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Critical Care

, 10:R89

First Online: 19 June 2006Received: 08 March 2006Accepted: 09 May 2006


IntroductionOur goal was to describe the epidemiology, clinical profiles, outcomes, and factors that might predict progression of critically ill patients to chronically critically ill CCI patients, a still poorly characterized subgroup.

MethodsWe prospectively studied all patients admitted to a university-affiliated hospital intensive care unit ICU between 1 July 2002 and 30 June 2005. On admission, we recorded epidemiological data, the presence of organ failure multiorgan dysfunction syndrome MODS, underlying diseases McCabe score, acute respiratory distress syndrome ARDS and shock. Daily, we recorded MODS, ARDS, shock, mechanical ventilation use, lengths of ICU and hospital stay LOS, and outcome. CCI patients were defined as those having a tracheotomy placed for continued ventilation. Clinical complications and time to tracheal decannulation were registered. Predictors of progression to CCI were identified by logistic regression.

ResultsNinety-five patients 12% fulfilled the CCI definition and, compared with the remaining 690 patients, these CCI patients were sicker APACHE II, 21 ± 7 versus 18 ± 9 for non-CCI patients, p = 0.005; had more organ dysfunctions SOFA 7 ± 3 versus 6 ± 4, p < 0.003; received more interventions TISS 32 ± 10 versus 26 ± 8, p < 0.0001; and had less underlying diseases and had undergone emergency surgery more frequently 43 versus 24%, p = 0.001. ARDS and shock were present in 84% and 83% of CCI patients, respectively, versus 44% and 48% in the other patients p < 0.0001 for both. CCI patients had higher expected mortality 38% versus 32%, p = 0.003, but observed mortality was similar 32% versus 35%, p = 0.59. Independent predictors of progression to CCI were ARDS on admission, APACHE II and McCabe scores odds ratio OR 2.26, p < 0.001; OR 1.03, p < 0.01; and OR 0.34, p < 0.0001, respectively. Lengths of mechanical ventilation, ICU and hospital stay were 33 24 to 50, 39 29 to 55 and 55 37 to 84 days, respectively. Tracheal decannulation was achieved at 40 ± 19 days.

ConclusionCCI patients were a severely ill population, in which ARDS, shock, and MODS were frequent on admission, and who suffered recurrent complications during their stay. However, their prognosis was equivalent to that of the other ICU patients. ARDS, APACHE II and McCabe scores were independent predictors of evolution to chronicity.

AbbreviationsAPACHE= Acute Physiologic and Chronic Health Evaluation

ARDS= acute respiratory distress syndrome

CCI= chronically critically ill

ICU= intensive care unit

LOS= length of stay

MODS= multiorgan dysfunction syndrome

SOFA= sequential organ failure assessment

TISS= therapeutic intervention scoring system

VAP= ventilator-associated pneumonia.

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Autor: Elisa Estenssoro - Rosa Reina - Héctor S Canales - María Gabriela Saenz - Francisco E Gonzalez - María M Aprea - Enri


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