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      Critical care beyond organ support: the importance of geriatric rehabilitation

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          Abstract

          Very old critically ill patients pose a growing challenge for intensive care. Critical illness and the burden of treatment in the intensive care unit (ICU) can lead to a long-lasting decline of functional and cognitive abilities, especially in very old patients. Multi-complexity and increased vulnerability to stress in these patients may lead to new and worsening disabilities, requiring careful assessment, prevention and rehabilitation. The potential for rehabilitation, which is crucial for optimal functional outcomes, requires a systematic, multi-disciplinary approach and careful long-term planning during and following ICU care. We describe this process and provide recommendations and checklists for comprehensive and timely assessments in the context of transitioning patients from ICU to post-ICU and acute hospital care, and review the barriers to the provision of good functional outcomes.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13613-024-01306-1.

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          Most cited references80

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          Frailty in elderly people

          Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. In landmark studies, investigators have developed valid models of frailty and these models have allowed epidemiological investigations that show the association between frailty and adverse health outcomes. We need to develop more efficient methods to detect frailty and measure its severity in routine clinical practice, especially methods that are useful for primary care. Such progress would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

            To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU.
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              Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.

              Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families. Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge. Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems. Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member. Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.
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                Author and article information

                Contributors
                christian.jung@med.uni-duesseldorf.de
                Journal
                Ann Intensive Care
                Ann Intensive Care
                Annals of Intensive Care
                Springer International Publishing (Cham )
                2110-5820
                10 May 2024
                10 May 2024
                2024
                : 14
                : 71
                Affiliations
                [1 ]Department of Geriatric Rehabilitation and the Center for Palliative Care. Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, ( https://ror.org/03qxff017) Jerusalem, Israel
                [2 ]Geriatric Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, ( https://ror.org/03qxff017) Jerusalem, Israel
                [3 ]Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, ( https://ror.org/03qxff017) Jerusalem, Israel
                [4 ]GRID grid.412370.3, ISNI 0000 0004 1937 1100, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, ; Paris, France
                [5 ]GRID grid.503257.6, ISNI 0000 0000 9776 8518, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, ; Paris, France
                [6 ]GRID grid.50550.35, ISNI 0000 0001 2175 4109, Department of Geriatrics, Centre d’immunologie et de Maladies Infectieuses (CIMI), , Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1135, Saint Antoine, Assistance Publique Hôpitaux de Paris,, Sorbonne Université, ; Paris, France
                [7 ]Department of Clinical Medicine, University of Bergen, ( https://ror.org/03zga2b32) Bergen, Norway
                [8 ]Department of Research and Development, Haukeland University Hospital, ( https://ror.org/03np4e098) Bergen, Norway
                [9 ]GRID grid.451052.7, ISNI 0000 0004 0581 2008, General Intensive Care, Department of Critical Care Medicine, , St George’s NHS Foundation Trust, ; London, UK
                [10 ]GRID grid.5477.1, ISNI 0000000120346234, Department of Intensive Care Medicine, , University Medical Center, University Utrecht, ; Utrecht, The Netherlands
                [11 ]Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, ( https://ror.org/03bqmcz70) Kraków, Poland
                [12 ]Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of Medicine, Heinrich-Heine-University, ( https://ror.org/024z2rq82) Moorenstraße 5, 40225 Düsseldorf, Germany
                Author information
                http://orcid.org/0000-0001-8325-250X
                Article
                1306
                10.1186/s13613-024-01306-1
                11087448
                38727919
                ccb558f7-d131-4baa-bb5c-2da498498b4c
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 4 February 2024
                : 29 April 2024
                Funding
                Funded by: Universitätsklinikum Düsseldorf. Anstalt öffentlichen Rechts (8911)
                Categories
                Review
                Custom metadata
                © La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF) 2024

                Emergency medicine & Trauma
                critical care,old patients,geriatric rehabilitation,comprehensive geriatric assessment,frailty,post-icu syndrome

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