The DOI matches its Crossref record; 77 of the 78 references it cites were found in a registry or an index.
Chronic Critical Illness
Open accessAbstract
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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Cited by
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Metadata
- 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)
- 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
- 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
- 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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