Chronic Critical Illness and the Long Term Sequela of Critical Care

Abstract

Although advances in intensive care have enabled more patients to survive an acute illness they have also created a large and growing population of patients with prolonged dependence on mechanical ventilation and other intensive care therapies. The term “chronically critically ill” was coined for this group of patients by girard and rafin in a 1985 article that asked in its title “to save or let die?” [1] they focused on patients who survived an initial episode of critical illness but remained dependent on intensive care, neither dying in the acute period of intensive care unit treatment no recovering. Chronic critical illness (cci) is usually defined as an icu patient who requires more than 21 days of assisted ventilation. The placement of a tracheostomy for long term ventilation is used by many to identify cci patients [2]. Although prolonged dependence on mechanical ventilation is a hallmark of cci, cci is not simply an extended period of acute critical illness but a discreet syndrome including profound weakness attributed to myopathy, neuropathy, alterations in body, anasarca, neuroendocrine changes, brain dysfunction manifesting as coma or delirium, increased vulnerability to infections and skin breakdown leading to decubital ulceration [3–6].