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The Chronically Critically Ill

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The Organization of Critical Care

Part of the book series: Respiratory Medicine ((RM,volume 18))

Abstract

Chronic critical illness is a condition that affects an increasing number of patients who suffer an acute illness or injury. Patients require prolonged weaning from mechanical ventilation which is best achieved by daily periods of unassisted breathing. They are at high risk of infectious complications, so infection control measures are essential elements of their care. Hospital mortality for chronically critically ill (CCI) patients is similar to that of patients who require mechanical ventilation for shorter periods; however, 1-year mortality is greater than 50 %. Fragmentation of care presents significant organizational challenges as hospital survivors cycle between multiple post-acute care institutions. Associated healthcare costs are significant, and the majority of those costs are covered by public programs. Patients and their surrogate decision makers should be made aware of long-term outcomes and care needs and be engaged in a discussion of patient values and appropriate goals of care.

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References

  1. Carson SS. Definitions and epidemiology of the chronically critically ill. Respir Care. 2012;57(6):848–56. discussion 856–8.

    Article  PubMed  Google Scholar 

  2. Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. Am J Respir Crit Care Med. 2010;182(4):446–54.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Estenssoro E, Reina R, Canales HS, et al. The distinct clinical profile of chronically critically ill patients: a cohort study. Crit Care. 2006;10(3):R89.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Carson SS, Kahn JM, Hough CL, et al. A multicenter mortality prediction model for patients receiving prolonged mechanical ventilation. Crit Care Med. 2012;40(4):1171–6.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Carson SS, Bach PB. The epidemiology and costs of chronic critical illness. Crit Care Clin. 2002;18(3):461–76.

    Article  PubMed  Google Scholar 

  6. Behrendt CE. Acute respiratory failure in the United States: Incidence and 31-day survival. Chest. 2000;118:1100–5.

    Article  CAS  PubMed  Google Scholar 

  7. Hollander JM, Mechanick JI. Nutrition support and the chronic critical illness syndrome. Nutr Clin Pract. 2006;21(6):587–604.

    Article  PubMed  Google Scholar 

  8. Nelson JE, Tandon N, Mercado AF, Camhi SL, Ely EW, Morrison RS. Brain dysfunction. Another burden for the chronically critically ill. Arch Intern Med. 2006;166:1993–9.

    Article  PubMed  Google Scholar 

  9. Cox CE, Carson SS, Holmes GM, Howard A, Carey TS. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993–2002. Crit Care Med. 2004;32(11):2219–26.

    PubMed  Google Scholar 

  10. Zilberberg MD, de Wit M, Prirone JR, Shorr AF. Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery. Crit Care Med. 2008;36(5):1451–5.

    Article  PubMed  Google Scholar 

  11. Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M, Wallace WA. Outcomes in post-ICU mechanical ventilation: a therapist-implemented weaning protocol. Chest. 2001;119(1):236–42.

    Article  CAS  PubMed  Google Scholar 

  12. Jubran A, Grant BJ, Duffner LA, et al. Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation: a randomized trial. JAMA. 2013;309(7):671–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Scales DC, Ferguson ND. Early vs late tracheotomy in ICU patients. JAMA. 2010;303(15):1537–8.

    Article  CAS  PubMed  Google Scholar 

  14. Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012;40(10):2890–6.

    Article  PubMed  Google Scholar 

  15. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874–82.

    Article  PubMed  Google Scholar 

  16. Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36(8):2238–43.

    Article  PubMed  Google Scholar 

  17. Kalb TH, Lorin S. Infection in the chronically critically ill: unique risk profile in a newly defined population. Crit Care Clin. 2002;18(3):529–52.

    Article  PubMed  Google Scholar 

  18. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–32.

    Article  CAS  PubMed  Google Scholar 

  19. Cox CE, Carson SS, Lindquist JAH, Olson MK, Govert JA, Chelluri L. Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study. Crit Care. 2007;11:R9.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Carson SS, Garrett J, Hanson LC, et al. A prognostic model for one-year mortality in patients requiring prolonged mechanical ventilation. Crit Care Med. 2008;36(7):2061–9.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Combes A, Costa MA, Trouillet JL, et al. Morbidity, mortality, and quality-of-life outcomes of patients requiring > or = 14 days of mechanical ventilation. Crit Care Med. 2003;31(5):1373–81.

    Article  PubMed  Google Scholar 

  22. Engoren M, Arslanian-Engoren C, Fenn-Buderer N. Hospital and long-term outcome after tracheostomy for respiratory failure. Chest. 2004;125(1):220–7.

    Article  PubMed  Google Scholar 

  23. Unroe M, Kahn JM, Carson SS, et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010;153(3):167–75.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Carson SS, Bach PB, Brzozowski L, Leff A. Outcomes after long-term acute care. An analysis of 133 mechanically ventilated patients. Am J Respir Crit Care Med. 1999;159(5 Pt 1):1568–73.

    Google Scholar 

  25. Nasraway SA, Button GJ, Rand WM, Hudson-Jinks T, Gustafson M. Survivors of catastrophic illness: outcome after direct transfer from intensive care to extended care facilities. Crit Care Med. 2000;28(1):19–25.

    Article  CAS  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. Jubran A, Lawm G, Kelly J, et al. Depressive disorders during weaning from prolonged mechanical ventilation. Intensive Care Med. 2010;36(5):828–35.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Jubran A, Lawm G, Duffner LA, et al. Post-traumatic stress disorder after weaning from prolonged mechanical ventilation. Intensive Care Med. 2010;36(12):2030–7.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Donahoe MP. Current venues of care and related costs for the chronically critically ill. Respir Care. 2012;57(6):867–86. discussion 886–8.

    Article  PubMed  Google Scholar 

  30. Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):1266–71.

    Article  PubMed  Google Scholar 

  31. Kahn JM, Angus DC, Linde-Zwirble WT, Iwashyna TJ. Development and validation of an algorithm for identifying prolonged mechanical ventilation in administrative data. Health Serv Outcomes Res Methodol. 2009;9(2):117–32.

    Article  Google Scholar 

  32. Dalton K, Kandilov AMG, Kennel D, Wright A. Final report: determining medical necessity and appropriateness of care for Medicare long-term care hospitals (LTCHs), CMS Contract No. HHSM-500-2006-0008I-T003. 2012; http://www.rti.org/reports/cms.

  33. Kahn JM, Werner RM, David G, Ten Have TR, Benson NM, Asch DA. Effectiveness of long-term acute care hospitalization in elderly patients with chronic critical illness. Med Care. 2013;51(1):4–10.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Cooke CR. Economics of mechanical ventilation and respiratory failure. Crit Care Clin. 2012;28(1):39–55, vi.

    Google Scholar 

  35. Cox CE, Carson SS, Govert JA, Chelluri L, Sanders GD. An economic evaluation of prolonged mechanical ventilation. Crit Care Med. 2007;35(8):1918–27.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Gracey DR, Naessens JM, Viggiano RW, Koenig GE, Silverstein MD, Hubmayr RD. Outcome of patients cared for in a ventilator-dependent unit in a general hospital. Chest. 1995;107(2):494–9.

    Article  CAS  PubMed  Google Scholar 

  37. Dasgupta A, Rice R, Mascha E, Litaker D, Stoller JK. Four-year experience with a unit for long-term ventilation (respiratory special care unit) at the Cleveland Clinic Foundation. Chest. 1999;116(2):447–55.

    Article  CAS  PubMed  Google Scholar 

  38. MacIntyre NR, Epstein SK, Carson S, et al. Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest. 2005;128(6):3937–54.

    Article  PubMed  Google Scholar 

  39. Kahn JM, Benson NM, Appleby D, Carson SS, Iwashyna TJ. Long-term acute care hospital utilization after critical illness. JAMA. 2010;303(22):2253–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Kahn JM, Werner RM, Carson SS, Iwashyna TJ. Variation in long-term acute care hospital use after intensive care. Med Care Res Rev. 2012;69(3):339–50.

    Article  PubMed  Google Scholar 

  41. Scheinhorn D, Hassenpflug M, Votto J, et al. Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation. Chest. 2007;131:76–84.

    Article  PubMed  Google Scholar 

  42. Dalton K, Kennel D, Bernard S, Kane H, Wright A. Report on site visits to IPPS critical care services and long term care hospitals, CMS Contract No. HHSM-500-2006-00081-T003. 2012; http://www.rti.org/reports/cms.

  43. Rudy EB, Daly BJ, Douglas S, Montenegro HD, Song R, Dyer MA. Patient outcomes for the chronically critically ill: special care unit versus intensive care unit. Nurs Res. 1995;44(6):324–31.

    Article  CAS  PubMed  Google Scholar 

  44. Votto JJ, Scalise PJ, Barton RW, Vogel CA. An analysis of clinical outcomes and costs of a long term acute care hospital. J Med Econ. 2011;14(2):141–6.

    Article  PubMed  Google Scholar 

  45. Kandilov AMG, Dalton K. Utilization and payment effects of Medicare referrals to long-term care hospitals (LTCHs). Final Report. 2011; www.rti.org/reports/cms.

  46. Daly BJ, Douglas SL, Kelley CG, O'Toole E, Montenegro H. Trial of a disease management program to reduce hospital readmissions of the chronically critically ill. Chest. 2005;128(2):507–17.

    Article  PubMed  Google Scholar 

  47. Daly BJ, Douglas SL, O’Toole E, et al. Effectiveness trial of an intensive communication structure for families of long-stay ICU patients. Chest. 2010;138(6):1340–8.

    Google Scholar 

  48. Nelson JE, Mercado AF, Camhi SL, et al. Communication about chronic critical illness. Arch Intern Med. 2007;167(22):2509–15.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Scheunemann LP, McDevitt M, Carson SS, Hanson LC. Randomized, controlled trials of interventions to improve communication in intensive care: a systematic review. Chest. 2011;139(3):543–54.

    Article  PubMed  Google Scholar 

  50. Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356(5):469–78.

    Article  CAS  PubMed  Google Scholar 

  51. Carson SS, Vu M, Danis M, et al. Development and validation of a printed information brochure for families of chronically critically ill patients. Crit Care Med. 2012;40(1):73–8.

    Article  PubMed Central  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, 4125 Bioinformatics Building, CB# 7020, Chapel Hill, NC, 27599, USA

    Shannon S. Carson

  2. Rural Health Research and Policy Analysis Center, University of North Carolina, Chapel Hill, NC, USA

    Kathleen Dalton

Authors
  1. Shannon S. Carson
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  2. Kathleen Dalton
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Correspondence to Shannon S. Carson .

Editor information

Editors and Affiliations

  1. Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada

    Damon C. Scales

  2. Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada

    Gordon D. Rubenfeld

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Carson, S.S., Dalton, K. (2014). The Chronically Critically Ill. In: Scales, D., Rubenfeld, G. (eds) The Organization of Critical Care. Respiratory Medicine, vol 18. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-0811-0_13

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  • DOI: https://doi.org/10.1007/978-1-4939-0811-0_13

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  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-0810-3

  • Online ISBN: 978-1-4939-0811-0

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