2019-04-01
AUTHORSHans Flaatten, Christian Jung, Helene Vallet, Bertrand Guidet
ABSTRACTFrailty as a concept has been developed a lot during the last 25 years. From its start in geriatrics, its usefulness has also been demonstrated in most other clinical specialties including anesthesia, surgery, and intensive care. Several tools have been found useful to characterize frailty status: frailty phenotype, clinical frailty scale, or specific scores for surgical patients. The purpose of this review is to discuss how frailty interactive with acute critical illness and may alter ICU outcomes, particularly in the old patients. Frailty has in many studies been found to have a substantial impact on most outcome parameters in ICU patients, mainly mortality, but also as non-mortality outcomes. Risk ratio for mortality in frail versus non-frail ICU patients is significantly increased. Frailty affects several important body functions like the endocrine system and brain, muscular, and immune functions. In the ICU, these impaired body functions add to the traditional acute vital organ dysfunctions, well described in the ICU patient. This combination of reduced body function in patients that in addition develops a critical illness is the most likely cause of not only increased short-term but also long-term mortality found in frail ICU patients. This review summarizes current tools to identify frailty and summarizes recent findings of the prognostic role of frailty in the ICU. More... »
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