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The chronic ICU patient: Is intensive care worthwhile for patients with very prolonged ICU-stay (≥ 90 days)?

Published:September 04, 2019DOI:https://doi.org/10.1016/j.ejim.2019.08.024

      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)
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