Toby Jeffcote1, Monica Foong1, Grace Gold1, Neil Glassford2, Raymond Robbins3, Theodore J Iwashyna4, Jai Darvall5, Sean M Bagshaw6, Rinaldo Bellomo7. 1. Department of Intensive Care Medicine, The Austin Hospital, Heidelberg, Melbourne, VIC, Australia. 2. Department of Intensive Care Medicine, The Austin Hospital, Heidelberg, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, VIC 3004, Australia. 3. Administrative Informatics Unit, The Austin Hospital, Melbourne, VIC, Australia. 4. Department of Medicine and Institute for Social Research, University of Michigan, USA; VA Center for Clinical Management Research, VA Ann Arbor Health Healthcare System, Ann Arbor, MI, USA. 5. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia. 6. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. 7. Department of Intensive Care Medicine, The Austin Hospital, Heidelberg, Melbourne, VIC, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, VIC 3004, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia; School of Medicine, University of Melbourne, Parkville, Melbourne, VIC, Australia. Electronic address: Rinaldo.bellomo@austin.org.au.
Abstract
OBJECTIVES: The primary objective was to identify the proportion of patients on mechanical ventilation (MV) beyond day 10, the recently defined time of onset of Persistent Critical Illness (PerCI). The secondary objective was to identify underlying diagnoses, intensive care unit (ICU) based therapies, relevant complications, and outcomes of patients with PerCI. SUBJECTS: 100 PerCI patients and 100 age, sex, mechanical ventilation for >24 h, acute physiology and chronic health score (APACHE III) and co-morbidity score-matched controls. MAIN RESULTS: The maximum proportion of PerCI patients requiring invasive MV beyond day 10 was 66%. PerCI patients were more likely to have respiratory, septic, or neurosurgical admission diagnoses (p = .01). In the first 10 ICU days, they received multiple types of ICU-based treatments for longer duration and had a higher incidence rate of ventilator-associated pneumonia (VAP) (p = .008). Hospital discharge destination differed significantly (p≤.001), with greater mortality (34% vs. 22%) and discharge to chronic care facility (11% vs. 0%). CONCLUSIONS: Mechanical ventilation beyond day 10 affected only two thirds of PerCI patients. However, VAP was a key complication in such patients. Discharge to chronic care facilities and hospital mortality were more common in PerCI patients.
OBJECTIVES: The primary objective was to identify the proportion of patients on mechanical ventilation (MV) beyond day 10, the recently defined time of onset of Persistent Critical Illness (PerCI). The secondary objective was to identify underlying diagnoses, intensive care unit (ICU) based therapies, relevant complications, and outcomes of patients with PerCI. SUBJECTS: 100 PerCI patients and 100 age, sex, mechanical ventilation for >24 h, acute physiology and chronic health score (APACHE III) and co-morbidity score-matched controls. MAIN RESULTS: The maximum proportion of PerCI patients requiring invasive MV beyond day 10 was 66%. PerCI patients were more likely to have respiratory, septic, or neurosurgical admission diagnoses (p = .01). In the first 10 ICU days, they received multiple types of ICU-based treatments for longer duration and had a higher incidence rate of ventilator-associated pneumonia (VAP) (p = .008). Hospital discharge destination differed significantly (p≤.001), with greater mortality (34% vs. 22%) and discharge to chronic care facility (11% vs. 0%). CONCLUSIONS: Mechanical ventilation beyond day 10 affected only two thirds of PerCI patients. However, VAP was a key complication in such patients. Discharge to chronic care facilities and hospital mortality were more common in PerCI patients.
Authors: Elizabeth M Viglianti; Erin F Carlton; Joanne McPeake; Xiao Qing Wang; Sarah Seelye; Theodore J Iwashyna Journal: Medicine (Baltimore) Date: 2022-07-08 Impact factor: 1.817
Authors: Jai N Darvall; Rinaldo Bellomo; Michael Bailey; Paul J Young; Kenneth Rockwood; David Pilcher Journal: Intensive Care Med Date: 2022-02-04 Impact factor: 41.787