Prediction of chronic critical illness in a general intensive care unit

Abstract

CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.

Chronic critical illness: are we saving patients or creating victims?

“…(11) Although CCI has been described for more than 40 years, we still know very little about the characteristics of this population, such as their risk factors, long-term mortality, functional capacity, cognition, and return to daily activities after hospital discharge. To further complicate the situation, the results of clinical trials vary from center to center.…”

“…(4) The prevalence of this syndrome ranges from 5 to 20% of patients admitted to the ICU. (11) This wide variation can be explained by the lack of consensus on diagnostic criteria. Table 1 was extracted and modified from a 2010 review of diagnostic criteria for this syndrome.…”

“…Table 1 was extracted and modified from a 2010 review of diagnostic criteria for this syndrome. (4,9,11,12,14-24) CCI patients are frequently dependent on prolonged ventilation support, and a period of three weeks or more on MV or the need for tracheotomy due to prolonged MV (PMV) were initially adopted as a consensus definition for the condition. (22,25,26) …”

“…There is no clear association between age and/or previous chronic disease and PCI, although once the transition from critically ill to a chronic condition is characterized the elderly tend to have higher rates of mortality. (11) …”

“…However, the simultaneous association of a few variables, such as sepsis at the time of admission to the ICU, a need for invasive ventilatory support, mental changes, overweightness, and insufficient nutrition in the acute phase, were associated with chronicity 92% of the time in an observational cohort study conducted by our group. (11) Variables used in other studies included age, previous chronic diseases, malnutrition, high severity scores at admission, need for enhanced invasive monitoring, and early development of organ dysfunction. (16,41,42) A study conducted by Carson et al validated a mortality prediction model for patients submitted to ventilatory support for twenty-one or more days.…”