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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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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