Prediction of chronic critical illness in a general intensive care unit

Loss, Sérgio Henrique; Marchese, Claudia Balhesteiro; Boniatti, Márcio Manozzo; Wawrzeniak, Iuri Christmann; Oliveira, Roselaine Pinheiro de; Nunes, Luciana Neves; Victorino, J.A.

doi:10.1016/s2255-4823(13)70463-6

Cited by 9 publications

(18 citation statements)

References 27 publications

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“…1 A 32-bed intensive care unit (ICU) in southern Brazil reported that 42 of 453 (9.3%) patients received PMV in half a year. 2 While PMV incidence was 6.3 per 100 ventilated ICU admissions from 2002 to 2006 in the United Kingdom, 3 in Taiwan, the PMV rate fell from 94.3 to 89.38 per 100,000 persons from 2004 to 2007. 4 In the United States, a population-based study found that the incidence of tracheostomy for PMV was 24.2 per 100,000 people in 2002, and this rate had increased by nearly 200% from the previous decade.…”

Section: Introductionmentioning

confidence: 99%

Survey of Prolonged Mechanical Ventilation in Intensive Care Units in Mainland China

Zhan

Wang

2016

Respir Care

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INTRODUCTION:In mainland China, there are no special care centers (long-term acute care, weaning, chronic care facilities) for patients requiring prolonged mechanical ventilation (PMV). Our goal was to characterize the prevalence and outcome of patients undergoing PMV in Chinese intensive care units (ICUs). METHODS: A prospective 1-d prevalence study was performed at 55 ICUs, with 28-d follow-up. RESULTS: On the observation day, 622 adult patients occupied ICU beds. Enrollment criteria were met by 302 subjects receiving invasive mechanical ventilation, of which 109 (36.1%) had received ventilation for more than 21 d (median 51, 21-3,419), which was defined as PMV. During the following 28 d, another 45 subjects were classified as receiving PMV, but only 5% (3/58) of the subjects who were newly admitted to the ICU on the study day received PMV. Thirty-six (22.9%) of the 157 subjects receiving PMV were weaned, and 81 (51.6%) continued ventilation in the ICU. In the logistic regression analysis, age >74 y (odds ratio ‫؍‬ 2.78, 95% CI 1.05-7.40, P ‫؍‬ .041) and chronic congestive heart failure (odds ratio ‫,32.21؍‬ 95% CI 1.48 -101.05, P ‫؍‬ .020) were associated with failure to wean in 28 d, while acute respiratory distress syndrome (ARDS) as the reason for mechanical ventilation (odds ratio ‫؍‬ 0.14, 95% CI 0.04 -0.52, P ‫؍‬ .003) was associated with successful weaning. CONCLUSION: The number of subjects receiving PMV was surprisingly high in this cross-section of Chinese ICUs. In the following 28 ICU days, only a small proportion of these subjects were weaned. Age and chronic heart dysfunction were high risk factors for weaning failure.

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Section: Introductionmentioning

confidence: 99%

Survey of Prolonged Mechanical Ventilation in Intensive Care Units in Mainland China

Zhan

Wang

2016

Respir Care

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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: Discussionmentioning

confidence: 56%

“…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%

“…Single-center studies [6,[13][14][15][16][17] indicate that approximately 3 to 11% of patients receiving MV meet the criteria for ventilatory dependency for more than 21 days; nevertheless, multicenter studies using this stricter definition of PMV have not been performed until now [18]. Therefore, the aim of this cohort study is to establish the incidence of PMV in four ICUs, and to report different characteristics, hospital outcomes, and the impact of costs and services of PMV patients (MV dependency ≥ 21 days) compared with non-PMV patients (MV dependency <21 days).…”

Section: Introductionmentioning

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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“…13,14 Inadvertent undernutrition and unnecessary fasting is associated with a greater chance of chronic critical illness. 15 Monitoring metabolic aspects in conjunction with the clinical context of these patients increase the likelihood of successful outcomes. This team ideally includes a medical specialist, a nutritionist, a nurse, and a pharmacist.…”

Section: Lustmentioning

confidence: 99%

Seven Deadly Sins of Nutrition Therapy in Critically Ill Patients

et al. 2019

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This article presents 7 nutrition steps that, if not followed by the clinical staff, may be metaphorically considered as “7 deadly sins” of nutrition therapy. In this review, we suggest approaches that must be avoided or accomplished to increase compliance with the “Ten Commandments” of good nutrition practice in the intensive care setting. Multiple aggressive and simultaneous sets of therapies are implemented in the intensive care setting, which include nutrition and metabolic support as important components in these therapies. “Sins” should be remembered as a mnemonic device for nutrition standard care in the intensive care unit; this incorporates nutrition adequacy and protocol adherence.

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Prediction of chronic critical illness in a general intensive care unit

Cited by 9 publications

References 27 publications

Survey of Prolonged Mechanical Ventilation in Intensive Care Units in Mainland China

Survey of Prolonged Mechanical Ventilation in Intensive Care Units in Mainland China

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

Seven Deadly Sins of Nutrition Therapy in Critically Ill Patients

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