My last tweetucation session for #ATS2022 😢😢😢 will be “Current Controversies in Geriatric Critical Care”!
First up we have Dr. Sean Morrison with “Does Advance Care Planning Have Any Effect on Reducing High-Intensity Care?” #ATS2022
Hint: It does not.
Hint: It does not.
He spent years studying advance care planning (ACP). #ATS2022
His most recent paper showed that ACP does not lead to less life sustaining treatment. #ATS2022
The goal of ACP is to ensure goal concord at care near the end of life. #ATS2022
What does ACP include? #ATS2022
Why is ACP so attractive? There’s a ton of support and encouragement to do it. #ATS2022
We also have more data on ACP than we know what to do with! #ATS2022
There is evidence that we can accomplish these things. #ATS2022
We have NOT shown that ACP does these things. #ATS2022
So why does ACP persist and why is it so controversial? #ATS2022
What is the harm in doing ACP? #ATS2022
What are the alternatives to ACP? #ATS2022
Next we have Dr. Ramona Hopkins with “Should Prognostication in the ICU Be Based on Age, Disability, and Frailty?” #ATS2022
Making predictions is hard. This meta-analysis showed a huge range of mortality and substantial heterogeneity in outcome. #ATS2022
A systematic review of frailty found that it was associated with higher mortality, but there was a lot of heterogeneity in patients and their outcomes. #ATS2022
Looking at longer outcomes post-COVID-19 there are a wide range of outcomes. #ATS2022
A lot of these symptoms persist over time. #ATS2022
This paper tried to identify factors within COVID patients and compared them to patients with sepsis. #ATS2022
There is not a ton of difference in cognitive impairment across different age groups. #ATS2022
This study looked at young healthy patients with COVID and they found impaired concentration and memory were common. #ATS2022
COVID-19 associated psychosis #ATS2022
Conclusions #ATS2022
Next up is Dr. Thanh Neville (@thanh_neville) with “Should Admission to the ICU Be Conditional on a Time-Limited Trial?” #ATS2022
State of critical care #ATS2022
What is a time-limited trial? #ATS2022
Why should we use time-limited trials in the ICU? #ATS2022
This study looked at time-limited trials as the default framework for family meetings. #ATS2022
Now let’s walk through the steps involved in the framework. First you define the patient’s acute care needs and prognosis. #ATS2022
Clarify the patient’s goals, values, and preferences. #ATS2022
Identify objective markers for improvement or deterioration. #ATS2022
Identify a time-frame for reevaluation of the patient’s condition. #ATS2022
Define potential actions to take at the end of the trial based on potential outcomes. #ATS2022
So why use a TLT framework for all patients? #ATS2022
Next we have “Is It Ethical and Legal to Include Age in Triage Protocols During a Pabdemic?” with Dr. Douglas White! #ATS2022
This study looked at variation in ventilator allocation guidelines by US state. #ATS2022
Example of PA’s framework. #ATS2022
What does age have to do with it? #ATS2022
The two main goals in creating crisis standards of care. #ATS2022
These theories apply to the concept of whether age should factor into these equations. #ATS2022
The goal is to show equal respect for everyone. #ATS2022
Dying young is a severe form of disadvantage because they have the least chance to flourish and carry out their life plans. #ATS2022
So that was the ethical viewpoint. But is it legal to consider age in triage? #ATS2022
Objections to considering age in triage protocols. #ATS2022
Conclusions! #ATS2022
And our last speaker of the day will be Dr. Bram Rochwerg (@Bram_Rochwerg) with “Do Older Adults Respond Differently to ICU Interventions?” #ATS2022
So do the interventions that we use in younger adults also work in order adults? There are very few trials looking at this. #ATS2022
There is a difference between having a different baseline risk versus subgroup effect modification. In the first the intervention works the same in the groups (there is just differing risks), and in the 2nd the intervention works differently between the groups. #ATS2022
This systematic review looked at subgroup effects. #ATS2022
There are different criteria to judge whether subgroup effects are trustworthy or not. #ATS2022
What did they find? Only 4 trials found an effect modification by age. #ATS2022
HYBERNATUS looked at vented patients in status epilepticus with an intervention of hypothermia. #ATS2022
TRICS looked at transfusion goals in CV surgery patients. Older patients did better with the restrictive strategy (liberal was better for younger patients). #ATS2022
SPICE III looked at vented patients and evaluated Precedex as the primary sedative. Older patients seemed to do better with Precedex. #ATS2022
COACT looks at OHCA without ST elevation with an intervention of immediate vs delayed angiography. Older patients seemed to do better with early angiography. #ATS2022
So do interventions work in older adults? Yes! Don’t use their age as a rationale for withholding interventions if they otherwise would want the intervention. #ATS2022
Where do we go from here? #ATS2022
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