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Pre-ICU Triage: The Very Old Critically Ill Patient

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The Very Old Critically Ill Patients

Part of the book series: Lessons from the ICU ((LEICU))

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Abstract

ICU resources are not unlimited, and in many circumstances frontline clinicians may be called upon to prioritize among patients who are referred for ICU care. When resources, manifested as ICU bed availability, are insufficient to offer ICU admission for all, some patients must be refused. There are concerns regarding this process of triage in the very elderly. On the one hand, some are concerned that the very elderly will be preferentially refused as a result of age discrimination, whereas others are concerned that the very elderly may receive inappropriately aggressive ICU care resulting in unnecessary suffering and pain, as well as consuming resources better redirected to the young.

This chapter will categorize the underlying reasons why very elderly patients may be refused ICU admission but focus on the process of triage in resource-restricted settings. A modified utilitarian approach will be used for justification of triage across all age groups, including the very elderly. Suggested methods of prioritization that avoid the need to directly and substantially consider chronological age will be described. A decision-making framework, coupled with a prioritization tool, is presented to inform the process of frontline triage.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China

    Gavin M. Joynt

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Editors and Affiliations

  1. Faculty of Medicine, Department of Clinical Medicine and Department of Anaesthesia and Intensive Care, University of Bergen and Haukeland University Hospital, Bergen, Norway

    Hans Flaatten

  2. Sorbonne Université, INSERM Institut Pierre Louis d’Epidémiologie et de, Santé Publique, AP-HP, Hôpital Saint Antoine, Paris, France

    Bertrand Guidet

  3. Sorbonne Université, Hôpital Saint Antoine Unité de Gériatrie Aiguë, Assistance Publique, Hôpitaux de Paris, Paris, France

    Hélène Vallet

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Joynt, G.M. (2022). Pre-ICU Triage: The Very Old Critically Ill Patient. In: Flaatten, H., Guidet, B., Vallet, H. (eds) The Very Old Critically Ill Patients. Lessons from the ICU. Springer, Cham. https://doi.org/10.1007/978-3-030-94133-8_15

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  • DOI: https://doi.org/10.1007/978-3-030-94133-8_15

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  • Print ISBN: 978-3-030-94132-1

  • Online ISBN: 978-3-030-94133-8

  • eBook Packages: MedicineMedicine (R0)

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