Chronic Critical Illness: The Growing Challenge to Health Care

MacIntyre, Neil R.

doi:10.4187/respcare.01768

Cited by 63 publications

(50 citation statements)

References 47 publications

(79 reference statements)

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“…The PMV population is growing rapidly and reflects a number of factors, including the aging of the general population and the ability of the healthcare system to keep patients alive longer after devastating illnesses or aggressive surgical procedures. [24][25][26] PMV patients are estimated to be as many as 5-10% of all mechanically ventilated patients in the United States. While in-patient mortality in PMV patients may be as high as 35%, as many as half of the survivors will be successfully withdrawn from mechanical ventilator support, usually within the first 90 days.…”

Section: Scope Of the Problemmentioning

confidence: 99%

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The Ventilator Discontinuation Process: An Expanding Evidence BaseDiscussion

MacIntyre

2013

Respir Care

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The ventilator discontinuation process is an essential component of overall ventilator management. Undue delay leads to excess stay, iatrogenic lung injury, unnecessary sedation, and even higher mortality. On the other hand, premature withdrawal can lead to muscle fatigue, dangerous gas exchange impairment, loss of airway protection, and also a higher mortality. Continued ventilator dependence can be a result of persistent illness or can be a result of poor management. It is obviously important for the clinician to be able to assess both of these issues. An evidence-based task force has recommended regular assessments focusing on the causes of ventilator dependence, regular assessments for evidence of disease stability/reversal, use of regular spontaneous breathing trials (SBTs) as the primary assessment tool for ventilator discontinuation potential, use of separate assessments to evaluate the need for an artificial airway in patients tolerating the SBT, and the use of comfortable, interactive ventilator modes (that do not need to be "weaned") in between regular SBTs. More recent developments have focused on the importance of linking sedation reduction protocols to ventilator discontinuation protocols. Patients with repeated SBT failures are often considered to require prolonged mechanical ventilation (PMV). These patients often receive tracheostomies and are probably better managed with more gradual reductions in support and gradually lengthened spontaneous breathing periods. PMV patients have a high 1-year mortality, and many may ultimately require lifelong support. This evidence base is growing, but the earlier guidelines are standing the test of time. Indeed, practice patterns are evolving in accordance with them. Nevertheless, there is still room for improvement, and further clinical studies, especially in the patient requiring PMV, are needed.

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Section: Scope Of the Problemmentioning

confidence: 99%

“…[24][25][26] Under these conditions, repeated daily SBTs are likely futile until substantial disease resolution has occurred and the balance in Figure 1 is clearly improving. In the PMV patient, gradual ventilator support reduction strategies ("weaning") now may make some sense.…”

Section: The Evidence Base Supporting Ventilator Withdrawal Strategiementioning

confidence: 99%

The Ventilator Discontinuation Process: An Expanding Evidence BaseDiscussion

MacIntyre

2013

Respir Care

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“…With the currently increasing elderly population and developments in intensive care, there is expected to be an increase in diseases requiring chronic intensive care and increased consumption of healthcare resources (25,26). Throughout the world, but especially in the USA, projects have been developed related to healthcare costs and resource management (25,26).…”

Section: General Features Of Ltchmentioning

confidence: 99%

“…Throughout the world, but especially in the USA, projects have been developed related to healthcare costs and resource management (25,26). Despite the rapid growth of LTCHs, little is still known about the quality of results and difficulty of weaning from mechanical ventilation (29).…”

Section: General Features Of Ltchmentioning

confidence: 99%

Long-term care hospitals in Turkey: a review

Dinçer

Kahveci

Döğer³

et al. 2017

East Mediterr Health J

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Centres de long séjour hospitaliers en Turquie : analyseUn centre hospitalier de soins de longue durée (CHSLD) est un établissement spécialisé accueillant des patients qui souffrent de graves problèmes de santé et nécessitent des soins continus et intensifs sans avoir à recourir à des méthodes diagnostiques complètes. Les CHLSD fournissent des soins prolongés et complexes ainsi que des soins de plaies dans la période qui suit la phase aigüe de la maladie. Aux États-Unis, lorsque le séjour en unité des soins intensifs est prolongé, les patients peuvent être transférés vers un CHSLD. Medicare recommande une période d'hospitalisation en CHSLD de plus de 25 jours. Le système des CHSLD en Europe est différent de celui qui est établi dans d'autres pays non-européens. On note par ailleurs des différences entre les pays européens eux-mêmes. Dans la pratique, les patients qui ont besoin de soins de longue durée en Turquie sont hospitalisés en unités de soins intensifs. Le concept des soins de longue durée est nouveau dans le système de santé turc et il n'y existe pas d'études sur les CHSLD. Une proportion importante des lits réservés aux unités de soins intensifs en Turquie sont utilisés pour les soins de longue durée aux patients atteints de problèmes complexes. ABSTRACT A long-term care hospital (LTCH) is a specialized facility for patients with serious health problems who require continuous and intensive care but not comprehensive diagnostic methods. LTCHs provide prolonged complex care and wound care in the period following the acute stage of disease. When intensive care unit (ICU) stay is prolonged in the United States of America, the patients may be transferred to an LTCH. Medicare suggests hospitalization > 25 days in LTCHs. The LTC system in Europe differs from that in other non-European countries and differences are also seen among European countries. In practice, patients who need LTC in Turkey are hospitalized in ICUs. Long term care is a new concept for the Turkish health system and there are no studies on LTCHs in Turkey. A significant proportion of intensive care beds in Turkey are used for long-term hospitalized patients with complex problems. This is a clear waste of resources. The establishment of LTCHs in Turkey would prevent from this waste and provide the opportunity to increase experience of complex treatments.

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“…Chronic critical illness is an emerging concept, as children are living longer with complex chronic illnesses, resulting in prolonged PICU stays, fluctuations in care needs, and frequent exacerbations of their illness that require frequent PICU admissions (MacIntyre, 2012). Patients with complex chronic illness who survive an acute critical illness may subsequently experience chronic critical illness, which is characterized by protein depletion, ongoing catabolism, and neuromuscular weakness (Kalb & Lorin, 2002).…”

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

confidence: 99%