PURPOSE: The heterogeneity of very old patients (age ≥ 80 years) and the prevalence of complex geriatric syndromes in this cohort constitute major challenges for the classical methods of evidence-based medicine to inform clinical practice. The lack of robust guidance for the management of critical conditions in these patients contributes to considerable uncertainty among practitioners and unwarranted variations of care. The European Society of Intensive Care Medicine (ESICM) initiated a Delphi study to translate the empirical knowledge of experts in this field into consensus-based recommendations for clinical practice. METHODS: A multi-national group of specialists in intensive care, emergency, and geriatric medicine provided opinions on managing very old patients with critical conditions. Strong or moderate consensus was defined as having at least 90% or 80% of experts, respectively, expressing agreement or disagreement on the three highest or lowest levels of a 9-points Likert scale. RESULTS: Twenty-eight members of the expert steering group and 82 additional experts completed two Delphi rounds. After discussing the results, the steering group issued recommendations for 48 statements and 2 checklists for which consensus was achieved. In addition to determining fundamental principles, they include advice on goals of care and the decision-making about admission to and treatment of patients in intensive care and the management after discharge. CONCLUSION: A multi-disciplinary group of experts achieved consensus on recommendations concerning intensive care for very old patients, which were approved and endorsed by ESICM. The implementation requires a careful analysis of available healthcare resources and should proceed in a stepwise fashion.

Assistance Publique Hôpitaux de Paris Hôpital Saint Antoine Service de Réanimation Médicale Paris France

Center for Intensive Care and Perioperative Medicine Jagiellonian University Medical College Krakow Poland

Centre for Care Excellence Coventry University Coventry UK

Centre for Education Faculty of Life Sciences and Medicine King's College London UK

Centre for Urgent and Emergency Care Research University of Sheffield Sheffield UK

Centre of Gerontology Centre of Expertise in Longevity and Long Term Care Faculty of Humanities Charles University Prague Czech Republic

Consejo Nacional de Investigaciones Científicas y Técnicas Instituto de Investigación en Medicina y Ciencias de la Salud Universidad del Salvador Ciudad de Buenos Aires Argentina

Department of Anaesthesia and Intensive Care Faculty of Medicine The Chinese University of Hong Kong Hong Kong China

Department of Anaesthesia and Intensive Care Medicine Galway University Hospital Galway Ireland

Department of Anesthesiology and Intensive Care Unit Assistance Publique Hopitaux Universitaires de Marseille Aix Marseille University Marseille France

Department of Cardiology Pulmonology and Vascular Medicine and Cardiovascular Research Institute Düsseldorf Heinrich Heine University Duesseldorf Medical Faculty Duesseldorf Germany

Department of Critical Care King's College Hospital NHS Foundation Trust London UK

Department of Emergency Medicine Radboud UMC Nijmegen The Netherlands

Department of Geriatric Rehabilitation and Center for Palliative Care Hadassah Medical Center and Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel

Department of Geriatrics University Medical Center Utrecht Utrecht The Netherlands

Department of Intensive Care Medicine Center for Critical Care Computational Intelligence Amsterdam UMC Vrije Universiteit Amsterdam The Netherlands

Department of Intensive Care Medicine University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Intensive Care Medicine University Medical Center University Utrecht Utrecht The Netherlands

Department of Medical Intensive Care Hadassah Medical Center and Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel

Department of Medical Intensive Care Hadassah Medical Center Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel

Department of Medicine NHS Highland Inverness UK

Department of Medicine University of Udine Udine Italy

Department of Population Health Sciences University of Leicester Leicester UK

Department of Research and Development Haukeland University Hospital Bergen Norway

Departments of Pharmacy and Critical Care Sheffield Teaching Hospitals NHS Foundation Trust Herries Road Sheffield UK

Dipartimento di Scienze Chirurgiche Diagnostiche ed Integrate IRCCS Policlinico San Martino University of Genoa Genoa Italy

Division of Pharmacy and Optometry School of Health Sciences Faculty of Biology Medicine and Health The University of Manchester Oxford Road Manchester UK

Division of Pulmonary Critical Care and Sleep Medicine The Ohio State University College of Medicine The Ohio State University Wexner Medical Center Columbus OH USA

Emergency Department Hospital Clínic IDIBAPS Barcelona Spain

Emergency Department University Hospital University of Basel Basel Switzerland

General Intensive Care St George's University Hospitals NHS Foundation Trust London UK

Intensive Care Department University Hospital of Liège Research Unit for a Life Course Perspective on Health and Education RUCHE University of Liège Liège Belgium

National Institute for Health and Care Research School of Health Sciences Faculty of Biology Medicine and Health University of Manchester Oxford Road Manchester UK

Operative Unit of Pain Therapy S Martino Hospital Belluno Italy

Research Centre for Emergency Medicine Aarhus University Hospital Aarhus Denmark

Service de Gériatrie Aigue UPREG Hôpital Saint Antoine Assistance Publique Hôpitaux de Paris Sorbonne Université UMRS 1135 Institut National de la Santé et de la Recherche Médicale Paris France

Sorbonne Université IMProving Emergency Care FHU Emergency Department Hôpital Pitié Salpêtrière Assistance Publique Hôpitaux de Paris Paris France

Sorbonne Universités UPMC Univ Paris 06 INSERM UMR_S 1136 Institut Pierre Louis d'Epidémiologie et de Santé Publique Equipe Épidémiologie Hospitalière Qualité et Organisation des Soins Paris France

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