/ Prof Hans Flaatten
I am trained as an Anesthesiologist but have for the last 30 years worked as a full time Intensivist, mainly at the University Hospital, Bergen, Norway. I was head of the ICU from 1994 to 2014 and have had a Professorship at the University of Bergen from 2004. From 2014 as a full professor. I have also worked a long time within the European Society of Intensive care Medicine (ESICM), first as a National council member, later in the EDIC sub-committee and also three years as Head of the Division of Professional Development in ESICM. This made me realize how important education is for Intensive Care. I am also a part of the BASIC group (Hong-Kong) that has developed a series of ICU courses, used a lot also in UK and Ireland.
Lately, I have been more active with research through the HSRO section of ESICM, and served as Head of this research group from 2014-17. My research area has mainly been outcomes after intensive care in general, but gradually the focus has shifted to study the very old (≥80 years) ICU patients. With the basis from the HSRO section, we have reached out and found a huge interest for this patient group in all countries, and hence founded a research group conduction the VIP studies.
Of other research interest is quality improvement, in particular within intensive care, and other organization matters. More about myself and my research interests can be found at: https://www.researchgate.net/profile/Hans_Flaatten
Brief outline of my two lectures:
The Very Old Intensive Care Patient study: what we learned
The increased life-expectancy will obviously increase the stress to health care, since a majority of patients admitted acutely to hospitals, are above 65-70 years. It has been estimated that the population ≥ 80 years may increase threefold by 2050! Some ICUs already admit > 30% as octogenarians. On one hand the number of healthy octogenarians increases and should probably be given intensive care as usual. On the other hand, there is a group of very old patients where intensive care just adds to the burden for patients as well as family, with a high mortality and reduced quality of life in survivors. A group of intensivists within ESICM have established a study project called the VIP-project, the Very old Intensive care Patient. The main goal was first to get more facts about epidemiology and outcomes from large prospective multinational studies in Europe. Too many studies have been small, single center and retrospective and does not add a lot of information. The VIP1 study recruited > 5000 patients from 21 countries and provided information about epidemiology and short time outcome. The study reinforced the important role frailty has in understanding of this patient group. In the following sub-studies, VIP1 also revealed the importance to separate elective from acute admitted elderly patients; the outcome of octogenarians with sepsis and also the large variety of withholding and withdrawal of care across Europe. The next VIP2 study will explore the effects of combination of various geriatric “syndromes” towards outcome in acutely admitted elderly patients, and ended recruitment May 1, so far with > 3500 patients included.
Development of a prognostic tool for very old ICU patients
Prognostication has for a long time been important for intensivists and has been accomplished in many ways. Most often a combination of clinical judgments and with support from objective tests are used, and sometimes supported by a prognostic score. However, it has been hard to develop prognostic scores that with a reasonable sensitivity and specificity is able to give much support for clinicians, and in particular in the very old where our traditional scoring systems like APACHE and SAPS are much less predictive than in younger patients. In the very old ICU patients, the mortality on short and long term is considerably higher than in less old, an indication that there must be additional elements that are more important than acute illness and age of the patient. Such important factors have been described and used by geriatricians for many years. Factors like frailty, cognitive decline, sarcopenia and immunosenescence probably all play important roles in the ability of very old ICU patients to survive critical care. From several studies in the recent years we can conclude that the degree of frailty plays an important role, probably more than the severity of organ failure, to predict 30-days mortality. The role of the other factors, and in particular in combination, remains virtually unknown. A large study is recently ended, the European VIP2 study (www.VIP2study.com), where the combination of frailty and cognition, activity of daily life and co-morbidity, all factors present prior to admission to the ICU, will be tested both for 30 day and 6 months survival. Hopefully this study may give us more answer to this puzzle.