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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "393" "paginaFinal" => "394" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "O. Rubio Sanchiz, R. Fernández Fernández" "autores" => array:2 [ 0 => array:4 [ "nombre" => "O." "apellidos" => "Rubio Sanchiz" "email" => array:1 [ 0 => "orubio@althaia.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Fernández Fernández" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Intensiva, Althaia Xarxa Hospitalaria Universitaria de Manresa, Manresa, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Resulta útil evaluar la fragilidad de los pacientes al ingreso en la unidad de cuidados intensivos (UCI)?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleSmallCaps">Medicina</span><span class="elsevierStyleSmallCaps">Intensiva</span> we publish an interesting research on the prevalence of frailty in patients over 65 years old (FRAIL-ICU) that amounts to 35%,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and its direct impact on mortality, especially 1 month and 6 months after ICU discharge.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Probably some readers will wonder what sense does it make to measure frailty at the ICU, what the profile of these patients should be, and what the utility of all this may be?</p><p id="par0015" class="elsevierStylePara elsevierViewall">In an era defined by the necessary efficiency of the healthcare system with more and more elderly patients being admitted to ICUs, more complexity and comorbidities, worse prior functional statuses and therefore, frail and vulnerable, the initial assessment of these patients has become more and more necessary. And yet there is still uncertainty about the mortality results and quality of life of this subgroup of patients, which is why we need objective predictive tools to help us decide what patients will benefit the most from the ICU stay, and who won’t.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Are the traditional criteria based on the patient's age, will, severity, prognosis, quality of life, presence of comorbidity, etc. any good anymore?</p><p id="par0025" class="elsevierStylePara elsevierViewall">Are we convinced about not making positive discrimination by admitting patients without a clear benefit… or negative discrimination by denying admission to patients just because they are too old?</p><p id="par0030" class="elsevierStylePara elsevierViewall">The severity of the disease that conditions the ICU admission and the patient's prior functional status, rather than age itself, are the key elements that determine the patient's overall mortality, and long-term vital prognosis and functional status.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The traditional criteria used in younger patients, with fewer comorbidities and diseases of one system only and acute decompensations cannot be used with complex patients or patients with several diseases or frail patients, so new tools are needed and they need to be more adapted to the most prevalent type of patient with more multidimensional and holistic assessments of such patients.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">On the other hand, it would be interesting to know what health results are patients really expecting, above all complex patients and patients with multiple diseases, but… what results do patients care the most? Saving their lives at all cost is a good health outcome for them? Or maybe recovering an acceptable functionality and quality of life after the ICU admission would be a better outcome?</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is hard to know or predict what is best for this or that patient, and here the first step should always be knowing the patient's will after giving him honest information of what is at stake during an ICU admission. Patients admitted to an ICU with organ failures pay an expensive toll: the severe frailty that has a direct impact on the patient's recovery and return to his prior functional status.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In line with recent international studies,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> the FRAIL-ICU study has opened Pandora's box on the impact frailty has (concept defined as a state of increasing vulnerability with poor resolution of homeostasis after a stressful event with an increased risk of adverse events, falls, delirium, and disability) on mortality, and whether it should be part of the decision-making process at admission and further therapeutic support.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Assessing frailty in elderly patients can be useful, but it is also important to assess it in young patients like the FRAIL-ICU says, especially in patients with chronic conditions, in those who have had prolonged prior admissions or in patients with criteria that contribute to frailty.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Frailty is associated with non-adjusted mortality, like the FRAIL-ICU study shows, and compromises the results and rehabilitation process of patients.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,6</span></a> That is why it may be useful to screen frailty in order to identify it early in young patients, be able to take preventive measures, help identify individual goals, and implement interventions to minimize the functional decline of critical conditions and reduce ICU stays.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Knowing about the existence of frailty can also help us adequate life-sustaining treatments at admission, since patients with frailty make more decisions of limitation of life-sustaining treatment (LLST)<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and early palliative care strategies even while at their ICU stay.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Still, we need more studies on this regard to be able to determine the weight of frailty in the decisions of initiating or withdrawing life-sustaining treatments.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Frailty is useful together with other criteria for the assessment of those patients who may benefit the most from an ICU admission; it should be measured whenever patients show a previously deteriorated functional status, to implement an adequate action program capable of assessing treatment and the maximum level of organ support, not to fall into futile diagnostic and therapeutic situations, and ultimately to give the patient proper end-of-life care.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rubio Sanchiz O, Fernández Fernández R. ¿Resulta útil evaluar la fragilidad de los pacientes al ingreso en la unidad de cuidados intensivos (UCI)? 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 9 | 8 | 17 |
2024 October | 36 | 39 | 75 |
2024 September | 43 | 33 | 76 |
2024 August | 47 | 29 | 76 |
2024 July | 41 | 32 | 73 |
2024 June | 49 | 36 | 85 |
2024 May | 37 | 25 | 62 |
2024 April | 43 | 35 | 78 |
2024 March | 32 | 29 | 61 |
2024 February | 32 | 37 | 69 |
2024 January | 31 | 47 | 78 |
2023 December | 31 | 41 | 72 |
2023 November | 37 | 41 | 78 |
2023 October | 33 | 27 | 60 |
2023 September | 34 | 37 | 71 |
2023 August | 35 | 16 | 51 |
2023 July | 33 | 21 | 54 |
2023 June | 28 | 15 | 43 |
2023 May | 35 | 39 | 74 |
2023 April | 16 | 17 | 33 |
2023 March | 34 | 26 | 60 |
2023 February | 24 | 31 | 55 |
2023 January | 22 | 34 | 56 |
2022 December | 35 | 22 | 57 |
2022 November | 42 | 30 | 72 |
2022 October | 44 | 20 | 64 |
2022 September | 28 | 27 | 55 |
2022 August | 43 | 34 | 77 |
2022 July | 57 | 28 | 85 |
2022 June | 30 | 21 | 51 |
2022 May | 60 | 31 | 91 |
2022 April | 59 | 28 | 87 |
2022 March | 43 | 53 | 96 |
2022 February | 25 | 31 | 56 |
2022 January | 40 | 37 | 77 |
2021 December | 41 | 43 | 84 |
2021 November | 29 | 37 | 66 |
2021 October | 33 | 63 | 96 |
2021 September | 14 | 21 | 35 |
2021 August | 12 | 47 | 59 |
2021 July | 10 | 32 | 42 |
2021 June | 23 | 21 | 44 |
2021 May | 23 | 47 | 70 |
2021 April | 66 | 91 | 157 |
2021 March | 63 | 30 | 93 |
2021 February | 44 | 22 | 66 |
2021 January | 30 | 14 | 44 |
2020 December | 26 | 11 | 37 |
2020 November | 26 | 13 | 39 |
2020 October | 22 | 23 | 45 |
2020 July | 14 | 7 | 21 |
2020 June | 24 | 8 | 32 |
2020 May | 15 | 4 | 19 |
2020 April | 21 | 10 | 31 |
2020 March | 16 | 9 | 25 |
2020 February | 21 | 19 | 40 |
2020 January | 4 | 5 | 9 |
2019 November | 1 | 0 | 1 |
2019 September | 2 | 4 | 6 |