Estenssoro et al described the clinical profile for a patient who spends a prolonged period in the intensive care unit (ICU), termed the chronically critically ill (CCI). These patients often require significant use of health care resources. The authors are from Buenos Aires, Argentina.


General features:

(1) ill enough to be admitted to the ICU

(2) multiple complications that prolong ICU stay

(3) absence of significant pre-existing comorbid conditions (people with significant comorbid conditions often do not survive when serious complications develop)


Common features that are present at the time of ICU admission:

(1) high APACHE II score

(2) adult respiratory distress syndrome (ARDS)

(3) shock

(4) multiple organ dysfunction/failure

(5) recent emergency surgery

(6) high McCabe score (fulminant disease, see Chapter 23)


Findings during ICU stay:

(1) prolonged mechanical ventilation, with failed attempts at weaning

(2) need for tracheostomy

(3) sepsis, often repeated episodes

(4) other infections (pneumonia, urinary tract infections, wound infection, central line infections, etc.)

(5) one or more organ failures (indicated by the SOFA score)

(6) neuropsychological complications

(7) malnutrition and need for nutritional support

(8) high levels of functional dependency

(9) complicated wound care

(10) need for additional surgery


A significant finding is that mortality, although high, may be less than expected, so continued quality care is justified.


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