2017, Number 1
Med Crit 2017; 31 (1)
Epidemiological characteristics of patients with chronic critical illness. An ambispective observational study
Vásquez-Revilla HR, Revilla-Rodríguez E, Raymundo-Aguilar CA, Gaytán-Sánchez BM, Terrazas-Luna V
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ABSTRACTIntroduction: The population of patients requiring intensive care for a prolonged time has increased in recent decades, resulting in a new population of individuals with chronic critical illness (CCI). The aim of this study was to describe the epidemiological characteristics of subjects with CCI in the ICU of the High Specialty Regional Hospital of Oaxaca.
Material and methods: It was a retrospective and prospective, observational and descriptive study that included people admitted between January 1, 2012 and December 31, 2015. Patients with CCI were defined as those with prolonged mechanical ventilation (more than 21 days of ventilation for more than six hours/day). The individuals were followed until their hospital discharge or death. Subjects with incomplete medical records, under 16 years of age, neuromuscular diseases (Guillain-Barre syndrome and Myasthenia gravis) and those without mechanical ventilation or who required it for less than 48 hours were excluded.
Results: Two-hundred eighty-four people were included; the incidence of CCI was 9.8%. In patients with CCI, the APACHE II score was 19.4 ± 9.7, and in those without CCI, it was 15.94 ± 8.6 (p = 0.044). The SOFA scale in individuals with CCI was 8.7 ± 2.6, and in those without CCI, 7.01 ± 4.4 (p = 0.007). The days of ICU stay were 17.1 ± 9.2 for subjects with CCI and 8 ±for those without CCI (p = 0.0000). The days of hospital stay were 45.9 ± 19.7 in people with CCI and 18.3 ± 12.4 in patients without CCI (p = 0.0000). ICU mortality was 17.8% in individuals with CCI and 27.7% in subjects without CCI (p = 0.0000). The hospital mortality was 50% in people with CCI and 16% in those without CCI (p = 0.0000). Of those patients with CCI, 32.2% were discharged from hospital, compared to 56.3% of individuals without CCI (p = 0.0000).
Conclusions: The incidence of CCI in our study was similar to that reported in the literature. The severity of acute disease upon admission, according to the APACHE and SOFA scales, was related to the development of CCI. Subjects with chronic critical illness had a longer ICU stay, more days on sedation and of hospital stay, and increased hospital mortality.