acharta, F., Perezlindo, M., Lovesio, L., Antonelli, P. Gauna, Dogliotti, A., Lovesio, C., Baron, J., Schiefer, J., Baron, D. M., Faybik, P., Chan, T. M., Ginos, P, Vicka, V., Gineityte, D., Ringaitiene, D., Sipylaite, J., Pekarskiene, J., Beurskens, D. M., Van Smaalen, T. C., Hoogland, P., Winkens, B., Christiaans, M. H., Reutelingsperger, C. P., Van Heurn, E., Nicolaes, G. A., Schmitt, F. S., Salgado, E. S., Friebe, J. F., Fleming, T. F., Zemva, J. Z., Schmoch, T. S., Uhle, F. U., Kihm, L. K., Morath, C. M., Nusshag, C. N., Zeier, M. Z., Bruckner, T. B., Mehrabi, A. M., Nawroth, P. N., Weigand, M. W., Hofer, S. H., Brenner, T. B., Fotopoulou, G., Poularas, I., Kokkoris, S., Brountzos, E., Elghonemi, M., Nilsson, K. F., Sandin, J., Gustafsson, L., Frithiof, R., Skorniakov, I., Varaksin, A., Vikulova, D., Shaikh, O., Whiteley, C., Ostermann, M., Di Lascio, G., Anicetti, L., Bonizzoli, M., Fulceri, G., Migliaccio, M. L., Sentina, P., Cozzolino, M., Peris, A., Khadzhynov, D., Halleck, F., Staeck, O., Lehner, L., Budde, K., Slowinski, T., Kindgen-Milles, D., Huysmans, N., Laenen, M. Vander, Helmschrodt, A., Boer, W., Debain, A., Jonckheer, J., Moeyersons, W., Van zwam, K., Puis, L., Staessens, K., Honoré, P. M., Spapen, H. D., De Waele, E., de Garibay, A. Perez Ruiz, Ende-Schneider, B., Schreiber, C., Kreymann, B., Bini, A., Votino, E., Steinberg, I., Vetrugno, L., Trunfio, D., Sidoti, A., Conroy, M., Marsh, B., and O’Flynn, J

Subjects
Critical Care and Intensive Care Medicine, Meeting Abstracts
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36. "HAIR" - a useful mnemonic.

Author

Linton D, Sviri S, Bayya A, van Heerden P, Linton, D M, Sviri, S, Bayya, A E, and van Heerden, P V

Published
2012

37. Leptin levels and clinical outcomes in patients with systemic inflammatory response syndrome.

Author

Sviri, S., Neuman, T., Berry, E. M., Bayya, A., Linton, D. M., van Heerden, P. V., Stav, I., Theodur, I., and Avraham, Y.

Subjects
*LEPTIN, *SYSTEMIC inflammatory response syndrome, *ENZYME-linked immunosorbent assay, *INTERLEUKIN-6, *TUMOR necrosis factors
Abstract

The article discusses a study which examined leptin levels and clinical outcomes in patients with systemic inflammatory response syndrome. The study involved 53 patients with systemic inflammatory response syndrome over a ten-month period. Enzyme-linked immunosorbent assay (ELISA) was used to measure leptin, interleukin-6 and tumor necrosis factor alpha levels.

Published
2016

39. Health-related quality of life in older patients surviving ICU treatment for COVID-19: results from an international observational study of patients older than 70 years

Author

Soliman, Ivo, Leaver, Susannah, Flaatten, Hans, Fjølner, Jesper, Wernly, Bernhard, Bruno, Raphael, Artigas, Antonio, Bollen Pinto, Bernardo, Schefold, Joerg, Beil, Michael, Sviri, Sigal, van Heerden, Peter Vernon, Szczeklik, Wojciech, Elhadi, Muhammed, Joannidis, Michael, Oeyen, Sandra, Zafeiridis, Tilemachos, Wollborn, Jakob, Banzo, Maria Jose Arche, Fuest, Kristina, Marsh, Brian, Andersen, Finn, Moreno, Rui, Boumendil, Ariane, Guidet, Bertrand, Jung, Christian, de Lange, Dylan, Eller, Philipp, Mesotten, Dieter, Reper, Pascal, Swinnen, Walter, Brix, Helene, Brushoej, Jens, Villefrance, Maja, Nedergaard, Helene Korvenius, Bjerregaard, Anders Thais, Balleby, Ida Riise, Andersen, Kasper, Hansen, Maria Aagaard, Uhrenholt, Stine, Bundgaard, Helle, Mohamed, Aliae Ar Hussein, Salah, Rehab, Ali, Yasmin Khairy Nasreldin Mohamed, Wassim, Kyrillos, Elgazzar, Yumna, Tharwat, Samar, Azzam, Ahmed, Habib, Ayman Abdelmawgoad, Abosheaishaa, Hazem Maarouf, Azab, Mohammed, Galbois, Arnaud, Charron, Cyril, Guerot, Emmanuel, Besch, Guillaume, Rigaud, Jean-Philippe, Maizel, Julien, Djibré, Michel, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Alexandru, Nica, Marin, Nathalie, Vaissiere, Marie, Plantefeve, Gaëtan, Vanderlinden, Thierry, Jurcisin, Igor, Megarbane, Bruno, Caillard, Anais, Valent, Arnaud, Garnier, Marc, Besset, Sebastien, Oziel, Johanna, Raphaelen, Jean-Herlé, Dauger, Stéphane, Dumas, Guillaume, Goncalves, Bruno, Piton, Gaël, Bruno, Raphael Romano, Kelm, Malte, Wolff, Georg, Barth, Eberhard, Goebel, Ulrich, Kunstein, Anselm, Schuster, Michael, Welte, Martin, Lutz, Matthias, Meybohm, Patrick, Steiner, Stephan, Poerner, Tudor, Haake, Hendrik, Schaller, Stefan, Kindgen-Milles, Detlef, Meyer, Christian, Kurt, Muhammed, Kuhn, Karl Friedrich, Randerath, Winfried, Dindane, Zouhir, Kabitz, Hans-Joachim, Voigt, Ingo, Shala, Gonxhe, Faltlhauser, Andreas, Rovina, Nikoletta, Aidoni, Zoi, Chrisanthopoulou, Evangelia, Papadogoulas, Antonios, Gurjar, Mohan, Mahmoodpoor, Ata, Ahmed, Abdullah Khudhur, Elsaka, Ahmed, Comellini, Vittoria, Rabha, Ahmed, Ahmed, Hazem, Namendys-Silva, Silvio, Ghannam, Abdelilah, Groenendijk, Martijn, Zegers, Marieke, Cornet, Alex, Evers, Mirjam, Haas, Lenneke, Dormans, Tom, Dieperink, Willem, Romundstad, Luis, Sjøbø, Britt, Strietzel, Hans Frank, Olasveengen, Theresa, Hahn, Michael, Czuczwar, Miroslaw, Gawda, Ryszard, Klimkiewicz, Jakub, de Lurdessantos, Maria Campos, Gordinho, André, Santos, Henrique, Assis, Rui, Oliveira, Ana Isabel Pinho, Badawy, Mohamed Raafat, Perez-Torres, David, Gomà, Gemma, Villamayor, Mercedes Ibarz, Mira, Angela Prado, Cubero, Patricia Jimeno, Rivera, Susana Arias, Tomasa, Teresa, Iglesias, David, Vázquez, Eric Mayor, Aldecoa, Cesar, Ferreira, Aida Fernández, Zalba-Etayo, Begoña, Canas-Perez, Isabel, Tamayo-Lomas, Luis, Diaz-Rodriguez, Cristina, Sancho, Susana, Priego, Jesús, Abualqumboz, Enas, Hilles, Momin Majed Yousuf, Saleh, Mahmoud, Ben-Hamouda, Nawfel, Roberti, Andrea, Dullenkopf, Alexander, Fleury, Yvan, Pinto, Bernardo Bollen, Al-Sadawi, Mohammed, Serck, Nicolas, Dewaele, Elisabeth, Kumar, Pritpal, Bundesen, Camilla, Innes, Richard, Gooch, James, Cagova, Lenka, Potter, Elizabeth, Reay, Michael, Davey, Miriam, Humphreys, Sally, Berlemont, Caroline Hauw, Chousterman, Benjamin Glenn, Dépret, François, Ferre, Alexis, Vettoretti, Lucie, Thevenin, Didier, Milovanovic, Milena, Simon, Philipp, Lorenz, Marco, Stoll, Sandra Emily, Dubler, Simon, Mulita, Francesk, Kondili, Eumorifa, Andrianopoulos, Ioannis, Meynaar, Iwan, Cornet, Alexander Daniel, Sjøbøe, Britt, Kluzik, Anna, Zatorski, Paweł, Drygalski, Tomasz, Solek-Pastuszka, Joanna, Onichimowski, Dariusz, Stefaniak, Jan, Stefanska-Wronka, Karina, Zabul, Ewa, Cardoso, Filipe Sousa, Banzo, Maria José Arche, Tomasa-Irriguible, Teresa Maria, Mira, Ángela Prado, Arias-Rivera, Susana, Frutos-Vivar, Fernando, Lopez-Cuenca, Sonia, de Gopegui, Pablo Ruiz, Abidi, Nour, Chau, Ivan, Pugh, Richard, Smuts, Sara, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Bouchard, Mélanie, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), COVIP-study group, Eller, P., Joannidis, M., Mesotten, D., Reper, P., Oeyen, S., Swinnen, W., Brix, H., Brushoej, J., Villefrance, M., Nedergaard, H.K., Bjerregaard, A.T., Balleby, I.R., Andersen, K., Hansen, M.A., Uhrenholt, S., Bundgaard, H., Fjølner, J., Mohamed, AAH, Salah, R., Ali, YKNM, Wassim, K., Elgazzar, Y.A., Tharwat, S., Azzam, A.Y., Habib, A.A., Abosheaishaa, H.M., Azab, M.A., Leaver, S., Galbois, A., Guidet, B., Charron, C., Guerot, E., Besch, G., Rigaud, J.P., Maizel, J., Djibré, M., Burtin, P., Garcon, P., Nseir, S., Valette, X., Alexandru, N., Marin, N., Vaissiere, M., Plantefeve, G., Vanderlinden, T., Jurcisin, I., Megarbane, B., Caillard, A., Valent, A., Garnier, M., Besset, S., Oziel, J., Raphaelen, J.H., Dauger, S., Dumas, G., Goncalves, B., Piton, G., Jung, C., Bruno, R.R., Kelm, M., Wolff, G., Barth, E., Goebel, U., Kunstein, A., Schuster, M., Welte, M., Lutz, M., Meybohm, P., Steiner, S., Poerner, T., Haake, H., Schaller, S., Kindgen-Milles, D., Meyer, C., Kurt, M., Kuhn, K.F., Randerath, W., Wollborn, J., Dindane, Z., Kabitz, H.J., Voigt, I., Shala, G., Faltlhauser, A., Rovina, N., Aidoni, Z., Chrisanthopoulou, E., Papadogoulas, A., Gurjar, M., Mahmoodpoor, A., Ahmed, A.K., Marsh, B., Elsaka, A., Sviri, S., Comellini, V., Rabha, A., Ahmed, H., Namendys-Silva, S.A., Ghannam, A., Groenendijk, M., Zegers, M., de Lange, D., Cornet, A., Evers, M., Haas, L., Dormans, T., Dieperink, W., Romundstad, L., Sjøbø, B., Andersen, F.H., Strietzel, H.F., Olasveengen, T., Hahn, M., Czuczwar, M., Gawda, R., Klimkiewicz, J., de LurdesSantos, M.C., Gordinho, A., Santos, H., Assis, R., Oliveira, AIP, Badawy, M.R., Perez-Torres, D., Gomà, G., Villamayor, M.I., Mira, A.P., Cubero, P.J., Rivera, S.A., Tomasa, T., Iglesias, D., Vázquez, E.M., Aldecoa, C., Ferreira, A.F., Zalba-Etayo, B., Canas-Perez, I., Tamayo-Lomas, L., Diaz-Rodriguez, C., Sancho, S., Priego, J., Abualqumboz, EMY, Hilles, MMY, Saleh, M., Ben-HAmouda, N., Roberti, A., Dullenkopf, A., Fleury, Y., Pinto, B.B., Schefold, J.C., Al-Sadawi, M., Serck, N., Dewaele, E., Kumar, P., Bundesen, C., Innes, R., Gooch, J., Cagova, L., Potter, E., Reay, M., Davey, M., Humphreys, S., Berlemont, C.H., Chousterman, B.G., Dépret, F., Ferre, A., Vettoretti, L., Thevenin, D., Milovanovic, M., Simon, P., Lorenz, M., Stoll, S.E., Dubler, S., Fuest, K., Mulita, F., Kondili, E., Andrianopoulos, I., Meynaar, I., Cornet, A.D., Sjøbøe, B., Kluzik, A., Zatorski, P., Drygalski, T., Szczeklik, W., Solek-Pastuszka, J., Onichimowski, D., Stefaniak, J., Stefanska-Wronka, K., Zabul, E., Cardoso, F.S., Banzo, MJA, Tomasa-Irriguible, T.M., Mira, Á.P., Arias-Rivera, S., Frutos-Vivar, F., Lopez-Cuenca, S., de Gopegui, P.R., Abidi, N., Chau, I., Pugh, R., and Smuts, S.

Subjects
Aging, Activities of Daily Living, Aged, COVID-19, Humans, Intensive Care Units, Prospective Studies, Quality of Life, SARS-CoV-2, Intensive Care Unit (ICU), Older people, Survival, frailty, [SDV]Life Sciences [q-bio], SOCIETY, 610 Medicine & health, General Medicine, INTENSIVE-CARE, humanities, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], [SDV] Life Sciences [q-bio], Medicine and Health Sciences, Geriatrics and Gerontology
Abstract

Background health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. Objective to quantify HRQoL in order to identify areas of interventions. Design prospective observation study. Setting admissions to European ICUs between March 2020 and February 2021. Subjects patients aged 70 years or older admitted with COVID-19 disease. Methods collected determinants include SOFA-score, Clinical Frailty Scale (CFS), number and timing of ICU procedures and limitation of care, Katz Activities of Daily Living (ADL) dependence score. HRQoL was assessed at 3 months after ICU admission with the Euro-QoL-5D-5L questionnaire. An outcome of ≥4 on any of Euro-QoL-5D-5L domains was considered unfavourable. Results in total 3,140 patients from 14 European countries were included in this study. Three months after inclusion, 1,224 patients (39.0%) were alive and the EQ-5D-5L from was obtained. The CFS was associated with an increased odds ratio for an unfavourable HRQoL outcome after 3 months; OR 1.15 (95% confidence interval (CI): 0.71–1.87) for CFS 2 to OR 4.33 (95% CI: 1.57–11.9) for CFS ≧ 7. The Katz ADL was not statistically significantly associated with HRQoL after 3 months. Conclusions in critically ill old intensive care patients suffering from COVID-19, the CFS is associated with the subjectively perceived quality of life. The CFS on admission can be used to inform patients and relatives on the risk of an unfavourable qualitative outcome if such patients survive.

Published
2022
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40. The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Author

Christian Jung, Hans Flaatten, Jesper Fjølner, Raphael Romano Bruno, Bernhard Wernly, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Georg Wolff, Malte Kelm, Michael Beil, Sviri Sigal, Peter Vernon van Heerden, Wojciech Szczeklik, Miroslaw Czuczwar, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Tilemachos Zafeiridis, Brian Marsh, Finn H. Andersen, Rui Moreno, Maurizio Cecconi, Susannah Leaver, Ariane Boumendil, Dylan W. De Lange, Bertrand Guidet, COVIP study group, Flaatten, H., Wernly, B., Artigas, A., Beil, M., Sviri, S., van Heerden, P.V., Szczeklik, W., Elhadi, M., Zafeiridis, T., Moreno, R., Cecconi, M., Boumendil, A., Abosheaishaa, H.M., Abualqumboz, EMY, Ahmed, A.K., Ahmed, H., Aidoni, Z., Aldecoa, C., Alexandru, N., Ali, YKNM, Al-Sadawi, M., Andersen, K., Andersen, F.H., Assis, R., Azab, M.A., Azzam, A.Y., Badawy, M.R., Balleby, I.R., Barth, E., Ben-HAmouda, N., Besch, G., Besset, S., Bjerregaard, A.T., Brix, H., Bruno, R.R., Brushoej, J., Bundgaard, H., Burtin, P., Caillard, A., Canas-Perez, I., Charron, C., Chrisanthopoulou, E., Comellini, V., Cornet, A., Cubero, P.J., Czuczwar, M., Dauger, S., Diaz-Rodriguez, C., Dieperink, W., Dindane, Z., Djibré, M., Dormans, T., Dullenkopf, A., Dumas, G., Elgazzar, Y.A., Eller, P., Elsaka, A., Evers, M., Faltlhauser, A., Ferreira, A.F., Fjølner, J., Fleury, Y., Galbois, A., Garcon, P., Garnier, M., Gawda, R., Ghannam, A., Goebel, U., Gomà, G., Goncalves, B., Gordinho, A., Groenendijk, M., Guerot, E., Guidet, B., Gurjar, M., Haake, H., Haas, L., Habib, A.A., Hahn, M., Hansen, M.A., Hilles, MMY, Hussein, AARM, Iglesias, D., Joannidis, M., Jung, C., Jurcisin, I., Kabitz, H.J., Kelm, M., Kindgen-Milles, D., Klimkiewicz, J., Kuhn, K.F., Kunstein, A., Kurt, M., De Lange, D.W., Leaver, S., Lutz, M., Mahmoodpoor, A., Maizel, J., Marin, N., Marsh, B., Megarbane, B., Mesotten, D., Meybohm, P., Meyer, C., Mira, A.P., Namendys-Silva, S.A., Nedergaard, H.K., Nseir, S., Oeyen, S., Olasveengen, T., Oliveira, AIP, Oziel, J., Papadogoulas, A., Perez-Torres, D., Bollen Pinto, B., Piton, G., Plantefeve, G., Poerner, T., Priego, J., Rabha, A., Randerath, W., Raphaelen, J.H., Reper, P., Rigaud, J.P., Rivera, S.A., Roberti, A., Romundstad, L., Rovina, N., Salah, R., Saleh, M., Sancho, S., de Lurdes Campos Santos, M., Santos, H., Schaller, S., Schefold, J.C., Schuster, M., Shala, G., Sjøbø, B., Steiner, S., Strietzel, H.F., Swinnen, W., Tamayo-Lomas, L., Tharwat, S., Tomasa, T., Uhrenholt, S., Vaissiere, M., Valent, A., Valette, X., Vanderlinden, T., Vázquez, E.M., Villamayor, M.I., Villefrance, M., Voigt, I., Wassim, K., Welte, M., Wolff, G., Wollborn, J., Zalba-Etayo, B., Zegers, M., and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

Subjects
Male, Aged, 80 and over, Pandemia, COVID-19/mortality, Frailty, Critical Care, Frail Elderly/statistics & numerical data, COVID-19, 610 Medicine & health, Prognosis, Survival Analysis, Elderly, Frailty/mortality, Humans, Female, Prospective Studies, Outcome, Aged, COVID-19/therapy
Abstract

BackgroundThe COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.MethodsA prospective multi-centre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the Clinical Frailty Scale (CFS). Additionally, comorbidities, management strategies and treatment limitations were recorded.ResultsThe study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years and 21% of the patients were frail. The overall survival at 30 days was 59% (95%CI 56-62), with 66% (63-69) in fit, 53% (47-61) in vulnerable and 41% (35-47) in frail patients (pConclusionFrailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.

Published
2021
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41. Sarilumab in patients admitted to hospital with severe or critical COVID-19: a randomised, double-blind, placebo-controlled, phase 3 trial

Author

François-Xavier Lescure, Hitoshi Honda, Robert A Fowler, Jennifer Sloane Lazar, Genming Shi, Peter Wung, Naimish Patel, Owen Hagino, Ignacio J. Bazzalo, Marcelo M. Casas, Sebastián A. Nuñez, Yael Pere, Carlos M. Ibarrola, Marco A. Solis Aramayo, Maria C. Cuesta, Andrea E. Duarte, Pablo M. Gutierrez Fernandez, Maria A. Iannantuono, Erica A. Miyazaki, Javier P. Silvio, Dario G. Scublinsky, Alessandra Bales, Daniela Catarino, Elie Fiss, Sara Mohrbacher, Victor Sato, Antonio Baylao, Adilson Cavalcante, Francini Correa, Celso A. de Andrade, Juvencio Furtado, Nelson Ribeiro Filho, Valéria Telles, Leopoldo T. Trevelin, Ricardo Vipich, Rodrigo Boldo, Paula Borges, Suzana Lobo, Graziela Luckemeyer, Luana Machado, Maysa B. Alves, Ana C. Iglessias, Marianna M. Lago, Daniel W. Santos, Hugo Chapdelaine, Emilia L. Falcone, Rahima Jamal, Me-Linh Luong, Madeleine Durand, Stephane Doucet, François-Martin Carrier, Bryan A. Coburn, Lorenzo Del Sorbo, Sharon L. Walmsley, Sara Belga, Luke Y. Chen, Allison D. Mah, Theodore Steiner, Alissa J. Wright, J. Hajek, Neill Adhikari, Robert A. Fowler, Nick Daneman, Kosar A. Khwaja, Jason Shahin, Carolina Gonzalez, Rafael Silva, Marcelo Lindh, Gabriel Maluenda, Patricia Fernandez, Maite Oyonarte, Martin Lasso, Alexandre Boyer, Didier Bronnimann, Hoang-Nam Bui, Charles Cazanave, Helene Chaussade, Arnaud Desclaux, Mailys Ducours, Alexandre Duvignaud, Denis Malvy, Lisa Martin, Didier Neau, Duc Nguyen, Thierry Pistone, Gaetane Soubrane-Wirth, Julie Leitao, Clotilde Allavena, Charlotte Biron, Sabelline Bouchez, Benjamin Gaborit, Antoine Gregoire, Paul Le Turnier, Anne-Sophie Lecompte, Raphael Lecomte, Maeva Lefebvre, Francois Raffi, David Boutoille, Pascale H. Morineau, Romain Guéry, Emmanuel Chatelus, Nathalie Dumoussaud, Renaud Felten, Florina Luca, Bernard Goichot, Francis Schneider, Marie-Caroline Taquet, Matthieu Groh, Mathilde Roumier, Mathilde Neuville, Antoine Bachelard, Valentina Isernia, F-Xavier Lescure, Bao-Chau Phung, Anne Rachline, Aurelie Sautereau, Dorothee Vallois, Yves Bleher, Delphine Boucher, Clémentine Coudon, Jean Esnault, Thomas Guimard, Sophie Leautez-Nainville, Dominique Merrien, Marine Morrier, Pauline Motte-Vincent, Romain Gabeff, Hélène Leclerc, Céline Cozic, Romain Decours, Ronan Février, Gwenhael Colin, Sophie Abgrall, Dorothee Vignes, Raluca Sterpu, Mira Kuellmar, Melanie Meersch-Dini, Raphael Weiss, Alexander Zarbock, Christiane Antony, Marc Berger, Thorsten Brenner, Christian Taube, Frank Herbstreit, Sebastian Dolff, Margarethe Konik, Karsten Schmidt, Markus Zettler, Oliver Witzke, Boris Boell, Jorge Garcia Borrega, Philipp Koehler, Thomas Zander, Fabian Dusse, Othman Al-Sawaf, Philipp Köhler, Dennis Eichenauer, Matthias Kochanek, Alexander Shimabukuro-Vornhagen, Sibylle Mellinghoff, Annika Claßen, Jan-Michel Heger, Charlotte Meyer-Schwickerath, Paul Liedgens, Katrin Heindel, Ana Belkin, Asaf Biber, Mayan Gilboa, Itzchak Levy, Vladislav Litachevsky, Galia Rahav, Anat Finesod Wiedner, Tal Zilberman-Daniels, Yonatan Oster, Jacob Strahilevitz, Sigal Sviri, Elena M. Baldissera, Corrado Campochiaro, Giulio Cavalli, Lorenzo Dagna, Giacomo De Luca, Emanuel Della Torre, Alessandro Tomelleri, Davide Bernasconi De Luca, Amedeo F. Capetti, Massimo Coen, Maria V. Cossu, Massimo Galli, Andrea Giacomelli, Guido A. Gubertini, Stefano Rusconi, Giulia J. Burastero, Margherita Digaetano, Giovanni Guaraldi, Marianna Meschiari, Cristina Mussini, Cinzia Puzzolante, Sara Volpi, Marina Aiello, Alarico Ariani, Alfredo A. Chetta, Annalisa Frizzelli, Andrea Ticinesi, Domenico Tuttolomondo, Stefano Aliberti, Francesco B. Blasi, Marta F. Di Pasquale, Sofia Misuraca, Tommaso Pilocane, Edoardo Simonetta, Alessio M. Aghelmo, Claudio Angelini, Enrico Brunetta, Giorgio W. Canonica, Michele Ciccarelli, Sara Dal Farra, Maria De Santis, Sebastian Ferri, Marco Folci, Giacomo M. Guidelli, Enrico M. Heffler, Ferdinando Loiacono, Giacomo Malipiero, Giovanni Paoletti, Rosa Pedale, Francesca A. Puggioni, Francesca Racca, Aurora Zumbo, Morihiko Satou, Tatyana Lisun, Denis Protsenko, Nikolay Rubtsov, Irina Beloglazova, Daria Fomina, Mariana Lysenko, Sofia Serdotetskova, Vitali Firstov, Ivan Gordeev, Ilia Kokorin, Ksenia Komissarova, Nina Lapochkina, Elena Luchinkina, Valentin Malimon, Sevinch Mamedguseyinova, Ksenia Polubatonova, Natalia Suvorova, Jose Arribas, Alberto M. Borobia Perez, Fernando de la Calle Prieto, Juan Carlos Figueira, Rocio Motejano Sanchez, Marta Mora-Rillo, Concepcion Prados Sanchez, Javier Queiruga Parada, Francisco Fernandez Arnalich, Maria Guerro Barrientos, Alejandro Bendala Estrada, Aranzazu Caballero Marcos, Maria E. Garcia Leoni, Rita García-Martínez, Ana María Collado, Patricia Munoz Garcia, Ana Torres do Rego, María V. Villalba García, Almudena Burrillo, Maricela Valerio Minero, Paloma Gijon Vidaurreta, Sonsoles Infante Herrero, Elena Velilla, Marina Machado, Maria Olmedo, Blanca Pinilla, Benito Almirante Gragera, Maria de la Esperanza Cañas Ruano, Sofia Contreras Medina, Alejandro Cortés Herrera, Vicenç Falcó Ferrer, Ricard Ferrer Roca, Xavier Nuvials Casals, Esteve Ribera Pascuet, Paula Suanzes Diez, Pedro Rebollo Castro, Felipe Garcia Alcaide, Alejandro Soriano, Aina Oliver Caldes, Ana González Cordón, Celia Cardozo, Lorena De la Mora Cañizo, Romina Pena López, Sandra Chamorro, Clara Crespillo-Andujar, Rosa Escudero Sanchez, Jesús Fortún-Abete, Begoña Monge-Maillo, Ana Moreno Zamora, Francesca Norman, Matilde Sanchez Conde, Sergio Serrano Villar, Pilar Vizcarra, Lescure, F. -X., Honda, H., Fowler, R. A., Lazar, J. S., Shi, G., Wung, P., Patel, N., Hagino, O., Bazzalo, I. J., Casas, M. M., Nunez, S. A., Pere, Y., Ibarrola, C. M., Solis Aramayo, M. A., Cuesta, M. C., Duarte, A. E., Gutierrez Fernandez, P. M., Iannantuono, M. A., Miyazaki, E. A., Silvio, J. P., Scublinsky, D. G., Bales, A., Catarino, D., Fiss, E., Mohrbacher, S., Sato, V., Baylao, A., Cavalcante, A., Correa, F., de Andrade, C. A., Furtado, J., Ribeiro Filho, N., Telles, V., Trevelin, L. T., Vipich, R., Boldo, R., Borges, P., Lobo, S., Luckemeyer, G., Machado, L., Alves, M. B., Iglessias, A. C., Lago, M. M., Santos, D. W., Chapdelaine, H., Falcone, E. L., Jamal, R., Luong, M. -L., Durand, M., Doucet, S., Carrier, F. -M., Coburn, B. A., Del Sorbo, L., Walmsley, S. L., Belga, S., Chen, L. Y., Mah, A. D., Steiner, T., Wright, A. J., Hajek, J., Adhikari, N., Daneman, N., Khwaja, K. A., Shahin, J., Gonzalez, C., Silva, R., Lindh, M., Maluenda, G., Fernandez, P., Oyonarte, M., Lasso, M., Boyer, A., Bronnimann, D., Bui, H. -N., Cazanave, C., Chaussade, H., Desclaux, A., Ducours, M., Duvignaud, A., Malvy, D., Martin, L., Neau, D., Nguyen, D., Pistone, T., Soubrane-Wirth, G., Leitao, J., Allavena, C., Biron, C., Bouchez, S., Gaborit, B., Gregoire, A., Le Turnier, P., Lecompte, A. -S., Lecomte, R., Lefebvre, M., Raffi, F., Boutoille, D., Morineau, P. H., Guery, R., Chatelus, E., Dumoussaud, N., Felten, R., Luca, F., Goichot, B., Schneider, F., Taquet, M. -C., Groh, M., Roumier, M., Neuville, M., Bachelard, A., Isernia, V., Phung, B. -C., Rachline, A., Sautereau, A., Vallois, D., Bleher, Y., Boucher, D., Coudon, C., Esnault, J., Guimard, T., Leautez-Nainville, S., Merrien, D., Morrier, M., Motte-Vincent, P., Gabeff, R., Leclerc, H., Cozic, C., Decours, R., Fevrier, R., Colin, G., Abgrall, S., Vignes, D., Sterpu, R., Kuellmar, M., Meersch-Dini, M., Weiss, R., Zarbock, A., Antony, C., Berger, M., Brenner, T., Taube, C., Herbstreit, F., Dolff, S., Konik, M., Schmidt, K., Zettler, M., Witzke, O., Boell, B., Garcia Borrega, J., Koehler, P., Zander, T., Dusse, F., Al-Sawaf, O., Kohler, P., Eichenauer, D., Kochanek, M., Shimabukuro-Vornhagen, A., Mellinghoff, S., Classen, A., Heger, J. -M., Meyer-Schwickerath, C., Liedgens, P., Heindel, K., Belkin, A., Biber, A., Gilboa, M., Levy, I., Litachevsky, V., Rahav, G., Finesod Wiedner, A., Zilberman-Daniels, T., Oster, Y., Strahilevitz, J., Sviri, S., Baldissera, E. M., Campochiaro, C., Cavalli, G., Dagna, L., De Luca, Giacomo., Della Torre, E., Tomelleri, A., Bernasconi De Luca, D., Capetti, A. F., Coen, M., Cossu, M. V., Galli, M., Giacomelli, A., Gubertini, G. A., Rusconi, S., Burastero, G. J., Digaetano, M., Guaraldi, G., Meschiari, M., Mussini, C., Puzzolante, C., Volpi, S., Aiello, M., Ariani, A., Chetta, A. A., Frizzelli, A., Ticinesi, A., Tuttolomondo, D., Aliberti, S., Blasi, F. B., Di Pasquale, M. F., Misuraca, S., Pilocane, T., Simonetta, E., Aghelmo, A. M., Angelini, C., Brunetta, E., Canonica, G. W., Ciccarelli, M., Dal Farra, S., De Santis, M., Ferri, S., Folci, M., Guidelli, G. M., Heffler, E. M., Loiacono, F., Malipiero, G., Paoletti, G., Pedale, R., Puggioni, F. A., Racca, F., Zumbo, A., Satou, M., Lisun, T., Protsenko, D., Rubtsov, N., Beloglazova, I., Fomina, D., Lysenko, M., Serdotetskova, S., Firstov, V., Gordeev, I., Kokorin, I., Komissarova, K., Lapochkina, N., Luchinkina, E., Malimon, V., Mamedguseyinova, S., Polubatonova, K., Suvorova, N., Arribas, J., Borobia Perez, A. M., de la Calle Prieto, F., Figueira, J. C., Motejano Sanchez, R., Mora-Rillo, M., Prados Sanchez, C., Queiruga Parada, J., Fernandez Arnalich, F., Guerro Barrientos, M., Bendala Estrada, A., Caballero Marcos, A., Garcia Leoni, M. E., Garcia-Martinez, R., Collado, A. M., Munoz Garcia, P., Torres do Rego, A., Villalba Garcia, M. V., Burrillo, A., Valerio Minero, M., Gijon Vidaurreta, P., Infante Herrero, S., Velilla, E., Machado, M., Olmedo, M., Pinilla, B., Almirante Gragera, B., Canas Ruano, M. D. L. E., Contreras Medina, S., Cortes Herrera, A., Falco Ferrer, V., Ferrer Roca, R., Nuvials Casals, X., Ribera Pascuet, E., Suanzes Diez, P., Rebollo Castro, P., Garcia Alcaide, F., Soriano, A., Oliver Caldes, A., Gonzalez Cordon, A., Cardozo, C., De la Mora Canizo, L., Pena Lopez, R., Chamorro, S., Crespillo-Andujar, C., Escudero Sanchez, R., Fortun-Abete, J., Monge-Maillo, B., Moreno Zamora, A., Norman, F., Sanchez Conde, M., Serrano Villar, S., and Vizcarra, P.

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Care, International Cooperation, Population, Antibodies, Monoclonal, Humanized, Placebo, Severity of Illness Index, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Intensive care, Severity of illness, medicine, Clinical endpoint, Humans, Immunologic Factors, 030212 general & internal medicine, Mortality, education, Respiratory Distress Syndrome, education.field_of_study, Dose-Response Relationship, Drug, SARS-CoV-2, business.industry, Hazard ratio, COVID-19, Articles, Middle Aged, Receptors, Interleukin-6, Sarilumab, Treatment Outcome, 030228 respiratory system, Female, Drug Monitoring, Cytokine Release Syndrome, business
Abstract

Summary Background Elevated proinflammatory cytokines are associated with greater COVID-19 severity. We aimed to assess safety and efficacy of sarilumab, an interleukin-6 receptor inhibitor, in patients with severe (requiring supplemental oxygen by nasal cannula or face mask) or critical (requiring greater supplemental oxygen, mechanical ventilation, or extracorporeal support) COVID-19. Methods We did a 60-day, randomised, double-blind, placebo-controlled, multinational phase 3 trial at 45 hospitals in Argentina, Brazil, Canada, Chile, France, Germany, Israel, Italy, Japan, Russia, and Spain. We included adults (≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and pneumonia, who required oxygen supplementation or intensive care. Patients were randomly assigned (2:2:1 with permuted blocks of five) to receive intravenous sarilumab 400 mg, sarilumab 200 mg, or placebo. Patients, care providers, outcome assessors, and investigators remained masked to assigned intervention throughout the course of the study. The primary endpoint was time to clinical improvement of two or more points (seven point scale ranging from 1 [death] to 7 [discharged from hospital]) in the modified intention-to-treat population. The key secondary endpoint was proportion of patients alive at day 29. Safety outcomes included adverse events and laboratory assessments. This study is registered with ClinicalTrials.gov, NCT04327388; EudraCT, 2020-001162-12; and WHO, U1111-1249-6021. Findings Between March 28 and July 3, 2020, of 431 patients who were screened, 420 patients were randomly assigned and 416 received placebo (n=84 [20%]), sarilumab 200 mg (n=159 [38%]), or sarilumab 400 mg (n=173 [42%]). At day 29, no significant differences were seen in median time to an improvement of two or more points between placebo (12·0 days [95% CI 9·0 to 15·0]) and sarilumab 200 mg (10·0 days [9·0 to 12·0]; hazard ratio [HR] 1·03 [95% CI 0·75 to 1·40]; log-rank p=0·96) or sarilumab 400 mg (10·0 days [9·0 to 13·0]; HR 1·14 [95% CI 0·84 to 1·54]; log-rank p=0·34), or in proportions of patients alive (77 [92%] of 84 patients in the placebo group; 143 [90%] of 159 patients in the sarilumab 200 mg group; difference −1·7 [−9·3 to 5·8]; p=0·63 vs placebo; and 159 [92%] of 173 patients in the sarilumab 400 mg group; difference 0·2 [−6·9 to 7·4]; p=0·85 vs placebo). At day 29, there were numerical, non-significant survival differences between sarilumab 400 mg (88%) and placebo (79%; difference +8·9% [95% CI −7·7 to 25·5]; p=0·25) for patients who had critical disease. No unexpected safety signals were seen. The rates of treatment-emergent adverse events were 65% (55 of 84) in the placebo group, 65% (103 of 159) in the sarilumab 200 mg group, and 70% (121 of 173) in the sarilumab 400 mg group, and of those leading to death 11% (nine of 84) were in the placebo group, 11% (17 of 159) were in the sarilumab 200 mg group, and 10% (18 of 173) were in the sarilumab 400 mg group. Interpretation This trial did not show efficacy of sarilumab in patients admitted to hospital with COVID-19 and receiving supplemental oxygen. Adequately powered trials of targeted immunomodulatory therapies assessing survival as a primary endpoint are suggested in patients with critical COVID-19. Funding Sanofi and Regeneron Pharmaceuticals.

Published
2021

42. Lactate is associated with mortality in very old intensive care patients suffering from COVID-19 : results from an international observational study of 2860 patients

Author

Raphael Romano Bruno, Bernhard Wernly, Hans Flaatten, Jesper Fjølner, Antonio Artigas, Bernardo Bollen Pinto, Joerg C. Schefold, Stephan Binnebössel, Philipp Heinrich Baldia, Malte Kelm, Michael Beil, Sivri Sigal, Peter Vernon van Heerden, Wojciech Szczeklik, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Tilemachos Zafeiridis, Jakob Wollborn, Maria José Arche Banzo, Kristina Fuest, Brian Marsh, Finn H. Andersen, Rui Moreno, Susannah Leaver, Ariane Boumendil, Dylan W. De Lange, Bertrand Guidet, Christian Jung, the COVIP Study Group, COVIP Study Group, Eller, P., Joannidis, M., Mesotten, D., Reper, P., Oeyen, S., Swinnen, W., Serck, N., Dewaele, E., Chapeta, E., Brix, H., Brushoej, J., Kumar, P., Nedergaard, H.K., Johnsen, T.K., Bundesen, C., Hansen, M.A., Uhrenholt, S., Bundgaard, H., Fjølner, J., Innes, R., Gooch, J., Cagova, L., Potter, E., Reay, M., Davey, M., Abusayed, M.A., Humphreys, S., Collins, A., Aujayeb, A., Leaver, S., Khaliq, W., Habib, A.A., Azab, M.A., Wassim, K., Elgazzar, Y.A., Salah, R., Abosheaishaa, H.M., Hussein Mohamed, AAR, Azzam, A.Y., Tharwat, S., Ali, YKNM, Elmandouh, O., Galal, I., Abu-Elfatth, A., Motawea, K., Elbahnasawy, M., Shehata, M., Tayeb, M., Osman, N., Abdel-Elsalam, W., Hussein, A.M., Aldhalia, A., Galbois, A., Guidet, B., Charron, C., Berlemont, C.H., Besch, G., Rigaud, J.P., Maizel, J., Djibré, M., Burtin, P., Garcon, P., Nseir, S., Valette, X., Alexandru, N., Marin, N., Vaissiere, M., Plantefeve, G., Mentec, H., Vanderlinden, T., Jurcisin, I., Megarbane, B., Chousterman, B.G., Dépret, F., Garnier, M., Besset, S., Oziel, J., Ferre, A., Dauger, S., Dumas, G., Goncalves, B., Vettoretti, L., Thevenin, D., Schaller, S., Kurt, M., Faltlhauser, A., Meyer, C., Milovanovic, M., Lutz, M., Shala, G., Haake, H., Randerath, W., Kunstein, A., Meybohm, P., Steiner, S., Barth, E., Poerner, T., Simon, P., Lorenz, M., Dindane, Z., Kuhn, K.F., Welte, M., Voigt, I., Kabitz, H.J., Wollborn, J., Goebel, U., Stoll, S.E., Kindgen-Milles, D., Dubler, S., Jung, C., Fuest, K., Schuster, M., Papadogoulas, A., Mulita, F., Rovina, N., Aidoni, Z., Chrisanthopoulou, E., Kondili, E., Andrianopoulos, I., Gurjar, M., Mahmoodpoor, A., Hussein, R., Al-Juaifari, M.A., Karantenachy, AKA, Sviri, S., Elsaka, A., Marsh, B., Comellini, V., Al-Ali, F., Almani, S., Khamees, A.A., Al-Shami, K., El Din, I.S., Abubaker, T., Ahmed, H., Rabha, A., Alhadi, A., Emhamed, M., Abdeewi, S., Abusalama, A., Huwaysh, M., Alghati, E.A., Ghannam, A., Namendys-Sylva, S.A., Groenendijk, M., Evers, M., Van Lelyveld-Haas, L., Meynaar, I., Cornet, A.D., Zegers, M., Dieperink, W., De Lange, D., Dormans, T., Hahn, M., Sjøbøe, B., Strietzel, H.F., Olasveengen, T., Romundstad, L., Andersen, F.H., Massoud, JGG, Khan, A.G., Al-Qasrawi, S., Amro, S., Kluzik, A., Zatorski, P., Drygalski, T., Szczeklik, W., Klimkiewicz, J., Solek-Pastuszka, J., Onichimowski, D., Czuczwar, M., Gawda, R., Stefaniak, J., Stefanska-Wronka, K., Zabul, E., Oliveira, AIP, Assis, R., De Lurdes Campos Santos, M., Santos, H., Cardoso, F.S., Gordinho, A., Grintescu, I.M., Tomescu, D., Badawy, M.R., José Arche Banzo, M., Zalba-Etayo, B., Cubero, P.J., Priego, J., Gomà, G., Tomasa-Irriguible, T.M., Sancho, S., Ferreira, A.F., Vázquez, E.M., Mira, Á.P., Ibarz, M., Iglesias, D., Arias-Rivera, S., Frutos-Vivar, F., Lopez-Cuenca, S., Aldecoa, C., Perez-Torres, D., Canas-Perez, I., Tamayo-Lomas, L., Diaz-Rodriguez, C., De Gopegui, P.R., Saleh, M., Hilles, MMY, Abualqumboz, EMY, Ben-Hamouda, N., Roberti, A., Fleury, Y., Abidi, N., Schefold, J.C., Chau, I., Dullenkopf, A., Chaaban, M.K., Shebani, M.M., Hmaideh, A., Shaher, A., Sahin, A.S., Saracoglu, K.T., Al-Sadawi, M., Pugh, R., Smuts, S., and Al-Saban, RAM

Subjects
SEPSIS, RC86-88.9, IMPACT, Research, SEPTIC SHOCK, LEVEL, Medicine and Health Sciences, Medical emergencies. Critical care. Intensive care. First aid, 610 Medicine & health, ELDERLY-PATIENTS, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Abstract

Purpose Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020. Methods This prospective international observation study (The COVIP study) recruited patients aged 70 years or older (ClinicalTrials.gov ID: NCT04321265) admitted to an intensive care unit (ICU) with COVID-19 disease from March 2020 to February 2021. In addition to serial lactate values (arterial blood gas analysis), we recorded several parameters, including SOFA score, ICU procedures, limitation of care, ICU- and 3-month mortality. A lactate concentration ≥ 2.0 mmol/L on the day of ICU admission (baseline) was defined as abnormal. The primary outcome was ICU-mortality. The secondary outcomes 30-day and 3-month mortality. Results In total, data from 2860 patients were analyzed. In most patients (68%), serum lactate was lower than 2 mmol/L. Elevated baseline serum lactate was associated with significantly higher ICU- and 3-month mortality (53% vs. 43%, and 71% vs. 57%, respectively, p

Published
2021
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44. Contemporary assessment of short- and functional 90-days outcome in old intensive care patients suffering from COVID-19.

Author

Bruno RR, Wernly B, Artigas A, Fuest K, Schaller SJ, Dannenberg L, Kindgen-Milles D, Kelm M, Beil M, Sviri S, Elhadi M, Joannidis M, Oeyen S, Kondili E, Moreno R, Leaver S, Guidet B, De Lange DW, Flaatten H, Szczeklik W, and Jung C

Abstract

Purpose: There are limited data about the outcome of old intensive care (ICU) patients suffering from Covid-19 in the post-vaccination era. This study distinguishes the pre- and post-acute illness living conditions of ICU survivors from non-survivors., Methods: This prospective international multicenter study included 642 old (≥ 70 years) ICU patients, including data ranging from pre-illness condition to functional 90-days follow-up. The primary endpoint was the difference of living conditions of ICU-survivors before ICU admission and 90-days after ICU discharge. Secondary outcomes were 90-days mortality, and quality of life., Results: A total of 642 patients were included. Significantly more ICU survivors lived at their own homes without support before ICU admission than non-survivors (p = 0.016), while more non-survivors resided in nursing homes (p = 0.016). ICU mortality was 39 %, 30-days and 90 days mortality were 47 %and 55 %. After 90 days, only 22 % maintained the same living conditions. Surviving patients viewed ICU admission positively after 90 days, while relatives were more uncertain. Quality of life indicated a self-reported average score of 60 (50-75)., Conclusion: Living conditions influence the outcome of critically ill old patients suffering from Covid-19. Only a minority returned to their initial habitat after ICU survival. Trial registration numberNCT04321265., Competing Interests: Declaration of competing interest SJS received grants and non-financial support from Reactive Robotics GmbH (Munich, Germany), ASP GmbH (Attendorn, Germany), STIMIT AG (Biel, Switzerland), ESICM (Geneva, Switzerland), grants, personal fees, and non-financial support from Fresenius Kabi Deutschland GmbH (Bad Homburg, Germany), grants from the Innovationsfond of The Federal Joint Committee (G-BA), personal fees from Springer Verlag GmbH (Vienna, Austria) for educational purposes and Advanz Pharma GmbH (Bielefeld, Germany), non-financial support from national and international societies (and their congress organisers) in the field of anesthesiology and intensive care medicine, outside the submitted work. Dr. Schaller holds stocks in small amounts from Alphabet Inc., Bayer AG, and Siemens AG; these holdings have not affected any decisions regarding his research or this study. All other authors declare that they have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Published
2024
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45. Brain health: A concern for anaesthesiologists and intensivists.

Author

Bonhomme V, Putensen C, Böttiger BW, Stevens MF, Marczin N, Arnal D, Brotfain E, Raz A, Defresne A, Bogossian E, Sviri S, Cardone P, Mair A, Robba C, Dilmen OK, Ly J, Crisan MI, De Graaff JC, Najafi N, Vutskits L, Absalom A, Abramovich I, Souberbielle Q, Momeni M, Campbell D, Evered L, Vacas S, Saxena S, Bruder N, Oksuz DA, Lobo FA, van Putten M, Sahinovic M, Hawryluk GWJ, Kustura A, Yürek F, Baron Shahaf D, Shahaf G, Radke F, and Khalifa C

Abstract

Damage to the brain can have disastrous and long-lasting consequences. The European Society of Anaesthesiology and Intensive Care (ESAIC) is aware of the importance of taking good care of the brain, both of patients and of anaesthesia and intensive care unit (ICU) caregivers, and has organised a complete learning track on brain health to bring this concern to the attention of practitioners. This learning track included an online Focus Meeting on Brain Health (November 25, 2023). We here provide readers with a digest of the information that was delivered during that meeting in an opinion paper driven by the authors' own reading of the literature. It is divided according to the meeting's sessions, including how to improve the health of an injured brain, how to keep a young or old brain healthy, how to keep a healthy adult brain unimpaired, how monitoring can impact brain health in the operating room and in the intensive care unit, and how to keep the anaesthesia and ICU caregivers' brain healthy. Each part is a brief and focused summary. The main delivered messages are that the management of injured brain patients involves an adequate choice of sedation, adequate brain monitoring, and focused attention to specific points depending on the underlying pathology; that several measures can be undertaken to protect the brain of the very young needing anaesthesia; that it is possible to detect older patients at risk of postoperative neurocognitive disorders, and that dedicated perioperative management by a multidisciplinary expert team may improve their outcomes; that apparently healthy adult brains may suffer during anaesthesia; that the electroencephalogram may track peri-operative brain dysfunction, and that female patients should be given special care in this respect; that multimodal brain monitoring helps to detect pathological processes and to maintain brain homeostasis; and that burnout in anaesthesiologists can be effectively fought using personal, organisational, managerial and legal approaches., Competing Interests: Conflicts of interest: VB has had or continue to have financial relationships with Medtronic, Edwards Medical, Orion Pharma, Grünenthal and Elsevier. He is Deputy Editor-in-Chief of the Acta Anaesthesiologica Belgica. BWB is treasurer of the European Resuscitation Council (ERC), Founder of the ERC Research NET, Chairman of the German Resuscitation Council (GRC), Member of the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR), Former Member of the Executive Committee of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), Founder of the ‘Deutsche Stiftung Wiederbelebung’, Federal Medical Advisor of the German Red Cross (DRK), Member of the Advisory Board of the ‘Deutsche Herzstiftung’, Co-Editor of ‘Resuscitation’, Editor of the Journal ‘Notfall + Rettungsmedizin’, Co-Editor of the Brazilian Journal of Anesthesiology. He received fees for lectures from the following companies: Forum für medizinische Fortbildung (FomF), ZOLL Medical Deutschland GmbH, C.R. Bard GmbH and Becton Dickinson GmbH. CR received fees as speaker from Edwards and BT. JCDG is an Editor for European Journal of Anaesthesiology. FAL is advisor for Masimo, Editor-in-Chief of the Journal of Clinical Monitoring and Computing, and EuroSIVA Chairman. AR has been a consultant for Medtronic and Neuroindex and has given a webinar for MSD., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.)

Published
2024
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47. Prognosticating the outcome of intensive care in older patients-a narrative review.

Author

Beil M, Moreno R, Fronczek J, Kogan Y, Moreno RPJ, Flaatten H, Guidet B, de Lange D, Leaver S, Nachshon A, van Heerden PV, Joskowicz L, Sviri S, Jung C, and Szczeklik W

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., (© 2024. The Author(s).)

Published
2024
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48. The trajectory of very old critically ill patients.

Author

Guidet B, Vallet H, Flaatten H, Joynt G, Bagshaw SM, Leaver SK, Beil M, Du B, Forte DN, Angus DC, Sviri S, de Lange D, Herridge MS, and Jung C

Subjects
Humans, Critical Care, Health Personnel, Hospitalization, Critical Illness therapy, Quality of Life
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., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2024
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49. Frailty's influence on 30-day mortality in old critically ill ICU patients: a bayesian analysis evaluating the clinical frailty scale.

Author

Wernly B, Bruno RR, Beil M, Flaatten H, Kelm M, Sigal S, Szczeklik W, Elhadi M, Joannidis M, Koköfer A, Oeyen S, Marsh B, Moreno R, Wernly S, Leaver S, De Lange DW, Guidet B, and Jung C

Abstract

Introduction: Frailty is widely acknowledged as influencing health outcomes among critically ill old patients. Yet, the traditional understanding of its impact has predominantly been through frequentist statistics. We endeavored to explore this association using Bayesian statistics aiming to provide a more nuanced understanding of this multifaceted relationship., Methods: Our analysis incorporated a cohort of 10,363 older (median age 82 years) patients from three international prospective studies, with 30-day all-cause mortality as the primary outcome. We defined frailty as Clinical Frailty Scale ≥ 5. A hierarchical Bayesian logistic regression model was employed, adjusting for covariables, using a range of priors. An international steering committee of registry members reached a consensus on a minimal clinically important difference (MCID)., Results: In our study, the 30-day mortality was 43%, with rates of 38% in non-frail and 51% in frail groups. Post-adjustment, the median odds ratio (OR) for frailty was 1.60 (95% CI 1.45-1.76). Frailty was invariably linked to adverse outcomes (OR > 1) with 100% probability and had a 90% chance of exceeding the minimal clinically important difference (MCID) (OR > 1.5). For the Clinical Frailty Scale (CFS) as a continuous variable, the median OR was 1.19 (1.16-1.22), with over 99% probability of the effect being more significant than 1.5 times the MCID. Frailty remained outside the region of practical equivalence (ROPE) in all analyses, underscoring its clinical importance regardless of how it is measured., Conclusions: This research demonstrates the significant impact of frailty on short-term mortality in critically ill elderly patients, particularly when the Clinical Frailty Scale (CFS) is used as a continuous measure. This approach, which views frailty as a spectrum, enables more effective, personalized care for this vulnerable group. Significantly, frailty was consistently outside the region of practical equivalence (ROPE) in our analysis, highlighting its clinical importance., (© 2023. The Author(s).)

Published
2023
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50. Limiting life-sustaining treatment for very old ICU patients: cultural challenges and diverse practices.

Author

Beil M, van Heerden PV, Joynt GM, Lapinsky S, Flaatten H, Guidet B, de Lange D, Leaver S, Jung C, Forte DN, Bin D, Elhadi M, Szczeklik W, and Sviri S

Abstract

Background: Decisions about life-sustaining therapy (LST) in the intensive care unit (ICU) depend on predictions of survival as well as the expected functional capacity and self-perceived quality of life after discharge, especially in very old patients. However, prognostication for individual patients in this cohort is hampered by substantial uncertainty which can lead to a large variability of opinions and, eventually, decisions about LST. Moreover, decision-making processes are often embedded in a framework of ethical and legal recommendations which may vary between countries resulting in divergent management strategies., Methods: Based on a vignette scenario of a multi-morbid 87-year-old patient, this article illustrates the spectrum of opinions about LST among intensivsts with a special interest in very old patients, from ten countries/regions, representing diverse cultures and healthcare systems., Results: This survey of expert opinions and national recommendations demonstrates shared principles in the management of very old ICU patients. Some guidelines also acknowledge cultural differences between population groups. Although consensus with families should be sought, shared decision-making is not formally required or practised in all countries., Conclusions: This article shows similarities and differences in the decision-making for LST in very old ICU patients and recommends strategies to deal with prognostic uncertainty. Conflicts should be anticipated in situations where stakeholders have different cultural beliefs. There is a need for more collaborative research and training in this field., (© 2023. The Author(s).)

Published
2023
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