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Frailty in ICU

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https://www.readbyqxmd.com/read/29774388/withholding-or-withdrawing-of-life-sustaining-therapy-in-older-adults-%C3%A2-80-years-admitted-to-the-intensive-care-unit
#1
Bertrand Guidet, Hans Flaatten, Ariane Boumendil, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zafeiridis, Dylan W De Lange
PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision)...
May 17, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29754983/cognitive-impairment-in-intensive-care-unit-patients-a-pilot-mixed-methods-feasibility-study-exploring-incidence-and-experiences-for-recovering-patients
#2
Rosalind Elliott, Elizabeth Yarad, Sarah Webb, Katherine Cheung, Frances Bass, Naomi Hammond, Doug Elliott
BACKGROUND: Despite improvements in survival after critical illness and intensive care unit (ICU) treatment, some recovering patients still face ongoing challenges. There are few investigations exploring the incidence, risk factors, and trajectory for cognitive impairment (CI) in former ICU patients in Australia. OBJECTIVES: To test the feasibility of a study protocol designed to ascertain the incidence and impact of CI during recovery from a critical illness. METHODS: We conducted a mixed-methods longitudinal single-centre pilot study...
May 10, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29727916/characteristics-and-outcomes-of-patients-with-hematologic-malignancies-receiving-chemotherapy-in-the-intensive-care-unit
#3
Stephen M Pastores, Debra A Goldman, David J Shaz, Natalie Kostelecky, Ryan J Daley, Tim J Peterson, Kay See Tan, Neil A Halpern
BACKGROUND: The objective of this study was to evaluate the short-term and long-term outcomes of adult patients with hematologic malignancies who received chemotherapy in the intensive care unit (ICU). METHODS: This was a retrospective, single-center study comparing the outcomes of patients with hematologic malignancies who received chemotherapy in the ICU with a matched cohort of ICU patients who did not receive chemotherapy. Conditional logistic regression and shared-frailty Cox regression were used to assess short-term (ICU and hospital) mortality and death by 12 months after hospital discharge, respectively...
May 4, 2018: Cancer
https://www.readbyqxmd.com/read/29705407/does-the-clinical-frailty-score-improve-the-accuracy-of-the-sofa-score-in-predicting-hospital-mortality-in-elderly-critically-ill-patients-a-prospective-observational-study
#4
Emilie Langlais, Nicolas Nesseler, Estelle Le Pabic, Denis Frasca, Yoann Launey, Philippe Seguin
PURPOSE: To determine whether the addition of the frailty status assessed by the clinical frailty scale (CFS) to the SOFA score (SOFA-CFS) improves the performance of the SOFA score alone in predicting the hospital mortality of elderly critically ill patients. METHODS: A prospective observational study performed between February 2015 and February 2016 including 189 patients aged ≥65 years and hospitalized ≥24 h in the intensive care unit (ICU). RESULTS: The SOFA-CFS score did not improve the performance of the SOFA score alone in predicting hospital mortality (AUC = 0...
April 22, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29689120/acute-on-chronic-liver-failure-getting-ready-for-prime-time
#5
Jasmohan S Bajaj, Richard Moreau, Patrick S Kamath, Hugo E Vargas, Vicente Arroyo, K Rajender Reddy, Gyongyi Szabo, Puneeta Tandon, Jody Olson, Constantine Karvellas, Thierry Gustot, Jennifer C Lai, Florence Wong
Acute on chronic liver failure (ACLF) is a culmination of chronic liver disease and extra-hepatic organ failures, which is associated with a high short-term mortality and immense healthcare expenditure. There are varying definitions for organ failures and ACLF in Europe, North America and Asia. These differing definitions need to be reconciled to enhance progress in the field. The pathogenesis of ACLF is multi-factorial and related to interactions between the immuno-inflammatory system, microbiota and the precipitating factors...
April 24, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29649027/pain-and-its-long-term-interference-of-daily-life-after-critical-illness
#6
Christina J Hayhurst, Jim C Jackson, Kristin R Archer, Jennifer L Thompson, Rameela Chandrasekhar, Christopher G Hughes
BACKGROUND: Persistent pain likely interferes with quality of life in survivors of critical illness, but data are limited on its prevalence and risk factors. We sought to determine the prevalence of persistent pain after critical illness and its interference with daily life. Additionally, we sought to determine if intensive care unit (ICU) opioid exposure is a risk factor for its development. METHODS: In a cohort of adult medical and surgical ICU survivors, we used the brief pain inventory (BPI) to assess pain intensity and pain interference of daily life at 3 and 12 months after hospital discharge...
April 11, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29580350/frailty-predicts-morbidity-after-colectomy-for-ulcerative-colitis
#7
Edwin Telemi, Oleksandr Trofymenko, Raghunandan Venkat, Viraj Pandit, T K Pandian, Valentine N Nfonsam
The rate of ulcerative colitis (UC), an inflammatory bowel disease, has been on the rise in the United States for the last several decades. Colectomy can be performed when other treatment options cannot provide a reasonable quality of life to patients with UC. Frailty has been shown to be a strong tool for evaluating preoperative risk factors for poor postoperative outcomes. The National Surgical Quality and Improvement Program cross-institutional database was used for this study. Data from 943 patients who underwent colectomy for UC between 2005 and 2012 were evaluated...
February 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29574340/assessing-frailty-in-the-intensive-care-unit-a-reliability-and-validity-study
#8
Melissa Shears, Alyson Takaoka, Bram Rochwerg, Sean M Bagshaw, Jennie Johnstone, Amanda Holding, Surenthar Tharmalingam, Tina Millen, France Clarke, Kenneth Rockwood, Guowei Li, Lehana Thabane, John Muscedere, Henry T Stelfox, Deborah J Cook
PURPOSE: To describe pre-ICU frailty in critically ill patients using the Clinical Frailty Scale (CFS). METHODS: We included patients ≥18years admitted to 2 ICUs in Hamilton, Canada. The ICU Research Coordinator (RC) generated 3 CFS scores using: 1) chart review, 2) family interview, 3) patient interview. Subsequently, an overall impression was captured in a final score. Mean differences were calculated to assess the RC intra-rater reliability and inter-rater reliability of chart reviews by the RC, Occupational Therapist (OT), and Geriatrics Resident (GR)...
June 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29559308/the-association-of-frailty-with-post-icu-disability-nursing-home-admission-and-mortality-a-longitudinal-study
#9
Lauren E Ferrante, Margaret A Pisani, Terrence E Murphy, Evelyne A Gahbauer, Linda S Leo-Summers, Thomas M Gill
BACKGROUND: Frailty is a strong indicator of vulnerability among older persons, but its association with ICU outcomes has not been evaluated prospectively (ie, with objective measurements obtained prior to ICU admission). Our objective was to prospectively evaluate the relationship between frailty and post-ICU disability, incident nursing home admission, and death. METHODS: The parent cohort included 754 adults aged ≥ 70 years, who were evaluated monthly for disability in 13 functional activities and every 18 months for frailty (1998-2014)...
March 17, 2018: Chest
https://www.readbyqxmd.com/read/29373362/acute-kidney-injury-and-subsequent-frailty-status-in-survivors-of-critical-illness-a-secondary-analysis
#10
Khaled Abdel-Kader, Timothy D Girard, Nathan E Brummel, Christina T Saunders, Jeffrey D Blume, Amanda J Clark, Andrew J Vincz, E Wesley Ely, James C Jackson, Susan P Bell, Kristin R Archer, T Alp Ikizler, Pratik P Pandharipande, Edward D Siew
OBJECTIVES: Acute kidney injury frequently complicates critical illness and is associated with high morbidity and mortality. Frailty is common in critical illness survivors, but little is known about the impact of acute kidney injury. We examined the association of acute kidney injury and frailty within a year of hospital discharge in survivors of critical illness. DESIGN: Secondary analysis of a prospective cohort study. SETTING: Medical/surgical ICU of a U...
May 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29285609/functional-compromise-cohort-study-fccs-sarcopenia-is-a-strong-predictor-of-mortality-in-the-intensive-care-unit
#11
P A de Hoogt, K W Reisinger, J J W Tegels, J W A M Bosmans, F Tijssen, J H M B Stoot
BACKGROUND: Functional compromise in elderly patients is considered to be a significant contributing factor in increased postoperative morbidity and mortality. It is described as a state of reduced physiologic reserves including, e.g., sarcopenia, cachexia, malnutrition and frailty with increased susceptibility to adverse health outcomes. Aim of this study was to investigate the association of sarcopenia with mortality in ICU patients. METHODS: A retrospective analysis of a total of 687 patients admitted to the ICU from January 2013 until December 2014 was performed...
December 29, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29145407/predicting-mortality-and-hospitalization-of-older-adults-by-the-multimorbidity-frailty-index
#12
Yao-Chun Wen, Liang-Kung Chen, Fei-Yuan Hsiao
BACKGROUND: Existing operational definitions of frailty are personnel-costly and time-consuming, resulting in estimates with a small sample size that cannot be generalized to the population level. The objectives were to develop a multimorbidity frailty index using Taiwan's claim database, and to understand its ability to predict adverse event. METHODS: This is a retrospective cohort study. Subjects aged 65 to 100 years who have full National Health Insurance coverage in 2005 were included...
2017: PloS One
https://www.readbyqxmd.com/read/29132505/the-mobility-and-impact-of-frailty-in-the-intensive-care-unit
#13
REVIEW
Bellal Joseph, Faisal S Jehan
Prevalence of pre-existing frailty in patients admitted to the intensive care unit (ICU) is increasing. Critical illness leads to a catabolic state that further diminishes body reserves and contributes to frailty independent of age and prehospital functional status. Because early mobilization of patients in the ICU results in accelerated recovery and improvement in functional status and quality of life, frailty can severely affect the mobility of patients in ICU ultimately prolonging recovery. Understanding the concept of frailty and the association of frailty and its impact on mobility in the ICU, identifying patients, and timely resource allocation helps in optimum care and improves clinical outcomes...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28936626/the-impact-of-frailty-on-icu-and-30-day-mortality-and-the-level-of-care-in-very-elderly-patients-%C3%A2-80-years
#14
Hans Flaatten, Dylan W De Lange, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Ariane Boumendil, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zaferidis, Bertrand Guidet
PURPOSE: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. METHODS: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine...
December 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28676896/the-impact-of-frailty-on-intensive-care-unit-outcomes-a-systematic-review-and-meta-analysis
#15
REVIEW
John Muscedere, Braden Waters, Aditya Varambally, Sean M Bagshaw, J Gordon Boyd, David Maslove, Stephanie Sibley, Kenneth Rockwood
PURPOSE: Functional status and chronic health status are important baseline characteristics of critically ill patients. The assessment of frailty on admission to the intensive care unit (ICU) may provide objective, prognostic information on baseline health. To determine the impact of frailty on the outcome of critically ill patients, we performed a systematic review and meta-analysis comparing clinical outcomes in frail and non-frail patients admitted to ICU. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, and Clinicaltrials...
August 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28659433/effect-of-communication-skills-training-on-outcomes-in-critically-ill-patients-with-life-limiting-illness-referred-for-intensive-care-management-a-before-and-after-study
#16
Neil R Orford, Sharyn Milnes, Nicholas Simpson, Gerry Keely, Tania Elderkin, Allison Bone, Peter Martin, Rinaldo Bellomo, Michael Bailey, Charlie Corke
OBJECTIVES: To describe the effect of a communication skills training programme on patient-centred goals of care documentation and clinical outcomes in critically ill patients with life-limiting illnesses (LLI) referred for intensive care management. METHODS: Prospective before-and-after cohort study in a tertiary teaching hospital in Australia. The population was 222 adult patients with LLI referred to the intensive care unit (ICU). The study was divided into two periods, before (1 May to 31 July 2015) and after (15 September to 15December 2015) the intervention...
June 28, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28574881/the-relationship-between-frailty-and-the-subjective-decision-to-conduct-a-goals-of-care-discussion-with-burned-elders
#17
Tarik D Madni, Paul A Nakonezny, Steven E Wolf, Bellal Joseph, M Jane Mohler, Jonathan B Imran, Audra Clark, Brett A Arnoldo, Herb A Phelan
Best practices are to conduct an early discussion of goals of care (GoC) after injury in the elderly, but this intervention is inconsistently applied. We hypothesized that a frail appearance was a factor in the decision to conduct a GoC discussion after thermal injury. A retrospective review was performed of all burn survivors aged ≥ 65 years at our ABA-verified level 1 burn center between April 02, 2009, and December 30, 2014. Demographic information included age, gender, mechanism of injury, percentage TBSA burned, revised Baux score, patient/physician racial discordance, documented GoC discussion (as defined within the electronic medical record), length of stay (LOS), and disposition...
May 31, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28510786/the-impact-of-frailty-on-noninvasive-mechanical-ventilation-in-elderly-medical-intensive-care-unit-patients
#18
Iskender Kara, F Yildirim, A Zerman, Z Gullu, N Boyaci, B B Aydogan, U Gaygisiz, K Gonderen, G Arik, M Turkoglu, M Aydogdu, G Aygencel, Z Ulger, G Gursel
AIM: Many factors affecting noninvasive ventilation (NIV) in critically ill patients have been reported in the literature, but there is no study about the effect of frailty. With this study, the frailty prevalence was evaluated with two different frailty scores among the NIV population of a medical intensive care unit (ICU). Besides, the impact of frailty on NIV success and mortality and its association with NIV application problems were evaluated. METHOD: A prospective observational cohort study was performed on patients who were over 50 years of age and assigned to NIV due to hypercapnic respiratory failure...
April 2018: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28486318/asking-a-better-question-development-and-evaluation-of-the-need-for-trauma-intervention-nfti-metric-as-a-novel-indicator-of-major-trauma
#19
REVIEW
Jacob W Roden-Foreman, Nakia R Rapier, Luanna Yelverton, Michael L Foreman
Many existing metrics, such as Injury Severity Score (ISS), cannot fully describe many trauma patients because of comorbidities. This study developed and evaluated the Need For Trauma Intervention (NFTI) metric as a novel indicator of major trauma. The NFTI metric was developed from an analysis of 2,396 trauma patients at a Level I trauma center. Six commonly recorded registry variables were found to be indicative of major trauma and comprised the NFTI criteria: receiving packed red blood cells within 4 hr; discharge from the emergency department (ED) to the operating room within 90 min; discharge from the ED to interventional radiology; discharge from the ED to the intensive care unit (ICU) with an ICU length of stay (LOS) of 3 or more days; mechanical ventilation outside of procedural anesthesia within 3 days; or death within 60 hr...
May 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28449296/frailty-index-intensive-care-unit-complications-in-head-and-neck-oncologic-regional-and-free-flap-reconstruction
#20
Nicholas B Abt, Yanjun Xie, Sidharth V Puram, Jeremy D Richmon, Mark A Varvares
BACKGROUND: Head and neck extirpations requiring reconstruction are challenging surgeries with high postoperative complication risk. METHODS: Regional and free flap reconstructions of head and neck defects were collected from the 2006-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The modified frailty index was made of 15 variables, with increasing index scores indicative of frailer patients. Intensive care unit (ICU)-level complications were defined by Clavien-Dindo classification IV and analyzed with multivariable logistic regression...
August 2017: Head & Neck
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