{"id":29526,"date":"2026-04-14T04:35:00","date_gmt":"2026-04-13T20:35:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=29526"},"modified":"2026-04-14T05:54:46","modified_gmt":"2026-04-13T21:54:46","slug":"icu-management-practice-%e6%ac%a7%e6%b4%b2%e9%87%8d%e7%97%87%e5%8c%bb%e5%ad%a6%e4%bc%9a%e6%9e%81%e8%80%81%e5%b9%b4%e6%82%a3%e8%80%85%e7%ae%a1%e7%90%86%e6%8c%87%e5%8d%97","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=29526","title":{"rendered":"[ICU Management &#038; Practice]: \u6b27\u6d32\u91cd\u75c7\u533b\u5b66\u4f1a\u6781\u8001\u5e74\u60a3\u8005\u7ba1\u7406\u6307\u5357"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">ESICM Recommendations for Management of Very Old Patients<\/h1>\n\n\n\n<ul>\n<li>In&nbsp;<a href=\"https:\/\/healthmanagement.org\/c\/icu\">ICU<\/a><\/li>\n\n\n\n<li>Wed, 29 Oct 2025<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/res.cloudinary.com\/healthmanagement-org\/image\/upload\/c_thumb,f_auto,fl_lossy,q_90\/v1761719531\/cw\/00131399_cw_image_wi_38de2b4f6d889bd4538006cadbbd3b9e.webp\" alt=\"\"\/><\/figure>\n\n\n\n<p>Very old patients, defined as those aged 80 years or older, represent the fastest-growing cohort in intensive care units across many countries. This population is characterised by high prevalence of functional impairments, multiple comorbidities, frailty, and marked biological and functional heterogeneity between individuals. The absence of robust evidence for managing critical conditions in this age group has created uncertainty and unwarranted variation in care practices among clinicians.<\/p>\n\n\n\n<p>To address these challenges, the European Society of Intensive Care Medicine initiated a comprehensive study to translate expert knowledge into practical recommendations for clinical practice.<\/p>\n\n\n\n<p>A multi-national steering group of 28 specialists in intensive care, emergency, and geriatric medicine conducted a two-round Delphi study involving 110 experts. The study utilized a 9-point Likert scale to measure agreement levels, with strong consensus defined as at least 90% agreement and moderate consensus as 80-90% agreement. After a literature search found no clinical trials addressing the distinct needs of very old patients in intensive care, the consensus-based approach was deemed the most appropriate methodology. Patient representatives from England, the Netherlands, and France provided input on the selection and wording of survey items.<\/p>\n\n\n\n<p>The expert panel achieved consensus on 48 statements and two checklists, covering general principles, specific care processes along the patient trajectory, and infrastructure development.<\/p>\n\n\n\n<p>The recommendations strongly emphasise that chronological age alone should not determine ICU admission decisions. Instead, management should be tailored according to patients' acute and chronic conditions while respecting their preferences regarding the ceiling of intensive care. Major geriatric characteristics requiring careful consideration include frailty, chronic multimorbidity, and pre-existing functional impairments. The evaluation of expected quality of life must consider the patient's individual perspective, including religious and spiritual beliefs. Decisions about life-sustaining treatment should be made within the context of both likely outcomes and the time-dependent burden of interventions, rather than based solely on age or expected functional outcomes. The panel also recognised that patient quality of life benefits from continuity in collaborative case management from before ICU admission through to community care after discharge.<\/p>\n\n\n\n<p>Prior to or upon ICU admission, several key elements should be established. Patients should be asked about their preferences for treatment escalation when possible, and if unable to communicate, these values should be discussed with family or caregivers. Efforts should be made to obtain advance directives if they exist. For patients with substantial prognostic uncertainty, time-limited trials could be considered after agreement with patients or caregivers. For elective surgery with planned ICU admission, comprehensive geriatric assessment is desirable beforehand.<\/p>\n\n\n\n<p>A detailed checklist for ICU admission should include reason for admission, level of acute organ dysfunction, functional independence in daily life, pre-existing frailty, pre-existing cognitive impairments including dementia, other chronic comorbidities, sensory impairments including use of aids, clinical signs of malnutrition, hospital and ICU admissions in the past year, treatment escalation plan including cardiopulmonary resuscitation instructions, current residence, and current support from family or other carers.<\/p>\n\n\n\n<p>Strong consensus supported multiple aspects of ICU management. Guidelines should exist for prevention, detection, and management of delirium, as well as for prevention of pressure ulcers and other skin problems. Sedation, ventilatory support, cardiovascular support, and nutrition management should all account for ageing-related characteristics. Non-invasive ventilation or high-flow nasal oxygen therapy can represent a reasonable ceiling of interventional treatment depending on the patient's functional baseline. Patients should be assessed for pre-existing sight and hearing problems and provided with their glasses and hearing aids. Early mobilisation should be initiated in the ICU.<\/p>\n\n\n\n<p>Family meetings with patient participation should be conducted to determine appropriate treatment levels. Decisions to limit life-sustaining therapy should be made when aggressive interventions are unlikely to achieve an acceptable quality of life as perceived by the patient, and consensus within the ICU team and with other healthcare professionals familiar with the patient's history should be sought before such decisions.<\/p>\n\n\n\n<p>A comprehensive transfer checklist was developed covering baseline status prior to acute condition, the acute condition itself, ongoing problems requiring observation, medication plan, indications for indwelling catheters and lines, cognition, speech or other communication means, oral intake, constipation, level of mobilisation in the ICU, rehabilitation plans and goals, summary of previous communication with family and stakeholders, ceiling of interventional treatment, and skin integrity with treatment plan for injuries.<\/p>\n\n\n\n<p>Medication review should be undertaken prior to or soon after ICU transfer by appropriate healthcare professionals such as clinical pharmacists or geriatricians. A statement about future goals of care should be documented in the patient record. Patients with geriatric characteristics should ideally have early transfer to step-down units with continuous access to the full spectrum of geriatric care, including rehabilitation. Early evaluation for social support in the community should occur as part of geriatric team assessment. Patients and families should be informed about available support for recovery, and the medical or geriatric team should update primary care teams regarding assessment and goals of care. Primary care teams should review patients as soon as possible after hospital discharge.<\/p>\n\n\n\n<p>Several service components were identified as important for efficient, high-quality care. Strong consensus supported physiotherapy for early mobilisation, dietitians for optimising nutrition during recovery, and systematic feedback about long-term functional outcomes and quality of life to improve ICU care quality. The panel strongly recommended that specialty training programmes should incorporate topics specific to very old patients, and geriatric medicine curricula should incorporate intensive care topics.<\/p>\n\n\n\n<p>This comprehensive consensus-based framework provides guidance for healthcare professionals managing very old patients with critical conditions. The recommendations emphasise patient-centred care that considers individual preferences, biological and functional heterogeneity, and the specific characteristics of aging populations. Successful implementation requires detailed analysis of available resources, stepwise and adaptive implementation approaches, and improved interactions between clinical specialties to support continuity of care and decision-making aligned with the specific needs of very old patients.<\/p>\n\n\n\n<p>Source:&nbsp;<a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00134-025-07794-4\" target=\"_blank\" rel=\"noreferrer noopener\">Intensive Care Medicine<\/a><\/p>\n\n\n\n<p>Image Credit: iStock&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">References:<\/h4>\n\n\n\n<p>Beil M, Alberto L, Bourne RS et al. (2025)&nbsp;<a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00134-025-07794-4\" target=\"_blank\" rel=\"noreferrer noopener\">ESICM consensus-based recommendations for the management of very old patients in intensive care.<\/a>&nbsp;Intensive Care Med. 51(2):287-301.&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>ESICM Recommendations for Management of Very Old Patien [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[25,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29526"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29526"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29526\/revisions"}],"predecessor-version":[{"id":29527,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29526\/revisions\/29527"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29526"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29526"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29526"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}