Characteristics of chronically critically ill patients: comparing two definitions

Boniatti, Márcio Manozzo; Friedman, Gilberto; Castilho, Rodrigo Kappel; Vieira, Sílvia Regina Rios; Fialkow, Léa

doi:10.1590/s1807-59322011000400027

Cited by 30 publications

(40 citation statements)

References 24 publications

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“…Admission of patients for nonsurgical reasons has been previously identified as a factor associated with the evolution to chronic critical illness [3,23]. The severity scores have been considered predictors of prolonged MV [3,17,23,29]. Our data, at admission, are not consistent with this assumption.…”

Section: Discussioncontrasting

confidence: 54%

“…Previous authors have found higher mortality in PMV patients [7,17,20,22,23], while others have not [6,22]. The reason for these discrepancies is probably related to the heterogeneity and intrinsic characteristics of studies' populations.…”

Section: Discussionmentioning

confidence: 95%

“…Using this criterion, our data demonstrated 9.92% of CCI, varying according to the characteristics of patients in each ICU study (ICU1=8.8%; ICU2=12%; ICU3=9%; ICU4=15%). However, other authors have identified chronically critically ill patients by elective placement of a tracheotomy to facilitate prolonged ventilation and weaning efforts [14,[22][23][24][25]. Referral for tracheotomy reflects the clinician's judgment that the patient will neither wean nor die in the immediate future and, thus, provides a point of demarcation between acute and chronic critical illness that is both clinically meaningful and practical [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, a longer hospital stay before ICU admission and nonsurgical admission (OR 1.8 (1.26-2.56), p<0.001) were associated with the evolution to CCI. Admission of patients for nonsurgical reasons has been previously identified as a factor associated with the evolution to chronic critical illness [3,23]. The severity scores have been considered predictors of prolonged MV [3,17,23,29].…”

Section: Discussionmentioning

confidence: 99%

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The Reality of Patients Requiring Prolonged Mechanical Ventilation: A Retrospective Multicenter Cohort Study

2014

J Palliat Care Med

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Context: The number of patients requiring prolonged mechanical ventilation (PMV) has increased over the last decade, generating a large population of chronically ill patients. Objective:To establish the incidence of PMV in four Intensive Care Units (ICUs), and to report different characteristics, hospital outcomes, and the impact of costs and services of PMV patients (mechanical ventilation dependency ≥ 21 days) compared with non-PMV patients (mechanical ventilation dependency < 21 days).Design, Setting, and Patients: A retrospective multicenter cohort study, including all patients admitted to four ICUs. Main Outcome Measures:Length of stay in the ICU, hospital, complications during ICU stay, and ICU and hospital mortality.Results: During study period, there were 5,287 admission episodes to the ICUs. Forty-one point five percent of these patients needed ventilatory support (n=2,197), and 218 met criteria for PMV (9.9%). Some complications developed during ICU stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of PMV. PMV patients had a significant increase in ICU mortality (absolute difference=14.2%, p<0.001), and in hospital mortality (absolute difference=19.1%, p<0.001); PMV group spent more days in the hospital after ICU discharge (26.9 ± 29.3 vs. 10.3 ± 20.4, p<0.001) and with higher costs.Conclusions: the classification of chronically critically ill patients according to the definition of PMV adopted by our study (mechanical ventilation dependency ≥21 days) identified patients with high risk for complications during ICU stay, high ICU and hospital stay, high death rates, as well as higher costs.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Reality of Patients Requiring Prolonged Mechanical Ventilation: A Retrospective Multicenter Cohort Study

2014

J Palliat Care Med

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“…Patients may or may not have tracheostomies and be mechanically ventilated (White, 2012). Although experts disagree on the length of time that a chronic care device needs to be in place for the patient to be considered chronically critically ill, the range of cited length of mechanical ventilation is as little as 2 days to as long as 15 years, with an average time cited as 21 days (Boniatti et al, 2011, González-Cortés et al, 2011, King, 2012and Nelson et al, 2010. Researchers cite a range of 16 to 40 days after tracheostomy placement and intensive care length of stay anywhere from 7 to 51 days as the criteria to be considered chronically critically ill (Carson, 2012).…”

Section: How Is a Patient Classified As Chronically Critically Ill?mentioning

confidence: 99%

An Emerging Population: The Chronically Critically Ill

Jurasinski¹,

Schindler²

2014

Journal of Pediatric Health Care

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Analysis of patient factors associated with 30‐day mortality after tracheostomy

et al. 2018

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Objective Mortality has been reported to be 22% to 45% in patients with a tracheostomy. To better counsel patients and families, we aimed to determine the effect of body mass index (BMI), socioeconomic status (SES), and the 17 conditions of the Charlson comorbidity index (CCI) on 30‐day survival posttracheostomy. Methods This retrospective cohort study identified adult patients enrolled from our institution in the Global Tracheostomy Collaborative database from March 2014 to June 2015. Data collected included age, BMI, residential zip code, and comorbidities. Cox proportionate univariate and multivariate analyses were used to measure the impact of BMI, SES, and CCI variables with 30‐day posttracheostomy survival. We used geocoding as a surrogate for patients' SES. We used Deyo's modification of the CCI, which utilized International Classification of Diseases, 9th Revision, codes to identify comorbidities. Results Of 326 tracheostomies identified, the 30‐day mortality rate was 15.6%. No significant differences were noted in BMI or in any of the SES categories between survivors and nonsurvivors. CCI was significantly higher in the 30‐day mortality group. Congestive heart failure (hazard ratio [HR] = 2.39), severe liver disease (HR = 3.15), and peripheral vascular disease (HR = 2.62) were found to significantly impact 30‐day survival. Conclusion Higher CCI and specifically severe liver disease, congestive heart failure, and peripheral vascular disease were associated with increased 30‐day mortality posttracheostomy. No association was found between BMI or SES and 30‐day survival. This study identified three comorbidities that independently affect mortality in tracheostomy patients, which should be discussed with patients and families before tracheostomy. Level of Evidence 3 Laryngoscope, 129:847–851, 2019

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Characteristics of chronically critically ill patients: comparing two definitions

Cited by 30 publications

References 24 publications

The Reality of Patients Requiring Prolonged Mechanical Ventilation: A Retrospective Multicenter Cohort Study

The Reality of Patients Requiring Prolonged Mechanical Ventilation: A Retrospective Multicenter Cohort Study

An Emerging Population: The Chronically Critically Ill

Analysis of patient factors associated with 30‐day mortality after tracheostomy

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