Persistent Critical Illness May Keep Patients From Leaving ICU

A small group of patients uses one-third of intensive care unit resources, a new study contends.

Researchers analyzed data from more than one million ICU patients in Australia and New Zealand, and found that just 5 percent of them accounted for 33 percent of all days that ICU beds got used.

These are critically ill patients who go from one health crisis to another and may never get well enough to leave the ICU, according to the study authors.

The findings could lead to better care and efforts to find ways to prevent patients from slipping into this situation, which the researchers called persistent critical illness.

"We have found that this truly is a separate 'thing' -- a state patients transition into where you're there because you're there, stuck in this cascade that we can't get you out of," said study leader Dr.
Theodore Iwashyna. He is a University of Michigan Medical School ICU physician, who led the study while on sabbatical in Australia.

"The reason why these patients came in to the hospital in the first place doesn't matter nearly as much anymore -- what matters is that they've been there, and some aspects of how well their body worked before they came in, such as age," Iwashyna explained in a university news release.

To reach their findings, the researchers used data from over one million critically ill patients treated in
182 ICUs across Australia and New Zealand between 2000 and 2014. Of these patients, about 51,500 were found to have persistent critical illness. This group collectively spent more than a million days in ICU beds, and more than 2.2 million days in the hospital overall, the findings showed.

In addition, almost one-quarter of the patients with persistent critical illness died in the ICU, the study found.

Just under half of ICU patients with persistent critical illness were able to go directly home from the hospital. This compared with three-quarters of ICU patients who were not deemed to have persistent critical illness, the researchers said.

Along with improved care, a better understanding of persistent critical illness could help discussions between medical teams and families about the long-term prospects for people who have been in the ICU for weeks, the study authors said.

The study's senior author, Dr. Rinaldo Bellomo of Monash University in Australia, concluded that "we need to help the fraction who are inevitably going to die do so with dignity, and at the same time help those who are not fated to die to get better treatment."

The study was published May 4 in The Lancet Respiratory Medicine.


More information
The American Association of Critical-Care Nurses has more on critical care.