Management of Frailty in the Intensive Care Unit

Assessment of Frailty in ICU

The Clinical Frailty Scale (CFS) is recommended as an assessment tool for all ICU patients, not just the elderly 1, 2, 3
Frailty can be diagnosed during ICU admission by identifying 3 or more of the following criteria: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity 4, 5

Frail patients should receive 1.2-1.5 g protein/kg/day, with even higher protein intake for individuals with severe illness or injury 4, 5, 6
Early and progressive enteral nutrition (EN) should be implemented after hemodynamic stabilization 5, 6
For non-intubated frail patients not reaching energy targets with oral diet, oral nutritional supplements should be considered first, followed by enteral nutrition if necessary 5, 7
Enteral nutrition enriched with omega-3 fatty acids (EPA) may decrease frailty occurrence 5, 6

Advanced age alone is not a reason to refrain from ICU treatment, but frailty should be considered in treatment decisions 1, 3, 8
For patients who have been under intensive care treatment for more than a week, therapy goal discussions should take place at least weekly with relatives and, if possible, with patients 1, 2, 3
A multidisciplinary approach should be used when discussing end-of-life care for elderly frail patients, considering patient directives, family feelings, and representatives' desires 8

Prolonged weaning from ventilation occurs in approximately 20% of patients, with advanced age and frailty contributing factors 1, 3
The usefulness of ventilation therapy should be clarified at the time of initiating therapy, particularly in frail patients 1, 3

An open culture of discussion in the multiprofessional team, regular team meetings, and supervision can ease the burden on intensive care teams caring for frail patients 1, 2, 3

The transitions from curative to palliative care can be fluid in frail patients, and reliable prognosis assessment is not always possible due to various influencing factors 1, 3
Frailty is distinct from malnutrition - in a systematic review of older patients, only a small percentage were malnourished while a larger percentage were frail, though a significant percentage of malnourished patients were frail 4, 5