Is It ‘Worthwhile' To Continue Treating Patients With a Prolonged Stay (&gt;14 Days) in the ICU?

Heyland, Daren K.; Konopad, Elsie; Noseworthy, Thomas; Johnston, Richard; Gafni, Amiram

doi:10.1378/chest.114.1.192

Cited by 106 publications

(76 citation statements)

References 23 publications

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“…First, we studied all critically ill residents of a well-defined population; since sampling was not performed, selection bias was minimized. Previous studies have been limited by selection bias as a result of being reported from single, tertiary care, university-affiliated ICUs, [1][2][3][4][5][6]10,11 or selected critically ill subpopulations such as elderly, 1 trauma, 2,5 surgical, 3 or longterm ventilator unit patients. 8 While these are important studies, the results obtained from within these specific critically ill patient subgroups must be generalized to other critically ill populations at large with great caution.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9] A number of studies have investigated the occurrence, risk factors, and/or outcome of prolonged admission to ICU, but a number of limitations exist. Prior studies [1][2][3][4][5][6]8,10,11 have typically been reported from highly selected patient subgroups or from single surgical or medical tertiary care ICUs such that they may not be readily generalized to critically ill populations at large. In addition, the majority of studies 1,2,4,5,11 to date have included relatively small numbers of patients and therefore are limited in statistical power.…”

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confidence: 99%

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Long-term Mortality Outcome Associated With Prolonged Admission to the ICU

Laupland

Kirkpatrick

Kortbeek

et al. 2006

Chest

122

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ICU Long-term Mortality Outcome Associated With Prolonged Admission to the This information is current as of April 19, 2006http://www.chestjournal.org/cgi/content/full/129/4/954 located on the World Wide Web at:The online version of this article, along with updated information and services, is may be reproduced or distributed without the prior written permission of the copyright holder. Long-term Mortality Outcome Associated With Prolonged Admission to the ICU* Kevin B. Laupland, MD, MSc; Andrew W. Kirkpatrick, MD, MSc; John B. Kortbeek, MD; and Danny J. Zuege, MD, MSc, FCCP Study objectives: Patients requiring prolonged admission to the ICU consume significant health-care resources and have a high rate of in-hospital death. The long-term mortality outcome of these patients has not been well defined in a nonselected cohort. The objective of this study was to describe the occurrence and factors predictive of prolonged ICU stay at admission, and to define the long-term (> 1 year) mortality outcome. Design: Population-based cohort. Setting: All adult multisystem and cardiovascular surgical ICUs in the Calgary Health Region (CHR) from July 1, 1999, to March 31, 2002. Patients: Adult (> 18 years old) residents of the CHR admitted to regional ICUs. Interventions: None. Measurements and results: During the study, 4,845 patients had a median length of stay of 2 days (interquartile range, 1 to 4 days); 2,115 patients (44%) were admitted for < 2 days, 1,496 patients (31%) were admitted for 2 to 3 days; 1,018 patients (21%) were admitted from 4 to 13 days; and 216 patients (4%) had a prolonged (> 14 day) admission to the ICU. A higher severity of illness, the presence of shock, and bloodstream infection were independently associated with a prolonged ICU admission, and cardiovascular surgery was associated with a lower risk. Patients with prolonged ICU admissions were nearly twice as likely to die as patients with shorter ICU admissions: 53 of 216 patients (25%) vs 584 of 4,629 patients (13%) [p ‫؍‬ 0.0001]. Among the 3,924 survivors to hospital discharge, the rates of mortality during the year following ICU admission were as follows: 59 deaths in 1,758 patients (3%) admitted < 2 days, 74 deaths in 1,267 patients (6%) with 2-to 3-day admissions, 78 deaths in 766 patients (10%) with 4-to 13-day admissions, and 10 deaths in 133 patients (8%) with admissions > 14 days. Conclusions: One in 25 critically ill patients will have prolonged ICU admission and higher ICU-related mortality. However, survivors of prolonged ICU admission have good long-term mortality outcome after acute illness.( Kevin B. Laupland, MD, MSc,#9, 3535 Research Rd NW, University of Calgary, Calgary, AB, Canada T2L 2K8; of studies have investigated the occurrence, risk factors, and/or outcome of prolonged admission to ICU, but a number of limitations exist. Prior studies [1][2][3][4][5][6]8,10,11 have typically been reported from highly selected patient subgroups or from single surgical or medical tertiary care ICUs such that they may not be readily ge...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Long-term Mortality Outcome Associated With Prolonged Admission to the ICU

Laupland

Kirkpatrick

Kortbeek

et al. 2006

Chest

122

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“…This study examined methods of identifying and analyzing the impact of such patients on bed utilization. Initial analyses selected an LOS value as an exceedence threshold 1323 [7,8,11], and others have used higher thresholds, such as 20 or 30 days [12,13,14,15,16]. Among homogeneous populations with low median ICU stays, for example, postcoronary artery bypass surgery, thresholds for prolonged stay as low as 2 days have been employed [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…A threshold of 15 days or longer was chosen because it represented stays greater than 2 weeks; this was the point of a further flattening of the frequency distribution ( Fig. 1), and previous investigators have used similar thresholds [7,8]. A threshold of 30 days or longer was chosen because it represented the LOS value after which there were only isolated patients (Fig.…”

Section: Selection Of Methods To Identify Long-term Patientsmentioning

confidence: 99%

Analyzing the impact of long-term patients on ICU bed utilization

Weissman

2000

Intensive Care Med

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“…[7][8][9] The main benefits of chronic ventilator facilities are the possibility of relieving congestion of ICU beds, providing a high level of nursing care, quickly responding to sudden changes in a patient's clinical condition, allowing enough time for a multidisciplinary rehabilitation approach, and acting as a bridge to home-care programs or other forms of continuous chronic assistance. However, chronic ventilator facilities have unique problems, which can be described as follows:…”

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confidence: 99%