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Nature and impact of in-hospital complications associated with persistent critical illness
Boris Tseitkin, Johan Mårtensson, Glenn M Eastwood, Alastair Brown, Paolo Ancona, Luca Lucchetta, Theodore J Iwashyna, Raymond Robbins, Rinaldo Bellomo
Crit Care Resusc 2020; 22 (4): 378-387
- Boris Tseitkin 1
- Johan Mårtensson 1, 2
- Glenn M Eastwood 1, 3
- Alastair Brown 1
- Paolo Ancona 1, 4
- Luca Lucchetta 1, 5
- Theodore J Iwashyna 6, 7
- Raymond Robbins 8
- Rinaldo Bellomo 1, 3, 9, 10, 11
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 ν 2.3 days (IQR, 1.1–3.7) for controls, and median hospital length of stay was 41 days (IQR, 22–75) ν 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% ν 1%) and/or tracheostomy (36% ν 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 ν 4.0 complications per patient; P < 0.0001) but had fewer exposure-adjusted complications (202 ν 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/Source of Funding
Austin Hospital Intensive Care Trust Fund.
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