Survival experience of chronically critically ill patients

Area of Science:

• Critical Care Medicine
• Health Services Research
• Patient Outcomes

Background:

• Chronically critically ill patients require specialized care, often in high-technology intensive care units (ICUs).
• Alternative care models, such as special care units (SCUs), may offer different approaches to managing these patients.
• The impact of care environment on survival for this patient population is not fully understood.

Purpose of the Study:

• To compare the survival experiences of chronically critically ill patients in a traditional high-technology ICU versus a low-technology, family-oriented SCU.
• To determine if the care environment influences mortality during hospitalization and after discharge.

Main Methods:

• Randomized assignment of patients to either an ICU or an SCU.
• The SCU featured a low-technology, family-oriented environment with nursing case management and shared governance.
• Survival analytic techniques were used to analyze 1-year cumulative mortality.

Main Results:

• The overall 1-year cumulative mortality for all patients was 59.9%.
• The risk of death was significantly lower after hospital discharge compared to during hospitalization.
• No significant difference in mortality experiences was observed between patients in the SCU and the ICU.

Conclusions:

• A high-technology ICU environment did not demonstrate superior outcomes compared to a low-technology SCU for chronically critically ill patients.
• Care environment, characterized by technology level and family involvement, may not be the primary determinant of survival in this population.
• Further research into optimal care models for chronically critically ill patients is warranted.