PDF(Pubmed)
Abstract：
OBJECTIVE: Older adults may be under-represented in critical care research, and results may not apply to this specific population. Our primary objective was to evaluate the prevalence of inclusion of older adults across critical care trials focused on common ICU conditions or interventions. Our secondary objective was to evaluate whether older age was used as a stratification variable for randomization or outcome analysis.
METHODS: We performed a systematic review of previously published systematic reviews of randomized controlled trials (RCTs) in critical care. We searched PubMed, Ovid, CENTRAL, and Cochrane from 2009 to 2022. Systematic reviews of any interventions across five topics: acute respiratory distress syndrome (ARDS), sepsis/shock, nutrition, sedation, and mobilization were eligible.
RESULTS: We identified 216 systematic reviews and included a total of 253 RCTs and 113,090 patients. We extracted baseline characteristics and the reported proportion of older adults. We assessed whether any upper age limit was an exclusion criterion for trials, whether age was used for stratification during randomization or data analysis, and if age-specific subgroup analysis was present. The most prevalent topic was sepsis (78 trials, 31%), followed by nutrition (62 trials, 25%), ARDS (39 trials, 15%), mobilization (38 trials, 15%), and sedation (36 trials, 14%). Eighteen trials (7%) had exclusion criteria based on older age. Age distribution with information on older adults prevalence was given in six trials (2%). Age was considered in the analysis of ten trials (5%) using analytic methods to evaluate the outcome stratified by age.
UNASSIGNED: In this systematic review, the proportion of older critically ill patients is undetermined, and it is unclear how age is or is not an effect modifier or to what extent the results are valid for older adult groups. Reporting age is important to guide clinicians in personalizing care. These results highlight the importance of incorporating older critically ill patients in future trials to ensure the results are generalizable to this growing population.
METHODS: We performed a systematic review of previously published systematic reviews of randomized controlled trials (RCTs) in critical care. We searched PubMed, Ovid, CENTRAL, and Cochrane from 2009 to 2022. Systematic reviews of any interventions across five topics: acute respiratory distress syndrome (ARDS), sepsis/shock, nutrition, sedation, and mobilization were eligible.
RESULTS: We identified 216 systematic reviews and included a total of 253 RCTs and 113,090 patients. We extracted baseline characteristics and the reported proportion of older adults. We assessed whether any upper age limit was an exclusion criterion for trials, whether age was used for stratification during randomization or data analysis, and if age-specific subgroup analysis was present. The most prevalent topic was sepsis (78 trials, 31%), followed by nutrition (62 trials, 25%), ARDS (39 trials, 15%), mobilization (38 trials, 15%), and sedation (36 trials, 14%). Eighteen trials (7%) had exclusion criteria based on older age. Age distribution with information on older adults prevalence was given in six trials (2%). Age was considered in the analysis of ten trials (5%) using analytic methods to evaluate the outcome stratified by age.
UNASSIGNED: In this systematic review, the proportion of older critically ill patients is undetermined, and it is unclear how age is or is not an effect modifier or to what extent the results are valid for older adult groups. Reporting age is important to guide clinicians in personalizing care. These results highlight the importance of incorporating older critically ill patients in future trials to ensure the results are generalizable to this growing population.
摘要：
目标：重症监护研究中老年人的比例可能不足，结果可能不适用于这一特定人群。我们的主要目标是评估老年人纳入重症监护试验的患病率，重点是常见的ICU条件或干预措施。我们的次要目标是评估年龄是否被用作随机化或结果分析的分层变量。
方法：我们对先前发表的重症监护随机对照试验（RCTs）的系统评价进行了系统评价。我们搜索了PubMed,奥维德,中部,和Cochrane从2009年到2022年。对五个主题的任何干预措施的系统评价：急性呼吸窘迫综合征(ARDS)，脓毒症/休克,营养,镇静,动员是合格的。
结果：我们确定了216篇系统评价，共包括253例RCTs和113,090例患者。我们提取了基线特征和报告的老年人比例。我们评估了年龄上限是否是试验的排除标准，在随机化或数据分析期间，年龄是否用于分层，以及是否存在年龄特异性亚组分析。最普遍的话题是败血症(78项试验，31%），其次是营养学(62项试验，25%），ARDS（39项试验，15%），动员(38项试验，15%），和镇静(36项试验，14%)。18项试验(7%)有基于年龄的排除标准。6项试验(2%)给出了年龄分布和老年人患病率信息。在使用分析方法评估按年龄分层的结果的10项试验（5％）的分析中考虑了年龄。
■在这篇系统综述中，老年危重病人的比例不确定，目前还不清楚年龄是或不是效应修正因子，或者结果在多大程度上对老年群体有效。报告年龄对于指导临床医生个性化护理很重要。这些结果强调了在未来的试验中纳入老年危重病人的重要性，以确保结果可推广到这个不断增长的人群。
方法：我们对先前发表的重症监护随机对照试验（RCTs）的系统评价进行了系统评价。我们搜索了PubMed,奥维德,中部,和Cochrane从2009年到2022年。对五个主题的任何干预措施的系统评价：急性呼吸窘迫综合征(ARDS)，脓毒症/休克,营养,镇静,动员是合格的。
结果：我们确定了216篇系统评价，共包括253例RCTs和113,090例患者。我们提取了基线特征和报告的老年人比例。我们评估了年龄上限是否是试验的排除标准，在随机化或数据分析期间，年龄是否用于分层，以及是否存在年龄特异性亚组分析。最普遍的话题是败血症(78项试验，31%），其次是营养学(62项试验，25%），ARDS（39项试验，15%），动员(38项试验，15%），和镇静(36项试验，14%)。18项试验(7%)有基于年龄的排除标准。6项试验(2%)给出了年龄分布和老年人患病率信息。在使用分析方法评估按年龄分层的结果的10项试验（5％）的分析中考虑了年龄。
■在这篇系统综述中，老年危重病人的比例不确定，目前还不清楚年龄是或不是效应修正因子，或者结果在多大程度上对老年群体有效。报告年龄对于指导临床医生个性化护理很重要。这些结果强调了在未来的试验中纳入老年危重病人的重要性，以确保结果可推广到这个不断增长的人群。
