Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Can J Cardiol. 2016 Sep;32(9):1157-65. doi: 10.1016/j.cjca.2016.05.011. Epub 2016 May 27.
Frailty is a clearly emerging theme in acute care medicine, with obvious prognostic and health resource implications. "Frailty" is a term used to describe a multidimensional syndrome of loss of homeostatic reserves that gives rise to a vulnerability to adverse outcomes after relatively minor stressor events. This is conceptually simple, yet there has been little consensus on the operational definition. The gold standard method to diagnose frailty remains a comprehensive geriatric assessment; however, a variety of validated physical performance measures, judgement-based tools, and multidimensional scales are being applied in critical care, cardiology, and cardiac surgery settings, including open cardiac surgery and transcatheter aortic value replacement. Frailty is common among patients admitted to the intensive care unit and correlates with an increased risk for adverse events, increased resource use, and less favourable patient-centred outcomes. Analogous findings have been described across selected acute cardiology and cardiac surgical settings, in particular those that commonly intersect with critical care services. The optimal methods for screening and diagnosing frailty across these settings remains an active area of investigation. Routine assessment for frailty conceivably has numerous purported benefits for patients, families, health care providers, and health administrators through better informed decision-making regarding treatments or goals of care, prognosis for survival, expectations for recovery, risk of complications, and expected resource use. In this review, we discuss the measurement of frailty and its utility in patients with critical illness and in cardiology and cardiac surgery settings.
虚弱是急性医疗保健医学中一个明显的新兴主题，具有明显的预后和卫生资源影响。“虚弱”一词用于描述一种多维度的稳态储备丧失综合征，这种综合征导致在相对较小的应激事件后容易出现不良后果。这一概念很简单，但在操作定义上尚未达成共识。诊断虚弱的金标准方法仍然是全面的老年评估；然而，各种经过验证的身体机能测量、基于判断的工具和多维量表正在重症监护、心脏病学和心脏外科领域中应用，包括开放性心脏手术和经导管主动脉瓣置换术。虚弱在入住重症监护病房的患者中很常见，与不良事件风险增加、资源使用增加以及患者为中心的结局较差相关。在选定的急性心脏病学和心脏外科环境中也描述了类似的发现，特别是那些经常与重症监护服务交叉的环境。在这些环境中，筛查和诊断虚弱的最佳方法仍然是一个活跃的研究领域。通过更明智地决策治疗或护理目标、生存预后、康复预期、并发症风险和预期资源使用，对虚弱进行常规评估，对患者、家属、医疗保健提供者和卫生管理人员可能具有众多所谓的益处。在这篇综述中，我们讨论了虚弱的测量及其在重症患者以及心脏病学和心脏外科环境中的应用。
