ICE-CUB 2
Trial question
What is the effect of systematic ICU triage among critically ill elderly patients?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
55.0% female
45.0% male
N = 3036
3036 patients (1675 female, 1361 male).
Inclusion criteria: critically ill patients aged ≥ 75 years, free of cancer, with preserved functional status and nutritional status who arrived at the emergency department.
Key exclusion criteria: emergency department stay of > 24 hours; secondary referral to the emergency department; refusal to participate.
Interventions
N=1518 a systematic strategy (a program to promote systematic ICU admission).
N=1518 standard practice (no specific recommendation regarding the ICU triage process).
Primary outcome
Death at 6 months
45%
39%
45.0 %
33.8 %
22.5 %
11.3 %
0.0 %
A systematic
strategy
Standard
practice
Significant
increase ▲
NNH = 16
Significant increase in death at 6 months (45% vs. 39%; RR 1.16, 95% CI 1.07 to 1.26).
Secondary outcomes
Significant increase in ICU admission (61% vs. 34%; RR 1.8, 95% CI 1.66 to 1.95).
Significant increase in death in the hospital (30% vs. 21%; RR 1.39, 95% CI 1.23 to 1.57).
No significant difference in the percentage of patients experiencing a decline in at least 1 of the Index of Independence in Activities of Daily Living domains (68% vs. 60%; RR 1.06, 95% CI 0.99 to 1.13).
Safety outcomes
No significant difference in self-reported physical QoL at 6 months and death in the ICU.
Significant differences in self-reported mental QoL score at 6 months (44.6 vs. 43.7), mechanical ventilation (42% vs. 31%), noninvasive ventilation (28% vs. 36%), and fluid resuscitation (21% vs. 32%).
Conclusion
In critically ill patients aged ≥ 75 years, free of cancer, with preserved functional status and nutritional status who arrived at the emergency department, a systematic strategy was inferior to standard practice with respect to death at 6 months.
Reference
Bertrand Guidet, Guillaume Leblanc, Tabassome Simon et al. Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France: A Randomized Clinical Trial. JAMA. 2017 Oct 17;318(15):1450-1459.
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