Alessandro Morandi's research while affiliated with VHIR Vall d’Hebron Research Institute and other places

Publications (16)

Article
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Background Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. Objective To...
Article
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Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determ...
Article
Full-text available
Female and male very elderly intensive patients (VIPs) might differ in characteristics and outcomes. We aimed to compare female versus male VIPs in a large, multinational collective of VIPs with regards to outcome and predictors of mortality. In total, 7555 patients were included in this analysis, 3973 (53%) male and 3582 (47%) female patients. The...
Article
Full-text available
Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determi...
Article
Purpose Premorbid conditions affect prognosis of acutely-ill aged patients. Several lines of evidence suggest geriatric syndromes need to be assessed but little is known on their relative effect on the 30-day survival after ICU admission. The primary aim of this study was to describe the prevalence of frailty, cognition decline and activity of dail...
Article
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Background: Delirium is a geriatric syndrome that presents in 1 out of 5 hospitalized older patients. It is also common in the community, in hospices, and in nursing homes. Delirium prevalence varies according to clinical setting, with rates of under 5% in minor elective surgery but up to 80% in intensive care unit patients. Delirium has severe ad...
Article
Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. Methods: In total, 5063 VIPs were included in this analysis,...
Article
Full-text available
OBJECTIVES To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs). DESIGN Prospective cohort study. SETTING A total of 306 ICUs from 24 European countries. PARTICIPANTS Older adults admitted to European ICUs (N = 3730; median age = 84 years [in...
Article
Full-text available
Background There is currently no international recommendation for the admission or treatment of the critically ill older patients over 80 years of age in the intensive care unit (ICU), and there is no valid prognostic severity score that includes specific geriatric assessments. Main body In this review, we report recent literature focusing on olde...
Article
In the original publication Dr Patrick Meybohm of the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt University Hospital, Frankfurt, Germany was inadvertently omitted from the list of investigators.
Article
Full-text available
Purpose: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. Methods: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. Results: LST limitation was iden...
Article
Full-text available
Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to st...

Citations

... Frail patients are indeed at high risk of functional and cognitive decline, falls, disability, and mortality after hospitalization [14]. In the Intensive Care Units (ICU), measures of frailty demonstrated to be accurate in stratifying the prognosis of older people affected by sepsis and other critical illnesses [15][16][17][18]. However, sepsis is common also in other acute hospital wards. ...
... Twelve (n = 12, 20.6) studies exclusively used this approach [2, 18-23, 27, 58-61], without using any additional frailty score. Ten studies [10,30,33,34,37,39,46,47,52,56] only assessed functional status for follow-up, after assessing frailty at the time of hospitalization. ...
... We found that the SOFA score, and CRP serum levels were the best predictors of in-hospital mortality in our population. This is not surprising given that previous studies have repeatedly demonstrated their association with short-term mortality, both in medical wards and ICU [19,[42][43][44][45][46]. Lactate serum levels also showed good ability to predict in-hospital mortality in the AUROC analyses, but this finding was not confirmed by the multivariate logistic regression. ...
... At the moment, NIV is strongly recommended by the combined European Respiratory Society and American Thoracic Society task force in two clinical scenarios, i.e., hypercapnic ARF due to COPD exacerbation and cardiogenic pulmonary oedema [18]. Previous reports by the VIP Study Group, based on a cohort of patients aged ≥ 80 years admitted to the ICUs before the pandemic, showed that every fourth patient received NIV [19]. In the light of a universal shortage of ICU beds during the COVID-19 pandemic, NIV became a promising alternative to IMV in patients with severe hypoxemic ARF. ...
... Importantly, all parts are closely connected with each other, e.g., the choice of sedation and analgesics will likely affect choice of pain assessment, but also success of the awakening trial. The choice of sedation could also affect, and even hinder early mobilization [67], and the occurrence of delirium, particularly when using benzodiazepines [36,68]. Performing all parts of the bundle, including restricting the use of physical restraints, will be crucial for optimizing patient outcomes, especially regarding delirium prevention. ...
... Other factors specific to older patients are known to influence ICU outcomes, such as the Clinical Frailty Scale, its components being items reflecting functional ability [10]. Age and pre-existing comorbidities weigh heavily in mortality prediction models [37], thus leading to lower discrimination of severity of these models in older patients [38]. We observed a difference between observed mortality and probability of mortality using SAPS-3 which suggests that this score is not suited for older patients. ...
... In this post-hoc analysis of these two studies, all patients admitted acutely (non-electively) with complete data on age, gender, clinical frailty score (CFS), sequential organ failure assessment (SOFA) score, and ICU mortality were included. For this study, the elective patients included in VIP1 were excluded as their outcomes differ significantly compared with those admitted acutely, as previously shown [18]. The primary endpoint of this study was ICU-mortality, and the secondary endpoint was 30-day-mortality. ...
... such as frailty, polypharmacy and multimorbidity, making it more difficult for them to overcome acute medical stress and to survive and recover their previous functional autonomy [4,5]. For all these reasons, mortality is increased among older patients hospitalized in an ICU, comparatively with younger populations, with a 6-month mortality ranging from 21 to 58% [1,[6][7][8]. Most studies evaluating short-and long-term mortality are heterogeneous in design and results, and factors associated with mortality vary widely across studies [9]. ...
... Most studies evaluating short-and long-term mortality are heterogeneous in design and results, and factors associated with mortality vary widely across studies [9]. Outcomes of older patients hospitalised in ICUs are influenced by premorbid conditions, notably frailty and comorbidities, as well as in-ICU events, such as duration of mechanical ventilation and decisions to withdraw life-sustaining therapies [4,5,[9][10][11][12][13]. In addition, among survivors, some may suffer from disabilities, cognitive impairment and decreased quality of life [14,15]. ...
... A growing body of evidence supports the role of occupational therapy (OT) in the management of delirium. 98 OT measures include facilitating the use of appropriate bed and chair aids, aiding with safe transfers, assisting with orientation through environmental adaptations, communicating with caregivers and family members, and providing opportunities for cognitive stimulation. 99 An OT protocol-based intervention providing daily assessment and treatment based on m-RASS scores was found to be feasible for the management of DSD in nursing home residents. ...