Cited by 616Respiratory Support and MechanismsIntensive Care Unit Cognitive DisordersNosocomial Infections in ICU

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Chronic Critical Illness

Open access

Nelson, Judith E., Cox, Christopher E., Hope, Aluko A., Carson, Shannon S.·2010·American Journal of Respiratory and Critical Care Medicine

DOI 10.1164/rccm.201002-0210ciPMC PMC2937238

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Abstract

Although advances in intensive care have enabled more patients to survive an acute critical illness, they also have created a large and growing population of chronically critically ill patients with prolonged dependence on mechanical ventilation and other intensive care therapies. Chronic critical illness is a devastating condition: mortality exceeds that for most malignancies, and functional dependence persists for most survivors. Costs of treating the chronically critically ill in the United States already exceed $20 billion and are increasing. In this article, we describe the constellation of clinical features that characterize chronic critical illness. We discuss the outcomes of this condition including ventilator liberation, mortality, and physical and cognitive function, noting that comparisons among cohorts are complicated by variation in defining criteria and care settings. We also address burdens for families of the chronically critically ill and the difficulties they face in decision-making about continuation of intensive therapies. Epidemiology and resource utilization issues are reviewed to highlight the impact of chronic critical illness on our health care system. Finally, we summarize the best available evidence for managing chronic critical illness, including ventilator weaning, nutritional support, rehabilitation, and palliative care, and emphasize the importance of efforts to prevent the transition from acute to chronic critical illness. As steps forward for the field, we suggest a specific definition of chronic critical illness, advocate for the creation of a research network encompassing a broad range of venues for care, and highlight areas for future study of the comparative effectiveness of different treatment venues and approaches.

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Self-citation
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Gonzalez, M. A., & Ochoa, C. D. (2017) · Springer eBooks · doi:10.1007/978-1-4939-7334-7_6 · Cited by 4
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Le syndrome post-réanimation
Marec, J. L., Jouan, Y., Ehrmann, S., & Gandonnière, C. S. (2021) · La Revue de Médecine Interne · doi:10.1016/j.revmed.2021.05.005 · Cited by 10
Transitional Care for Communication Impaired Older Adults: ICU to Home
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An Emerging Population: The Chronically Critically Ill
Jurasinski, P., & Schindler, C. A. (2014) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2014.04.004 · Cited by 4
Rethinking Delivery of Care for Patients Requiring Prolonged Mechanical Ventilation
Rose, L. (2020) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202002-0292ed · Cited by 4
Trends in tracheostomy placement after out-of-hospital cardiac arrest
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Immune signatures of megakaryocytes in persistent inflammation-immunosuppression and catabolism syndrome
Sun, X., Nan, K., Zhong, Z., Liu, Z., & Miao, C. (2025) · Acta Biochimica et Biophysica Sinica · doi:10.3724/abbs.2025087 · Cited by 3
Nurses' Role in Transitional Care During Intensive Care Unit Family Meetings for Patients With Prolonged Mechanical Ventilation
You, H., Docherty, S. L., Ashana, D. C., Pan, W., Cox, C. E., & Oyesanya, T. O. (2025) · Journal of Advanced Nursing · doi:10.1111/jan.70191 · Cited by 3
Self-citation
Immune status in chronic critical illness: a systematic review
Бондоевич, Б. Л., Geyze, A. V., KORNELYUK, R. A., & Плотников, Г. П. (2023) · Annals of critical care · doi:10.21320/1818-474x-2023-1-133-144 · Cited by 3
Trends in Medicare Utilization and Reimbursement of Tracheostomy From 2000 to 2022
Patel, R. A., Torabi, S. J., Izreig, S., & Manes, R. P. (2024) · Otolaryngology · doi:10.1002/ohn.1044 · Cited by 3
Clinical characteristics and risk factors of chronic critical illness in children with sepsis
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Inspiratory muscle training for chronic critically ill patients: a systematic review and meta-analysis of randomized controlled trials
das Chagas, G. R., Vieira, A. G. D. S., de Araújo, J. C. G., Eid, R. A. C., Mól, C. G., & Nawa, R. K. (2025) · Einstein (São Paulo) · doi:10.31744/einstein_journal/2025rw1134 · Cited by 4
Yoğun Bakım Ünitesinde Uzun Yatış Süresi (≥90 Gün): Predispozan Faktörlerin ve Sonuçların Retrospektif Analizi
Miniksar, Ö. H., & Keten, H. S. (2021) · Türk yoğun bakım derneği dergisi/Türk yoğun bakım dergisi · doi:10.4274/tybd.galenos.2021.58077 · Cited by 3
End-Expiratory Lung Volumes During Spontaneous Breathing Trials in Tracheostomized Subjects on Prolonged Mechanical Ventilation
Cheng, J.-C., Chen, H., Jerng, J., Kuo, P., & Wu, H. (2021) · Respiratory Care · doi:10.4187/respcare.08957 · Cited by 3
Acquisition of new medical devices among the persistently critically ill: A retrospective cohort study in the Veterans Affairs
Viglianti, E. M., Carlton, E. F., McPeake, J. M., Wang, X. Q., Seelye, S. M., & Iwashyna, T. J. (2022) · Medicine · doi:10.1097/md.0000000000029821 · Cited by 3
A protocol for exploring patients' and support peoples' experiences after prolonged critical illness
Best, A., Harvey, C. L., & Minton, C. (2023) · Nursing in Critical Care · doi:10.1111/nicc.12872 · Cited by 3

Authors: Nelson, J. E., Cox, C. E., Hope, A. A., & Carson, S. S.
Affiliations: Mount Sinai Hospital (US)
Duke University (US)
Icahn School of Medicine at Mount Sinai (US)
University of North Carolina at Chapel Hill (US)
ORCID: Nelson, Judith E.
Cox, Christopher E.
Hope, Aluko A.
Carson, Shannon S.
Venue: American Journal of Respiratory and Critical Care Medicine
Publisher: Oxford University Press (OUP)
Published: 2010-08
Volume: 182
Issue: 4
Pages: 446-454
ISSN: 1073-449X (ISSN-L)
1535-4970
DOI: 10.1164/rccm.201002-0210ci
PMC: PMC2937238
OpenAlex: W2110115774
Cited by: 616
References: 78
Citations by year: 2026: 33 · 2025: 36 · 2024: 37 · 2023: 40 · 2022: 43 · 2021: 48 · 2020: 52 · 2019: 51 · 2018: 35 · 2017: 49 · 2016: 45 · 2015: 43 · 2014: 27 · 2013: 26 · 2012: 27
FWCI: 4.31
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations: American Journal of Respiratory and Critical Care Medicine (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
UNC Libraries
Funders: National Institute on Aging (AG034234)
National Heart, Lung, and Blood Institute
National Institute of Nursing Research (R01NR012413)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords: chronic critical illness, prolonged mechanical ventilation, ventilator liberation, mortality, functional dependence, cognitive function, family burden, end-of-life decisions, health care costs, resource utilization (health care), nutritional support, rehabilitation, palliative care, research networks
MeSH terms: Chronic Disease, Critical Care, Humans, United States, Ventilator Weaning, Critical Illness, Cost of Illness, Nutritional Support

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