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Abstract

Introduction Our goal was to describe the epidemiology, clinical profiles, outcomes, and factors that might predict progression of critically ill patients to chronically critically ill (CCI) patients, a still poorly characterized subgroup.

Relationship Between ICU Length of Stay and Long-Term Mortality for Elderly ICU Survivors*

“…Definitions of chronic critical illness used in studies do vary, including mechanical ventilation for more than 24 hours (14, 25), 2 days (26), 4 days (12), 14 days (11, 27), 21 days (6, 9, 16, 18), and 28 days (5); tracheostomy (2, 13, 17, 19); or ICU length of stay of more than 7 days (28, 29), 10 days (30, 31), 14 days (32–35), 21 days (10), and 28 days (3–5, 7, 8). After studying the impact of a categorical continuum of ICU length of stay on mortality, we found that although mortality rates increased with increasing length of stay, there does not appear to be a clear length of stay cutoff at which a patient’s prognosis significantly changes.…”

“…These patients are often described as being “chronically critically ill”(1). The development of this new type of patient in the modern era poses novel challenges for care, prognosis, and health care utilization in the ICU and after discharge (2). Yet, studies are hampered by a lack of data identifying the appropriate at-risk groups, and associated long-term outcomes, and often focus on data from single centers (3–8).…”

“…Most studies use a minimum length of stay in the ICU such as 21 days (10), or 28 days to define this illness (3–5, 7, 8). Several studies have investigated patients who specifically received prolonged mechanical ventilation (ranging from 24 hours to 28 days) (5, 6, 9, 11–18), while others have used the need for tracheostomy (2, 13, 17, 19). However, patients who are mechanically ventilated represent a small subgroup of elderly patients who receive intensive care in the United States (20), and the broader population of hospital survivors who received intensive care remains unexplored.…”

Characteristics of chronically critically ill patients: comparing two definitions

“…Regardless of the definition, the main characteristics of this population are repeated episodes of shock and infection during their stays in the Intensive Care Unit (ICU) 9. It is clear that a chronic critical illness is not simply an extension of an acute critical illness but, rather, is a complex syndrome characterized by metabolic, neuroendocrine, neuropsychiatric and immunological changes 10.…”

Evaluating the Critical Care Family Satisfaction Survey for Chronic Critical Illness

“…In addition to the family members’ characteristics shown in Table 1, there was not a statistically significant difference in the mean age in years between the EFA subsample ( M = 54.3, SD = 13.9) and CFA subsample ( M = 53.4, SD = 14.2, t = .61, p = .54). Consistent with the demographics of family members of the CCI who participated in prior research (Douglas & Daly, 2003; Douglas & Daly, 2005; Douglas et al, 2010; Estenssoro et al, 2006; Im et al, 2004; Nelson et al, 2004, 2005, 2007), participants in this study were middle-aged, White females who were mostly spouses or the adult children of the patient. In addition, CCI patients were most often White males who were middle aged ( M = 56.5 years) with a mean duration of mechanical ventilation of 11 days and a mean ICU length of stay of 15 days, which is congruent with the clinical profile of patients with chronic critical illness (Chelluri et al, 2003, 2004; Combes et al, 2003; Daly & Douglas, 2005; Douglas & Daly, 2001; Douglas et al, 2002).…”