Chronic critical illness is a disease state which affects

intensive care Intensive care medicine, also called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes pro ...

patients who have survived an initial insult but remain dependent on intensive care for a protracted period, neither dying nor recovering.Girard K, Raffin TA. The chronically critically ill: to save or let die? ''Respir Care''. 1985; 30: 339-47. The most characteristic clinical feature is a prolonged requirement for

mechanical ventilation Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move air ...

.Nelson JE, Cox CE, Hope AA, Carson SS. Chronic critical illness. ''Am J Respir Crit Care Med''. 2010; 182(4): 446-54. Other features include profound weakness associated with

critical illness polyneuropathy Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) are overlapping syndromes of diffuse, symmetric, flaccid muscle weakness occurring in critically ill patients and involving all extremities and the diaphragm with relative ...

and

myopathy In medicine, myopathy is a disease of the muscle in which the muscle fibers do not function properly. This results in muscular weakness. ''Myopathy'' means muscle disease (Greek : myo- ''muscle'' + patheia '' -pathy'' : ''suffering''). This meani ...

, increased susceptibility to infection,

metabolic Metabolism (, from el, μεταβολή ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cell ...

changes and

hormonal A hormone (from the Greek participle , "setting in motion") is a class of signaling molecules in multicellular organisms that are sent to distant organs by complex biological processes to regulate physiology and behavior. Hormones are required fo ...

changes. There may be protracted or permanent

delirium Delirium (also known as acute confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in ...

, or other marked cognitive impairment. The physical and psychological symptoms of the disease are very severe, including a propensity to develop

post traumatic stress syndrome Post or POST commonly refers to: *Mail, the postal system, especially in Commonwealth of Nations countries **An Post, the Irish national postal service **Canada Post, Canadian postal service **Deutsche Post, German postal service ** Iraqi Post, Ir ...

.Nelson JE, Meier DE, Litke A, Natale DA, Siegel RE, Morrison RS. The symptom burden of chronic critical illness. ''Crit Care Med''. 2004; 32(7): 1527-34. Strict definitions of chronic critical illness vary. One definition is the requirement for mechanical ventilation for 21 days or more. It is estimated that 5-10% of patients who require mechanical ventilation as part of their initial illness will go on to develop chronic critical illness. Overall prevalence has been estimated at 34.4 per 100 000 of the population.Kahn JM, Le T, Angus DC, Cox CE, Hough CL, White DB et al. The epidemiology of chronic critical illness in the United States. ''Crit Care Med''. 2005; 43(2): 282-7. Most adult patients do not survive chronic critical illness, and furthermore even those who are discharged from hospital frequently die soon after discharge. One-year mortality in adults is 48-68%. However, children fare better with two-thirds surviving to 5 years or beyond. Namachivayam SP, Alexander J, Slater A, Millar J, Erickson S, Tibballs J et al. Five-Year Survival of Children With Chronic Critical Illness in Australia and New Zealand ''Crit Care Med''. 2015; 43(9): 1978-85.

References

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See also

References