{"id":30527,"date":"2026-06-13T04:30:00","date_gmt":"2026-06-12T20:30:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=30527"},"modified":"2026-06-13T06:07:05","modified_gmt":"2026-06-12T22:07:05","slug":"crit-care-med%e5%8f%91%e5%b8%83%e6%8c%87%e5%8d%97%ef%bc%9a%e7%be%8e%e5%9b%bd%e9%87%8d%e7%97%87%e5%8c%bb%e5%ad%a6%e4%bc%9a%e6%9c%89%e5%85%b3%e8%80%81%e5%b9%b4%e4%ba%baicu%e7%85%a7%e6%8a%a4%e7%9a%84","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=30527","title":{"rendered":"[Crit Care Med\u53d1\u5e03\u6307\u5357]\uff1a\u7f8e\u56fd\u91cd\u75c7\u533b\u5b66\u4f1a\u6709\u5173\u8001\u5e74\u4ebaICU\u7167\u62a4\u7684\u6307\u5357"},"content":{"rendered":"\n
SPECIAL ARTICLE<\/p>\n\n\n\n
Society of Critical Care Medicine Guidelines on Caring for Older Adults in the ICU<\/h1>\n\n\n\n
Older adults (those 65 years old or greater) compose a substantial proportion of the ICU population. As older adults with critical illness possess unique factors and considerations relevant to their care and outcomes, there is a need for evidence-based recommendations to guide critical care clinicians in the care of older ICU patients.<\/p>\n\n\n\n
Objective: <\/h3>\n\n\n\n
The objective of this guideline is to develop evidence-based recommendations addressing the care of older adults during and after critical illness.<\/p>\n\n\n\n
Design: <\/h3>\n\n\n\n
The American College of Critical Care Medicine Board convened a 22-member interprofessional panel, comprising physicians, advanced practice providers, nurses, a pharmacist, physical therapist, occupational therapist, and a patient representative. The panel included two expert methodologists specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guideline development including task force selection and voting.<\/p>\n\n\n\n
Methods: <\/h3>\n\n\n\n
The panel members prioritized five Population, Intervention, Comparator, and Outcomes questions. A systematic review was conducted for each question to identify the best available evidence, synthesize the evidence and assess the certainty of evidence using GRADE. The evidence-to-decision framework was used to formulate recommendations.<\/p>\n\n\n\n
Results: <\/h3>\n\n\n\n
The panel generated two conditional recommendations and three \u201cno recommendation\u201d statements. The conditional recommendations are: 1) We suggest a geriatric model of care for all older adults admitted to the ICU and 2) We suggest not using antipsychotic medications for the prevention of delirium in older adults with critical illness. The three \u201cno recommendation\u201d statements are: 1) We make no recommendation regarding specialized post-ICU follow-up for older survivors of critical illness, 2) For older adults (age 65 and over) admitted to the ICU with vasodilatory shock, we make no recommendation with regard to targeting a mean arterial pressure (MAP) of 60\u201365\u2009mm Hg as compared with usual care (MAP target > 65\u2009mm Hg), and 3) We make no recommendation regarding the use of antipsychotic medication in the treatment of delirium in older adults with critical illness.<\/p>\n\n\n\n
TABLE 1. - Caring for Older Adults in the ICU Population, Intervention, Comparator, and Outcomes Questions<\/em><\/p>\n\n\n\n
Question 1. Should Older Adults With Critical Illness Receive a Geriatrics Consultation or a Geriatric Model of Care Upon ICU Admission?<\/th><\/tr>
Population<\/th>
Intervention<\/th>
Comparator<\/th>
Outcomes<\/th><\/tr><\/thead>
Older adult patients admitted to any ICU<\/td>
Geriatric consult or geriatric-specific model of care or care pathway<\/td>
No geriatrics consult or no geriatric-specific model of care<\/td>
Mortality<\/td><\/tr>
Subgroups to consider:<\/td><\/tr>
\u2003Type of ICU (surgical vs. medical vs. CV surgery)<\/td>
Quality of life<\/td><\/tr>
\u2003Older (age \u2265 65) vs. oldest old (age \u2265 80)<\/td>
Disability in functional activities post-hospital discharge<\/td><\/tr>
Long-term cognitive impairment<\/td><\/tr>
Duration of IMV<\/td><\/tr>
Ability to perform ADLs at long-term follow-up<\/td><\/tr>
Discharge to nursing home (not previously at nursing home)<\/td><\/tr>
Question 3. Should We Aim for a Lower MAP Target (60\u201365 mm Hg) As Compared With Usual Care (Typically > 65 mm Hg) in Older Patients Admitted to the ICU With Vasodilatory Shock?<\/th><\/tr>
Population<\/th>
Intervention<\/th>
Comparator<\/th>
Outcomes<\/th><\/tr><\/thead>
Older adult patients admitted to ICU with shock<\/td>
Question 5. Should Older Patients Admitted to the ICU Receive Antipsychotics for Treatment of Delirium?<\/th><\/tr>
Population<\/th>
Intervention<\/th>
Comparator<\/th>
Outcomes<\/th><\/tr><\/thead>
Older adult patients admitted to any ICU with delirium<\/td>
Antipsychotic for treatment of delirium<\/td>
No antipsychotic for treatment of delirium<\/td>
Mortality<\/td><\/tr>
Subgroups to consider:<\/td>
Quality of life<\/td><\/tr>
\u2003Type of ICU (surgical vs. medical vs. CV surgery)<\/td>
Disability in functional activities post-hospital discharge<\/td><\/tr>
\u2003Older (age \u2265 65) vs. oldest old (age \u2265 80)<\/td>
Long-term cognitive impairment<\/td><\/tr>
\u2003Type of antipsychotic<\/td>
Duration of IMV<\/td><\/tr>
\u2003Hypoactive vs. hyperactive delirium<\/td>
Ability to perform ADLs at long-term follow-up<\/td><\/tr>
Discharge to nursing home (not previously at nursing home)<\/td><\/tr>
Delirium<\/td><\/tr>
Hospital LOS<\/td><\/tr>
Depression, PTSD, anxiety symptoms<\/td><\/tr><\/tbody><\/table>ADLs = activities of daily living, CV = cardiovascular, IMV = invasive mechanical ventilation, LOS = length of stay, MAP = mean arterial pressure, PTSD = post-traumatic stress disorder.<\/figcaption><\/figure>\n\n\n\n
TABLE 2. - Implications of Strong and Conditional Recommendations<\/em><\/p>\n\n\n\n
Target Audience<\/th>
Strong Recommendation<\/th>
Conditional Recommendation<\/th><\/tr><\/thead>
For patients<\/td>
Most individuals in this situation would want the recommended course of action and only a small proportion would not<\/td>
The majority of individuals in this situation would want the suggested course of action, but many would not<\/td><\/tr>
For clinicians<\/td>
Most individuals should receive the recommended course of action. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences<\/td>
Recognize that different choices will be appropriate for different patients and that you must help each patient arrive at a management decision consistent with her or his values and preferences. Decision aids may well be useful helping individuals making decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision<\/td><\/tr>
For policy makers<\/td>
The recommendation can be adapted as policy in most situations including for the use as performance indicators<\/td>
Policymaking will require substantial debates and involvement of many stakeholders. Policies are also more likely to vary between regions. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place<\/td><\/tr><\/tbody><\/table>Source: Grading of Recommendations, Assessment, Development, and Evaluation Handbook (10<\/a><\/sup>).<\/figcaption><\/figure>\n\n\n\n