Nature and impact of in-hospital complications associated with persistent critical illness
Boris Tseitkin1, Johan Mårtensson1,2, Glenn M Eastwood1,3
1Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
Insights
Patients with persistent critical illness (PerCI) experience more in-hospital complications but not a higher rate when adjusted for exposure. Identifying these complications can guide preventative strategies for high-risk ICU patients.
Area of Science:
- Critical Care Medicine
- Intensive Care Unit (ICU) Management
- Patient Outcomes Research
Background:
- Persistent critical illness (PerCI) is defined as an ICU stay of 10 days or more.
- The specific in-hospital complications associated with PerCI are not well understood.
- Understanding these complications is crucial for improving patient care and outcomes.
Purpose of the Study:
- To determine if PerCI is linked to a higher prevalence and specific types of in-hospital complications.
- To compare complication rates between patients with PerCI and those without.
- To identify potential targets for intervention and prevention strategies.
Main Methods:
- A single-centre, retrospective, observational case-control study was conducted.
- 1200 patients admitted to a tertiary ICU between 2010 and 2015 were analyzed.
- Patients were categorized into PerCI (ICU stay ≥ 10 days) and control groups.
Main Results:
- PerCI patients had significantly longer ICU and hospital stays compared to controls.
- Higher rates of acute renal replacement therapy, reintubation, and tracheostomy were observed in PerCI patients.
- Despite increased complications, hospital mortality rates were similar between PerCI and control groups.
Conclusions:
- PerCI is associated with a higher prevalence of specific in-hospital complications.
- Exposure-adjusted complication rates were lower in PerCI patients, suggesting efficient care despite complexity.
- Certain complications in PerCI patients may be preventable, offering targets for future interventions.
Abstract:
Background: Persistent critical illness (PerCI) is defined as an intensive care unit (ICU) admission lasting ≥ 10 days. The in-hospital complications associated with its development are poorly understood. Aims: To test whether PerCI is associated with a greater prevalence, rate and specific types of in-hospital complications. Methods: Single-centre, retrospective, observational case-control study. Results: We studied 1200 patients admitted to a tertiary ICU from 2010 to 2015. Median ICU length of stay was 16 days (interquartile range [IQR], 12-23) for PerCI patients v 2.3 days (IQR, 1.1-3.7) for controls, and median hospital length of stay was 41 days (IQR, 22-75) v 8 days (IQR, 4-17) respectively. A greater proportion of PerCI patients received acute renal replacement therapy (37% v 6.8%) or underwent reintubation (17% v 1%) and/or tracheostomy (36% v 0.6%); P < 0.0001. Despite these complications, PerCI patients had similar hospital mortality (29% v 27%; P = 0.53). PerCI patients experienced a greater absolute number of complications (12.1 v 4.0 complications per patient; P < 0.0001) but had fewer exposure-adjusted complications (202 v 272 complications per 1000 hospital bed-days; P < 0.001) and a particularly high overall prevalence of specific complications. Conclusions: PerCI patients experience a higher prevalence, but not a higher rate, of exposure-adjusted complications. Some of these complications appear amenable to prevention, helping to define intervention targets in patients at risk of PerCI. Funding: Austin Hospital Intensive Care Trust Fund.
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