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Advances in critical care for the older patient

  • Diane Monkhouse (a1)


As the proportion of elderly people in the general population increases, so does the number admitted to critical care. In caring for an older patient, the intensivist has to balance the complexities of an acute illness, pre-existing co-morbidities and patient preference for life-sustaining treatment with the chances of survival, quality of life after critical illness and rationing of expensive, limited resources. This remains one of the most challenging areas of critical care practice.


Corresponding author

Address for correspondence: Diane Monkhouse, Consultant in Anaesthesia & Critical Care, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK. Email:


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1Fan, E, Ferguson, ND. One for all and all for one? The globalization of critical care. Crit Care Med 2008; 36: 2942–43.
2Millibrandt, EB, Eldadah, B, Nayfield, Set al.Toward an Integrated research agenda for critical illness in aging. Am J Repir Crit Care Med 2010; 182: 9951003.
3Nguyen, Y-L, Angus, DC, Boumendil, Aet al.The challenges of admitting the very elderly to intensive care. Ann Intensive Care 2011; 1: 29.
4Wilson, DM, Thurston, A, Lichlyter, Bet al.Should the oldest-old be admitted to the intensive care unit and receive advanced life-supporting care? Crit Care Med 2010; 38: 303–4.
5Boumendil, A, Somme, D, Garrouste-Orgeas, Met al.Should elderly patients be admitted to the intensive care unit? Intensive Care Med 2007; 33: 1252–62.
6Bagshaw, SM, Webb, SA, Delaney, Aet al.Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care 2009; 13: R45.
7de Rooij, SE, Govers, AC, Korevaar, JCet al.Cognitive, functional and quality of life outcomes of patients aged 80 or older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment. J Am Geriatr Soc 2008; 56: 816–22.
8Lerolle, N, Trinquart, L, Bornstein, Cet al.Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade. Crit Care Med 2010; 8: 5964.
9Roch, A, Wiramus, S, Pauly, Vet al.Long term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care 2011; 15: R36
10Tabah, A, Philippart, F, Timsit, JFet al.Quality of life in patients aged 80 or over after ICU discharge. Crit Care 2010; 14: R2.
11Nathanson, BH, Higgins, TL, Brennan, MJet al.Do elderly patients fare well in ICU? Chest 2011; 139: 825–31.
12Fuchs, L, Chronaki, CE, Park, Set al.ICU admission characteristics and mortality rates among elderly and very elderly patients. Intensive Care Med doi: 10.1007/s00134-012-2629-6.
13Boumendil, A, Aegerter, P, Guidet, B. Treatment intensity and outcomes of patients aged 80 and older in intensive care units: a multi-center matched-cohort study. J Am Geriatr Soc 2005; 53: 8893.
14Pisani, MA, Redlich, C, McNicholl, Let al.Under-recognition of pre-existing cognitive impairment by physicians in older ICU patients. Chest 2003; 124: 2267–74.
15Girard, T, Pandharipande, P, Ely, EW. Delirium in the intensive care unit. Crit Care 2008; 12: S3.
16Bo, M, Massaia, M, Raspo, Set al.Predictive factors of in-hospital mortality in older patients admitted to a medical intensive care unit. J Am Geriatr Soc 2003; 51: 529–33.
17Sprung, CL, Artigas, A, Kesecioglu, Jet al.The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for elderly. Crit Care Med 2012; 40: 132–38.
18Boumendil, A, Angus, DC, Guitonneau, A-Let al.Variability of intensive care decisions for the very elderly. PLoS ONE 2012; 7: e34387. doi: 10.1371/journal.pone.0034387.
19de Rooij, Se, Abu-Hanna, A, Levi, Met al.Identification of high-risk subgroups in very elderly intensive care unit patients. Critical Care 2007; 11: R33.
20Angus, DC, Linde-Zwirble, WT, Lidicker, Jet al.Epidemiology of severe sepsis in the United States: analysis of incidence and outcome and associated costs of care. Crit Care Med 2001; 29: 303–10.
21Girard, TD, Opal, SM, Ely, EW. Insights into severe sepsis in older patients: from epidemiology to evidence-based management. Clinical Infectious Diseases 2005; 40: 719–27.
22Desterac, LA, Ely, EW. Sepsis in older patients: an emerging concern in critical care. Advances in Sepsis 2002; 2: 1522.
23Gavazzi, G, Krause, KH. Ageing and infection. Lancet Infect Dis 2002; 2: 659–66.
24Norman, DC. Fever and aging. Infect Dis Clin Pract 1998; 7: 387–90.
25Bellmann-Weiler, R, Weiss, G. Pitfalls in the diagnosis and therapy of infections in elderly patients – a mini-review. Gerontology 2009; 55: 241–49.
26Scheutz, P, Christ-Crain, M, Muller, B. Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections – hope for hype? Swiss Med Wkly 2009; 139: 319–26.
27Martin, GS, Mannino, DM, Moss, M.The effect of age on the development and outcome of adult sepsis. Crit Care Med 2006; 34: 1521.
28Dellinger, RP, Levy, MM, Carlet, JMet al.Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock. Intensive Care Medicine 2008; 34: 1760.
29Rivers, E, Nguyen, B, Havstad, Set al.Early goal directed therapy in the treatment of severe sepsis nad septic shock. N Engl J Med 2001; 345: 1368–77.
30The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and acute respiratory distress syndrome. N Engl J Med 2000; 342: 1301–8.
31Ranieri, VM, Thompson, BT, Barie, PSet al.Drotrcogin alfa (activated) in adults with septic shock. N Engl Med 2012; 366: 2055–64.
32Behrendt, CE. Acute respiratory failure in the United States: incidence and 31-day survival. Chest 2000; 118: 1100–5.
33Ray, P, Birolieau, S, Lefort, Yet al.Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Critical Care 2006; 10: R82.
34Ely, EW, Wheeler, AP, Thompson, BTet al.Recovery rate and prognosis in older persons who develop acute lung injury and acute respiratory distress syndrome. Ann Intern Med 2002; 136: 2536.
35Delerme, S, Ray, P. Acute respiratory failure in the elderly: diagnosis and prognosis. Age and Ageing 2008; 37: 251–57.
36Severansky, JE, Haponik, EF. Respiratory failure in elderly patients. Clin Geriatr Med 2003; 19: 205–24.
37Masip, J, Roque, M, Sánchez, Bet al.Non-invasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 2005; 294: 3124–30.
38Plant, PK, Owen, JL, Elliott, MW. A multicentre randomised controlled trial of the early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. Lancet 2000; 355: 1931–35.
39Confalonieri, M, Potena, , Carbone, Get al.Acute respiratory failure in patients with severe community acquired pneumonia. A prospective randomized evaluation of non-invasive ventilation. Am J Respir Crit Care Med 1999; 160: 1585–91.
40Niu, N, Lorente, JA, De Paula, Met al.Ageing increases the susceptibility to injurious mechanical ventilation. Intensive Care Med 2008; 34: 923–31.
41Herridge, MS, Cheung, AM, Tansey, CMet al.One-year outcome in survivors of acute respiratory distress syndrome. N Engl J Med 2003; 348: 683–93.
42Girard, TD, Kress, JP, Fuchs, BDet al.Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised control trial. Lancet 2008; 371: 126–34.
43Chelluri, L, Im, KA, Belle, SHet al.Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med 2004; 32: 2536.
44Joannidis, M, Metnitz, B, Bauer, Pet al.Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS3 database. Intensive Care Med 2009; 35: 1692–702.
45Chronopoulos, A, Rosner, MH, Cruz, Det al.Acute kidney injury in elderly intensive care patients: a review. Intensive Care Med 2010; 36: 1454–64.
46Feest, TG, Round, A, Hamad, S. Incidence of severe acute renal failure in adults: results of a community-based study. BMJ 1993; 306: 481–83.
47Uchino, S, Kellum, JA, Bellomo, Ret al.Acute renal failure in critically ill patients. A multinational, multicenter study. JAMA 2005; 294: 813–18.
48Rosner, MH. Acute kidney injury in the elderly: pathogenesis, diagnosis and therapy. Aging Health 2009; 5: 635–46.
49Joannidis, M, Druml, W, Forni, LGet al.Prevention of acute kidney injury and protection of renal function in the intensive care unit. Expert opinion of the working group for nephrology, ESICM. Intensive Care Med 2010; 36: 392411.
50Bellomo, R, Wan, L, May, C. Vasoactive drugs and acute kidney injury. Crit Care Med 2008; 36: S17986.
51Pearse, R, Dawson, D, Fawcett, Jet al.Early goal directed therapy after major surgery reduces complications and duration of hospital stay. A randomised controlled trial. Critical Care 2005; 9: R68793.
52Myburgh, JA, Finfer, S, Bellomo, Ret al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. (accessed 27 October 2012).
53Bagshaw, SM, Laupland, KB, Doid, CJet al.Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population- based study. Crit Care 2005; 9: R7009.
54Girard, TD, Pandharipande, PP, Ely, EW. Delirium in the intensive care unit. Critical Care 2008; 12 (suppl 3): S3.
55Pun, BT, Ely, EW. The importance of diagnosing and managing delirium in ICU. Chest 2007; 132: 624–36.
56Ely, EW, Shintani, A, Truman, Bet al.Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291: 1753–62.
57Ely, EW, Gautam, S, Margolin, Ret al.The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001; 27: 1892–900.
58Hopkins, RO, Jackson, JC. Long-term neurocognitive function after critical illness. Chest 2006; 130: 869–78.
59Ely, EW, Inouye, SK, Bernard, GRet al.Delirium in mechanically ventilated patients: validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA 2001; 286: 2703–10.
60Griffiths, RD, Jones, C. Seven lessons from 20 years of follow-up of intensive care survivors. Curr Opin Crit Care 2007; 13: 508–13.
61Griffiths, JA, Gager, M, Waldmann, C. Follow-up after intensive care. Continuing Education in Anaesth Crit Care and Pain 2004; 4: 202–5.
62Herridge, MS, Tansey, CM, Matté, Aet al.Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364: 1293–304.
63Hopkins, RO, Weaver, LK, Collingridge, Det al.Two year cognitive, emotional and quality of life outcomes in Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2005; 171: 340–47.
64O'Donnell, ML, Creamer, M, Holmes, ACet al.Post traumatic stress disorder after injury: does admission to intensive care unit increase risk. J Trauma 2010; 69: 627–32.


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Advances in critical care for the older patient

  • Diane Monkhouse (a1)


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