Elderly patients (over age 85) are increasingly treated in Intensive Care Units (ICU), despite doctors’ reluctance to accept these frail patients. There are only few studies describing the relevance of treatments for this group of patients in ICU. One of these studies defined an age of 85 or over as the essential admittance criterion. Exclusion criteriwere low autonomy before admittance or an inability to answer the phone. Epidemiological data, history, lifestyle, and autonomy (ADL score of six items) were recorded during admission to the ICU and by phone interviews six months later. Eight French ICUs included 239 patients aged over 85. The most common diagnostics were non-cardiogenic lung disease (36%), severe sepsis/septic shock (29%), and acute pulmonary oedem (28%). Twenty-three percent of patients were dependent at the time of their admission. Seventy-one percent of patients were still alive when released from ICU, and 52% were still alive after 6 months. Among the patients which were non-dependent before hospitalization, 17% became dependent. The only prognostic criterifound were the SAPS II score on admission and the place of residence before admission (nursing home or family environment had poor prognosis). Although the prognosis of these elderly patients was good after hospitalization in ICU, it should be noted that the population was carefully selected as having few comorbidities or dependence. No triage critericould be suggested.

Une enquête menée auprès des réanimations néonatales franciliennes en janvier 2016 a montré que les équipes médicales et soignantes s’étaient bien approprié les pratiques imposées par l’évolution législative du début des années 2000. Une autre préoccupation était de savoir quelles modifications étaient attendues par les professionnels dans deux domaines : la tenue des réunions collégiales (RC) et l’implication des parents dans la prise de décision.Matériel et méthodes : L’enquête a été réalisée auprès de l’ensemble des professionnels impliqués autour du nouveau-né hospitalisé, dans tous les services de réanimation néonatale de la région parisienne, sur la période du 1er au 31 janvier 2016. Elle a été menée à partir d’un questionnaire de type fermé, élaboré par un groupe pluriprofessionnel après revue de la littérature. Il était divisé en trois grandes parties. La première portait sur l’analyse des pratiques recommandées par la loi, la deuxième, au centre de ce travail, interrogeait les professionnels sur ce qui, selon eux, était à modifier dans le texte de loi afin de faire évoluer les pratiques pour les améliorer. La troisième partie du questionnaire cherchait à établir des profils sociologiques et professionnels.Résultats : Six cent soixante-dix questionnaires issus de 14 centres ont été analysés. Le taux moyen de participation était de 55 % pour les médecins (personnel médical [PM]) et de 39 % pour le personnel non médical (PNM). RC : la demande de RC pouvait venir d’autres professionnels que le seul médecin référent (90 % des PM et 94 % des PNM), mais aussi des parents (respectivement 67 et 61 %). La demande devait surtout être adressée au médecin référent (84 et 82 %). Participation active des parents à la décision : 25 % des PM et 19 % des PNM estimaient que les parents ne devaient jamais participer activement à la décision. La crainte d’une culpabilisation des parents était l’argument majoritaire. Les autres réponses se répartissaient entre « parfois » et « systématiquement ». Des différences sensibles existaient entre les catégories professionnelles.Conclusion : Notre étude illustre l’évolution de la pensée médicosoignante dans les services franciliens de réanimation néonatale. Après avoir compris les impératifs de la réflexion sur la démarche palliative et le respect à apporter à ses obligations formelles, les personnels médicaux et non médicaux imaginent une évolution possible de ces procédures, accordant une place nouvelle aux différents acteurs, à commencer par les parents de l’enfant. Introduction: A survey conducted in January 2016 in the neonatal intensive care units of Île-de-France showed that medical and non-medical professionals had adapted their practices to the evolution of the law at the beginning of 2000. Another concern was to assess the modifications expected by the professionals in two areas: the setting of the multidisciplinary meeting (MM) and the place dedicated to parents in the decision-making process.Material and methods: All the professionals who have contact with the neonates were questioned, in all the intensive care units of Île-de-France, between January 1 and January 31, 2016. The survey was based on a questionnaire prepared by an informal multidisciplinary group, after a review of the literature. All the questions were of the closed type. The questionnaire was divided into three parts: the first dealt with the analysis of the practices required by law; the second part, which is at the center of this study, listed the practices likely to evolve according to the opinion of the personnel surveyed. Finally, the third part gathered demographic and professional information.Results: 692 questionnaires from 14 centres were analysed. Mean participation rate was 55% for medical personnel (MP) and 39% for non-medical personnel (NMP). Multidisciplinary meeting (MM): The setting of a MM could be initiated by any professional other than the referring doctor (according to 90% of MP and 94% of NMP), and also by the parents (67 and 61%, respectively). Still, the request must go through the referring doctor (84 and 82%). Place of the parents in the decision process: 25% of MP and 19% of NMP thought that parents should never actively participate in decision-making. Fear of parental guilt was the main reason. Other answers were divided into “sometimes” and “systematically”. There was significant divergence of opinions between professional categories.Conclusion: Our study illustrates the evolution of the medical and non-medical professionals’ opinion regarding palliative care in the neonatal intensive care units of Île-de-France. Although they all thoroughly understood the importance of a reflexion about palliative approach, and the respect that should be conferred to its formal requirements, medical and non-medical personnel believe that an evolution of their practice is possible, especially to grant a new place to the different actors, starting with the parents of the child.

Background: Very elderly patients (aged over 85 years) are increasingly treated in intensive care units (ICU) despite the reluctance of doctors to admit these patients considered fragile. Only a few studies in this age group have described the relevance of treatment of these patients in the intensive care unit. Methods: he inclusion criterion for this study was patients aged 85 years or over on admission. The exclusion criteria were high dependence before admission or an inability to answer the telephone. Epidemiological data, antecedents, lifestyle, autonomy (ADL score of six items) were recorded on admission to the ICU and by telephone interview at six months. Results: Eight French ICU included 239 patients aged over 85 years. The most common diagnoses were non-cradiogenic lung disease (36%), severe sepsis / septic shock (29%) and acute pulmonary oedema (28%). 23% of patients were dependent on admission. 71% of patients were still living when discharged from the ICU and 52% were still living at 6 months. Among the non-dependent patients before hospitalisation, 17% became dependent. The only prognostic criteria found were the SAPS II score on admission and the place of residence before admission (nursing home or ”with family” had a poor prognosis). Conclusions: Although the prognosis of these very elderly patients was good after hospitalisation in the ICU, it should be noted that the population was highly selected with few comorbidities or dependence. No triage criteria could be proposed. ClinicalTrials.gov Identifier: NCT02849756