RT Book, Section
A1 Carson, Shannon S.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2283878
T1 Chapter 18. Chronic Critical Illness
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accessanesthesiology.mhmedical.com/content.aspx?aid=2283878
RD 2023/03/23
AB Chronically  critically  ill  patients  account  for  5%  to  10%  of  patients  admitted  to  an  adult  ICU.  They  account  for  as  many  as  88,000  hospital  discharges  per  year  in  the  United  States.  Most  chronically  critically  ill  patients  are  over  age  65.  The  burden  of  chronic  critical  illness  is  anticipated  to  increase  dramatically  in  the  next  decade.Chronically  critically  ill  patients  have  distinct  physiology  compared  with  more  acutely  ill  patients,  including  suppressed  levels  of  anterior  pituitary  hormones  and  severe  depletion  of  protein  stores  with  muscle  wasting.Important  principles  of  patient  management  include  prevention  of  infection,  protein  repletion,  aggressive  physical  therapy,  and  careful  attention  to  treating  symptoms.Liberation  from  mechanical  ventilation  usually  is  achieved  with  work-rest  cycles  that  are  guided  by  frequent  assessments  of  readiness  for  weaning  and  careful  monitoring  to  avoid  fatigue.One-year  survival  for  chronically  critically  ill  patients  is  between  23%  and  38%  in  most  cohorts,  but  younger  patients  with  few  comorbidities  have  distinctly  better  chances  of  survival.  Quality  of  life  for  survivors  is  similar  to  that  of  patients  with  shorter  periods  of  critical  illness.Costs  of  care  for  chronically  critically  ill  patients  are  extreme  during  hospitalization  and  after  discharge.  Cost  savings  can  be  achieved  by  managing  patients  in  dedicated  wards  or  facilities  outside  of  the  acute  ICU  setting.