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The Chronically Critically Ill

  • Shannon S. CarsonEmail author
  • Kathleen Dalton
Chapter
Part of the Respiratory Medicine book series (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.

Keywords

Critical care Critical illness Critically ill Mechanical ventilation Mechanical ventilator weaning Outcomes assessment Costs Costs analysis Long-term care Sub-acute care 

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineUniversity of North Carolina School of MedicineChapel HillUSA
  2. 2.Rural Health Research and Policy Analysis CenterUniversity of North CarolinaChapel HillUSA

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