ESICM consensus-based recommendations for the management of very old patients in intensive care

Michael Beil; Laura Alberto; Richard S Bourne; Nathan E Brummel; Bas de Groot; Dylan W de Lange; Paul Elbers; Marielle Emmelot-Vonk; Hans Flaatten; Yonathan Freund; Alessandro Galazzi; Ana Garcia-Martinez; Bertrand Guidet; Iva Holmerova; Jeremy M Jacobs; Gavin M Joynt; Susannah Leaver; Marc Leone; Bairbre McNicholas; David McWilliams; Victoria Metaxa; Christian H Nickel; Daniele Poole; Chiara Robba; Kevin Roedl; Marc Romain; Anne-Françoise Rousseau; Sigal Sviri; Wojciech Szczeklik; Helene Vallet; James van Oppen; Christian Jung

doi:10.1007/s00134-025-07794-4

ESICM consensus-based recommendations for the management of very old patients in intensive care

Michael Beil^*
, Laura Alberto
, Richard S Bourne
, Nathan E Brummel
, Bas de Groot
, Dylan W de Lange
, Paul Elbers
, Marielle Emmelot-Vonk
, Hans Flaatten
, Yonathan Freund
, Alessandro Galazzi
, Ana Garcia-Martinez
, Bertrand Guidet
, Iva Holmerova
, Jeremy M Jacobs
, Gavin M Joynt
, Susannah Leaver
, Marc Leone
, Bairbre McNicholas
, David McWilliams

Victoria Metaxa, Christian H Nickel, Daniele Poole, Chiara Robba, Kevin Roedl, Marc Romain, Anne-Françoise Rousseau, Sigal Sviri, Wojciech Szczeklik, Helene Vallet, James van Oppen, Christian Jung

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

PURPOSE: The heterogeneity of very old patients (age ≥ 80 years) and the prevalence of complex geriatric syndromes in this cohort constitute major challenges for the classical methods of evidence-based medicine to inform clinical practice. The lack of robust guidance for the management of critical conditions in these patients contributes to considerable uncertainty among practitioners and unwarranted variations of care. The European Society of Intensive Care Medicine (ESICM) initiated a Delphi study to translate the empirical knowledge of experts in this field into consensus-based recommendations for clinical practice.

METHODS: A multi-national group of specialists in intensive care, emergency, and geriatric medicine provided opinions on managing very old patients with critical conditions. Strong or moderate consensus was defined as having at least 90% or 80% of experts, respectively, expressing agreement or disagreement on the three highest or lowest levels of a 9-points Likert scale.

RESULTS: Twenty-eight members of the expert steering group and 82 additional experts completed two Delphi rounds. After discussing the results, the steering group issued recommendations for 48 statements and 2 checklists for which consensus was achieved. In addition to determining fundamental principles, they include advice on goals of care and the decision-making about admission to and treatment of patients in intensive care and the management after discharge.

CONCLUSION: A multi-disciplinary group of experts achieved consensus on recommendations concerning intensive care for very old patients, which were approved and endorsed by ESICM. The implementation requires a careful analysis of available healthcare resources and should proceed in a stepwise fashion.

Original language	English
Article number	q116
Pages (from-to)	287-301
Number of pages	15
Journal	Intensive Care Medicine
Volume	51
Issue number	2
Early online date	17 Feb 2025
DOIs	https://doi.org/10.1007/s00134-025-07794-4
Publication status	Published - Feb 2025

Keywords

Critical care
Delphi study
Emergency medicine
Geriatric medicine
Intensive care

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10.1007/s00134-025-07794-4

s00134-025-07794-4Final published version, 980 KBLicence: Taverne

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Beil, M., Alberto, L., Bourne, R. S., Brummel, N. E., de Groot, B., de Lange, D. W., Elbers, P., Emmelot-Vonk, M., Flaatten, H., Freund, Y., Galazzi, A., Garcia-Martinez, A., Guidet, B., Holmerova, I., Jacobs, J. M., Joynt, G. M., Leaver, S., Leone, M., McNicholas, B., ... Jung, C. (2025). ESICM consensus-based recommendations for the management of very old patients in intensive care. Intensive Care Medicine, 51(2), 287-301. Article q116. https://doi.org/10.1007/s00134-025-07794-4

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title = "ESICM consensus-based recommendations for the management of very old patients in intensive care",

abstract = "PURPOSE: The heterogeneity of very old patients (age ≥ 80 years) and the prevalence of complex geriatric syndromes in this cohort constitute major challenges for the classical methods of evidence-based medicine to inform clinical practice. The lack of robust guidance for the management of critical conditions in these patients contributes to considerable uncertainty among practitioners and unwarranted variations of care. The European Society of Intensive Care Medicine (ESICM) initiated a Delphi study to translate the empirical knowledge of experts in this field into consensus-based recommendations for clinical practice.METHODS: A multi-national group of specialists in intensive care, emergency, and geriatric medicine provided opinions on managing very old patients with critical conditions. Strong or moderate consensus was defined as having at least 90\% or 80\% of experts, respectively, expressing agreement or disagreement on the three highest or lowest levels of a 9-points Likert scale.RESULTS: Twenty-eight members of the expert steering group and 82 additional experts completed two Delphi rounds. After discussing the results, the steering group issued recommendations for 48 statements and 2 checklists for which consensus was achieved. In addition to determining fundamental principles, they include advice on goals of care and the decision-making about admission to and treatment of patients in intensive care and the management after discharge.CONCLUSION: A multi-disciplinary group of experts achieved consensus on recommendations concerning intensive care for very old patients, which were approved and endorsed by ESICM. The implementation requires a careful analysis of available healthcare resources and should proceed in a stepwise fashion.",

keywords = "Critical care, Delphi study, Emergency medicine, Geriatric medicine, Intensive care",

author = "Michael Beil and Laura Alberto and Bourne, \{Richard S\} and Brummel, \{Nathan E\} and \{de Groot\}, Bas and \{de Lange\}, \{Dylan W\} and Paul Elbers and Marielle Emmelot-Vonk and Hans Flaatten and Yonathan Freund and Alessandro Galazzi and Ana Garcia-Martinez and Bertrand Guidet and Iva Holmerova and Jacobs, \{Jeremy M\} and Joynt, \{Gavin M\} and Susannah Leaver and Marc Leone and Bairbre McNicholas and David McWilliams and Victoria Metaxa and Nickel, \{Christian H\} and Daniele Poole and Chiara Robba and Kevin Roedl and Marc Romain and Anne-Fran{\c c}oise Rousseau and Sigal Sviri and Wojciech Szczeklik and Helene Vallet and \{van Oppen\}, James and Christian Jung",

note = "Publisher Copyright: {\textcopyright} Springer-Verlag GmbH Germany, part of Springer Nature 2025.",

year = "2025",

month = feb,

doi = "10.1007/s00134-025-07794-4",

language = "English",

volume = "51",

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Beil, M, Alberto, L, Bourne, RS, Brummel, NE, de Groot, B, de Lange, DW, Elbers, P, Emmelot-Vonk, M, Flaatten, H, Freund, Y, Galazzi, A, Garcia-Martinez, A, Guidet, B, Holmerova, I, Jacobs, JM, Joynt, GM, Leaver, S, Leone, M, McNicholas, B, McWilliams, D, Metaxa, V, Nickel, CH, Poole, D, Robba, C, Roedl, K, Romain, M, Rousseau, A-F, Sviri, S, Szczeklik, W, Vallet, H, van Oppen, J & Jung, C 2025, 'ESICM consensus-based recommendations for the management of very old patients in intensive care', Intensive Care Medicine, vol. 51, no. 2, q116, pp. 287-301. https://doi.org/10.1007/s00134-025-07794-4

TY - JOUR

T1 - ESICM consensus-based recommendations for the management of very old patients in intensive care

AU - Beil, Michael

AU - Alberto, Laura

AU - Bourne, Richard S

AU - Brummel, Nathan E

AU - de Groot, Bas

AU - de Lange, Dylan W

AU - Elbers, Paul

AU - Emmelot-Vonk, Marielle

AU - Flaatten, Hans

AU - Freund, Yonathan

AU - Galazzi, Alessandro

AU - Garcia-Martinez, Ana

AU - Guidet, Bertrand

AU - Holmerova, Iva

AU - Jacobs, Jeremy M

AU - Joynt, Gavin M

AU - Leaver, Susannah

AU - Leone, Marc

AU - McNicholas, Bairbre

AU - McWilliams, David

AU - Metaxa, Victoria

AU - Nickel, Christian H

AU - Poole, Daniele

AU - Robba, Chiara

AU - Roedl, Kevin

AU - Romain, Marc

AU - Rousseau, Anne-Françoise

AU - Sviri, Sigal

AU - Szczeklik, Wojciech

AU - Vallet, Helene

AU - van Oppen, James

AU - Jung, Christian

PY - 2025/2

Y1 - 2025/2

N2 - PURPOSE: The heterogeneity of very old patients (age ≥ 80 years) and the prevalence of complex geriatric syndromes in this cohort constitute major challenges for the classical methods of evidence-based medicine to inform clinical practice. The lack of robust guidance for the management of critical conditions in these patients contributes to considerable uncertainty among practitioners and unwarranted variations of care. The European Society of Intensive Care Medicine (ESICM) initiated a Delphi study to translate the empirical knowledge of experts in this field into consensus-based recommendations for clinical practice.METHODS: A multi-national group of specialists in intensive care, emergency, and geriatric medicine provided opinions on managing very old patients with critical conditions. Strong or moderate consensus was defined as having at least 90% or 80% of experts, respectively, expressing agreement or disagreement on the three highest or lowest levels of a 9-points Likert scale.RESULTS: Twenty-eight members of the expert steering group and 82 additional experts completed two Delphi rounds. After discussing the results, the steering group issued recommendations for 48 statements and 2 checklists for which consensus was achieved. In addition to determining fundamental principles, they include advice on goals of care and the decision-making about admission to and treatment of patients in intensive care and the management after discharge.CONCLUSION: A multi-disciplinary group of experts achieved consensus on recommendations concerning intensive care for very old patients, which were approved and endorsed by ESICM. The implementation requires a careful analysis of available healthcare resources and should proceed in a stepwise fashion.

AB - PURPOSE: The heterogeneity of very old patients (age ≥ 80 years) and the prevalence of complex geriatric syndromes in this cohort constitute major challenges for the classical methods of evidence-based medicine to inform clinical practice. The lack of robust guidance for the management of critical conditions in these patients contributes to considerable uncertainty among practitioners and unwarranted variations of care. The European Society of Intensive Care Medicine (ESICM) initiated a Delphi study to translate the empirical knowledge of experts in this field into consensus-based recommendations for clinical practice.METHODS: A multi-national group of specialists in intensive care, emergency, and geriatric medicine provided opinions on managing very old patients with critical conditions. Strong or moderate consensus was defined as having at least 90% or 80% of experts, respectively, expressing agreement or disagreement on the three highest or lowest levels of a 9-points Likert scale.RESULTS: Twenty-eight members of the expert steering group and 82 additional experts completed two Delphi rounds. After discussing the results, the steering group issued recommendations for 48 statements and 2 checklists for which consensus was achieved. In addition to determining fundamental principles, they include advice on goals of care and the decision-making about admission to and treatment of patients in intensive care and the management after discharge.CONCLUSION: A multi-disciplinary group of experts achieved consensus on recommendations concerning intensive care for very old patients, which were approved and endorsed by ESICM. The implementation requires a careful analysis of available healthcare resources and should proceed in a stepwise fashion.

KW - Critical care

KW - Delphi study

KW - Emergency medicine

KW - Geriatric medicine

KW - Intensive care

UR - https://www.scopus.com/pages/publications/85219711906

U2 - 10.1007/s00134-025-07794-4

DO - 10.1007/s00134-025-07794-4

M3 - Article

C2 - 39961851

SN - 0342-4642

VL - 51

SP - 287

EP - 301

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 2

M1 - q116

ER -

ESICM consensus-based recommendations for the management of very old patients in intensive care

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Keywords

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Correction: ESICM consensus-based recommendations for the management of very old patients in intensive care (Intensive Care Medicine, (2025), 51, 2, (287-301), 10.1007/s00134-025-07794-4)

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