Differences in early, intermediate, and long-term mortality among elderly patients admitted to the ICU: results of a retrospective observational study.

BACKGROUND: Few studies have investigated both short- and long-term prognostic factors, and the differences between chronic and acute conditions in the very old critically ill patient. Our study aims to shed light in this field and to provide useful prognostic factors that may support clinical decisions in the management of the elderly. METHODS: Six ICUs collected data concerning 80-year-old (or more) patients admitted in 2015 and 2016 and followed-up until May 2018. Three prognostic models were developed: an in-hospital mortality model, a model for patients discharged from the hospital and entering follow-up, and an intermediate model for those alive after three days from ICU admission. RESULTS: Our centers admitted 1189 patients, 1071 (90.1%) had survived after three days from admission, 889 (74.8%) were discharged from the hospital, 701 (59.0%) survived six months after hospital discharge, 539 (45.3%) survived at the end of follow-up. Among survivors the median follow-up time was 810 days. Acute organ failures were the main causes of death in the hospital mortality multivariable model. These factors are modifiable and potentially a target for intervention to improve outcome. The model focused on mortality six months after hospital in patients that survived a three-day time-limited trial, showed a clear shift toward chronic diseases, unmodifiable factors crucial for prognostic assessment. This trend was even more evident at the end of follow-up. CONCLUSIONS: Among very old ICU patients, prognostic factors shift from acute to chronic conditions in passing from in-hospital to posthospital outcomes.

Care and compassion at time of pandemic: an ICU field experience in Italy.

After the COVID-19 pandemic outbreak in March 2020, the majority of hospital policies have followed guidelines aimed to prevent the virus transmission and the families' entry was denied in all hospital wards and intensive care units (ICU). Despite being necessary, such restrictions have been experienced with discomfort and sufferings by the general ICU staff of Treviso Hospital (Italy) and by families of patients. Therefore, from April 2020, a step-by-step project was developed to reactivate contact with COVID-19 patients' families. The several requests and appeals of intensive care communities and organizations, both nationally and internationally, motivated the Treviso hospital initiative, leading to a model that might be potentially useful to other intensive care units worldwide.

Effect of Hemoadsorption for Cytokine Removal in Pneumococcal and Meningococcal Sepsis.

Bacterial meningitis and septicemia are invasive bacterial diseases, representing a significant cause of morbidity and mortality worldwide. Both conditions are characterized by an impressive inflammatory response, resulting rapidly in cerebral edema, infarction, hydrocephalus, and septic shock with multiple organ failure. Despite advances in critical care, outcome and prognosis remain critical. Available adjunctive treatments to control the inflammatory response have shown encouraging results in the evolution of patients with sepsis and systemic inflammation, but meningococcal or pneumococcal infection has not been investigated. We herein report five patients with similar critical pathological conditions, characterized by pneumococcal or meningococcal sepsis and treated with hemoadsorption for cytokine removal. All patients showed a progressive stabilization in hemodynamics along with a rapid and marked reduction of catecholamine dosages, a stabilization in metabolic disorders, and less-than-expected loss of extremities. Therapy proved to be safe and well tolerated. From this first experience, extracorporeal cytokine removal seems to be a valid and safe therapy in the management of meningococcal and pneumococcal diseases and may contribute to the patient stabilization and prevention of severe sequelae. Further studies are required to confirm efficacy in a larger context.