Long-stay critically ill patients' characteristics and outcomes: a cohort study

Introduction

Long-stay critically ill patients represent a small subgroup of ICU patients with huge resource consumption. The goal of this study was to identify outcomes and characteristics of these patients.

Methods

Data were collected retrospectively from consecutive patients requiring at least 60 days of ICU care admitted over seven calendar years (2000–2006) to a general ICU in a university-affiliated 427-bed hospital.

Results

A total of 27 patients met the inclusion criteria. Long-stay ICU patients represented 1.2% of total admissions. The mean age was 69 years (26–92 years). The median ICU stay in overall ICU patients was 7 days, while in long-stay ICU patients it was 98 days (62–202 days). General ICU mortality was 17.4%, in the studied group the mortality rate was 44.4%. A further eight patients died in the hospital after discharge from the ICU, representing an additional 26% of all long-stay ICU patients. Two years after the discharge 22.2% of these patients were alive, and 14.8% are alive until now. We found no obvious differences between the ones that died in ICU or in the hospital, or were discharged from the hospital, whether looking at APACHE II score, preadmission heart failure, obesity, diabetes mellitus or lung disease. One prominent factor in long-stay ICU patients that died in the unit was the occurrence of acute respiratory distress syndrome (83%) as opposed to the two other groups of patients (25% and 26%). Consequently, the median length of mechanical ventilation was greater in this group (101.8 days). Catecholamine requirement was also greater (83.3%) as well as the duration of the support (median 57.3 days). End-stage renal disease and immunosuppression had a negative impact and lead to prolonged ICU stay. The data regarding immunosuppression are supported by other authors [1].

Conclusion

End-stage renal disease and immunosuppression increase the risk of long-stay in ICU. The patients that died in the unit had a greater incidence of acute respiratory distress syndrome, needed more ventilation days and were more dependent on catecholamines and for longer time.

Despite the severity of the illness these patients still has favorable chances of 22.2% two years survival. More studies are needed to explore long stay ICU patient's population.