Chronic critical illness
Chronic critical illness is a disease state which affects intensive care patients who have survived an initial insult but remain dependent on intensive care for a protracted period, neither dying nor recovering.[1] The most characteristic clinical feature is a prolonged requirement for mechanical ventilation.[2] Other features include profound weakness associated with critical illness polyneuropathy, increased susceptibility to infection, metabolic changes and hormonal changes. There may be protracted or permanent delirium, or other marked cognitive impairment. The physical and psychological symptoms of the disease are very severe, including a propensity to develop post traumatic stress syndrome.[3]
Strict definitions of chronic critical illness vary. One definition is the requirement for mechanical ventilation for 21 days or more. It is estimated that 5-10% of patients who require mechanical ventilation as part of their initial illness will go on to develop chronic critical illness. [2] Overall prevalence has been estimated at 34.4 per 100 000 of the population.[4] Most adult patients do not survive chronic critical illness, and furthermore even those who are discharged from hospital frequently die soon after discharge. [3] One-year mortality in adults is 48-68%. [2] However, children fare better with two-thirds surviving to 5 years or beyond. [5]
References
- ^ Girard K, Raffin TA. The chronically critically ill: to save or let die? Respir Care. 1985; 30: 339-47. PMID 10315661
- ^ a b c Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med. 2010; 182(4): 446-54. PMID 20448093
- ^ a b Nelson JE, Meier DE, Litke A, Natale DA, Siegel RE, Morrison RS. The symptom burden of chronic critical illness. Crit Care Med. 2004; 32(7): 1527-34. PMID 15241097
- ^ Kahn JM, Le T, Angus DC, Cox CE, Hough CL, White DB et al. The epidemiology of chronic critical illness in the United States. Crit Care Med. 2005; 43(2): 282-7. PMID 25377018
- ^ Namachivayam SP, Alexander J, Slater A, Millar J, Erickson S, Tibballs J et al. Five-Year Survival of Children With Chronic Critical Illness in Australia and New Zealand Crit Care Med. 2015; 43(9): 1978-85. PMID 25962079
