Long‐term outcome after 60 days of intensive care

Abstract

Summary Patients with a long stay in the intensive care unit because of chronic critical illness consume many resources, and yet their outcome may be poor. We evaluated the long‐term outcome of patients spending more than 60 days in the intensive care unit. We performed a retrospective cohort and prospective follow‐up study of 78 patients staying more than 60 days in the 19–26 bed mixed intensive care unit of a university hospital from November 1995 to January 2003. The mortality in the intensive care unit was 38%; at 1 and 5 years it was 56% and 67%, respectively. Advanced age, prior pulmonary disease, long duration of renal replacement therapy, a low oxygenation ratio and platelet count and high Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores on day 60 influenced long‐term mortality. A Simplified Acute Physiology Score II of 50 or a Sequential Organ Failure Assessment score of 8 or higher was associated with 100% mortality during follow‐up. The overall 5‐year survival rate of 33% suggests that prolonged intensive care may be worth the effort in certain patients.

Outcome and functional capacity after prolonged intensive care unit stay

“…As shown in the Kaplan-Meier curve, the higher risk of death in the long-term group continued throughout the observation period, but nevertheless a substantial number of longterm ICU patients were long-time survivors with good or only modestly reduced functional capacity. Our outcome data compare well with other studies on "chronic" critically ill patients, where in-hospital mortality has been reported to be 37-49% and long-term mortality 55-67% [4][5][6][7][8][9][10][11][12][13]. Our data show that SAPS II scores during the first 24 hours after ICU admission were significantly higher in long-term patients than in short-term patients.…”

“…Moreover in an era of cost containment the allocation of disproportionate ICU resources to this relatively small number of patients requires justification, and careful examination of this cohort of patients is warranted. Existing data indicate that outcome of long-term critically ill patients is generally poor [4][5][6][7][8][9][10][11][12][13]: Spicher and White reported that among patients requiring mechanical ventilation for ≥ 10 days, > 70% were dead at 1 year after hospital discharge [4]; Hughes and coworkers reported that hospital mortality was 42% in patients with an ICU stay ≥ 30 days [11]. Nevertheless, data on risk factors for inhospital mortality and especially for long-term mortality and functional capacity are scarce.…”

Characteristics and Outcome for Very Elderly Patients (≥ 80 years) Admitted to a Respiratory Care Center in Taiwan

“…An increase in the geriatric population means that more elderly people will become critically ill and potentially require critical care resources for life-threatening diseases. Today, approximately 9% of patients admitted to ICUs are elderly 6,7 . If the need for intensive care remains unchanged, the demand for ICU beds is expected to increase by 19% by the year 2020 due to the change in age distribution for the Finnish population 6 .…”

“…i j g e -o n l i n e .c o m been considered an important factor in hospital mortality 7,8 . Although MV has been standard practice in Taiwan for years, there are few data available on outcomes and characteristics for elderly and very elderly patients 9 .…”

Homöopathie in der Notfall- und Intensivmedizin

“…Additionally, diagnostic procedures such as right heart catheterization, bronchoscopy, endoscopies, sonography, computer tomography, magnetic resonance tomography are often necessary. Patient survival is often dependent on this armory, though mortality reaches 35 % in spite of it [3]. This situation presents unique challenge for patients, relatives, doctors and nurses.…”