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 McWilliamsVictoria 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

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

5 Citations (Scopus)

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
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

Bibliographical note

Publisher Copyright:
© Springer-Verlag GmbH Germany, part of Springer Nature 2025.

Funding

The implementation of the Delphi study on the Welphi platform ( www.welphi.com ) was funded by ESICM.

Funders	Funder number
European Society of Intensive Care Medicine

Keywords

Critical care
Delphi study
Emergency medicine
Geriatric medicine
Intensive care

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

Access to Document

10.1007/s00134-025-07794-4

Cite this

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. https://doi.org/10.1007/s00134-025-07794-4

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, AF, 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, pp. 287-301. https://doi.org/10.1007/s00134-025-07794-4

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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.",

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AU - Bourne, Richard S.

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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

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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.

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

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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