Highlights
- •Due to medical advances, an increasing number of patients are surviving the acute critical illness.
- •Only a small number of patients requires a very prolonged ICU stay ≥90 days.
- •About two-third of patients survives the ICU stay, one-third 1-Year.
- •A small number of patients survives 1-Year with a remarkable recovery.
- •Critical care treatment seems worthwhile in this highly selected patient population.
Abstract
Background
Due to medical advances, an increasing number of patients are surviving the acute
critical illness. However, some patients require a prolonged critical care treatment.
Data on outcome and functional status of patients with an ICU-stay ≥90 days are scarce.
Methods
Single-center retrospective study including all adult patients with ICU stay ≥90 days
treated at the department of intensive care medicine at the university medical center
Hamburg-Eppendorf, Germany, between January 1st 2008 and December 31st 2016.
Results
Out of 65,249 patients, we identified 96 (0.1%) patients with a very prolonged ICU stay. Median age was 61
(49.8–67) years, 30 (31%) patients were female. Patients were admitted to ICU due
to abdominal (28%) reasons, followed by sepsis (23%) and transplantation (15%). Fourteen
patients received organ-transplantation: 9 received liver-, 4 lung- and 1 heart-transplantation.
All patients needed mechanical ventilation (MV), median duration was 74.1 (55–95.1)
days. Sixty-Three (66%) patients survived the ICU-stay and 1-Year survival rate was
28%. Overall eight (8%) patients had a favourable outcome after 1-Year. Severity of
illness (SOFA, SAPS II) on admission were comparable. Length of MV, use of renal replacement
therapy (both p < .01) and maximum lactate (5.3 vs 11.5 mmol/l; p < .001) were significantly higher in ICU non-survivors. ICU-stay was significantly
longer in ICU non-survivors (137 vs 107 days; p < .05). Cox-regression-model revealed age (HR 1.02, 95% CI 1.00–1.04, p < .05) and
surgical admission (HR 0.50, 95% CI 0.28–0.90, p < .05) as independent predictors
of 1-year mortality.
Conclusions
Only a small number of patients requires a very prolonged ICU stay. Two-third of patients
survive the ICU stay and about one-third 1-Year. However, about 10% of patients have
a remarkable recovery with a favourable overall outcome after 1-Year.
Keywords
Abbreviations:
BMI (Body mass index), CCI (Chronically critically ill), CCo (Charlson comorbidity index), ECMO (Extracorporeal membrane oxygenation), ICU (Intensive care unit), IQR (Interquartile range), LVAD (Left ventricular assist device), MV (Mechanical ventilation), OPC (Overall performance category), PDMS (Patient data management system), RRT (Renal replacement therapy), SAPS II (Simplified acute physiology score II), SOFA (Sequential organ failure assessment)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 04, 2019
Accepted:
August 27,
2019
Received in revised form:
August 26,
2019
Received:
July 7,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
