Table 2 Components of decision-making for very old ICU patients
Country/region | Key parameters of decision-making (in addition to acute and chronic conditions) | How to deal with prognostic uncertainty | Involvement of geriatric medicine/palliative care | Trigger to consider limiting LST in the presented scenario |
|---|---|---|---|---|
Australia | Expected functional outcome | Treatment trial in- or outside ICU | Rarely | AKI |
Brazil | Patient's and family's values | Time-limited trial in ICU | Rarely | AKI requiring dialysis |
Canada | Patient's and family's values | Time-limited trial in ICU | Palliative care | AKI, stroke |
China | Family's wishes | ICU trial, discussion with patient's legal representative | Palliative care | Lack of appropriate response to treatment |
England | Baseline function, expected functional outcome | ICU trial | Palliative care, geriatric medicine (rarely) | AKI |
Hong Kong | Family's wishes | Time-limited trial in ICU | Rarely | High vasopressor doses, AKI, stroke |
Israel | Expected functional outcome, family's wishes | ICU trial | Geriatric medicine (rarely) | Increased suffering, decreased likelihood of acceptable functional outcome |
Libya | Patient's and family's values, functional independence, social support | Discussions with family, colleagues and other healthcare staff | Physicians with experience in geriatric medicine or palliative care | Individual (depending on patient's values) |
Norway | Patient's values | Treatment trial in- or outside ICU | Rarely | AKI |
Poland | Expected functional outcome, burden of treatment | Time-limited trial in ICU | Rarely | Stroke |