Outcome and functional capacity after prolonged intensive care unit stay

Area of Science:

• Critical Care Medicine
• Intensive Care Unit (ICU) Outcomes
• Prognostic Factor Analysis

Background:

• A significant number of critically ill patients require prolonged intensive care unit (ICU) management.
• Data on risk factors for in-hospital and long-term mortality, as well as functional capacity, in these long-term ICU patients are limited.
• This study aimed to investigate outcomes and prognostic factors in critically ill patients with extended ICU stays.

Purpose of the Study:

• To identify risk factors for in-hospital and long-term mortality in critically ill patients with intensive care unit (ICU) stays of 30 days or longer.
• To assess the functional capacity of long-term ICU survivors.
• To compare outcomes between patients with prolonged ICU stays and those with shorter stays.

Main Methods:

• Retrospective observational cohort study analyzing data from a mixed adult cardiologic ICU.
• Inclusion criteria: intensive care unit (ICU) stay of greater than or equal to 30 days.
• Functional capacity assessed using the Barthel mobility index via telephone interviews.

Main Results:

• Long-term ICU patients (≥30 days) had significantly higher initial SAPS II scores compared to short-term patients.
• In-hospital and ICU mortality rates were comparable between long-term and short-term ICU groups.
• Long-term ICU survivors faced significantly higher cumulative mortality rates at 12 and 48 months post-discharge.
• Renal replacement therapy during ICU stay was the sole independent predictor of in-hospital death and 1-year mortality in long-term ICU patients.
• 90% of long-term survivors exhibited no or only moderate disability in daily activities.

Conclusions:

• Hospital mortality rates are similar for critically ill patients with short (<30 days) versus long (≥30 days) intensive care unit (ICU) stays.
• The need for renal replacement therapy is a key predictor of mortality in long-term ICU patients.
• Critically ill patients with prolonged ICU stays face a substantial ongoing risk of death post-discharge, yet many achieve functional recovery.