Late organ failures in patients with prolonged intensive care unit stays

Elizabeth M Viglianti; Rachel Kramer; Andrew J Admon; Michael W Sjoding; Carol L Hodgson; Rinaldo Bellomo; Theodore J Iwashyna

doi:10.1016/j.jcrc.2018.03.029

Late organ failures in patients with prolonged intensive care unit stays

J Crit Care. 2018 Aug:46:55-57. doi: 10.1016/j.jcrc.2018.03.029. Epub 2018 Apr 4.

Authors

Elizabeth M Viglianti¹, Rachel Kramer², Andrew J Admon³, Michael W Sjoding⁴, Carol L Hodgson⁵, Rinaldo Bellomo⁶, Theodore J Iwashyna⁷

Affiliations

¹ Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan Ann Arbor, MI 48109, USA. Electronic address: eviglian@med.umich.edu.
² University of Michigan School of Medicine, Ann Arbor, MI, USA.. Electronic address: rdkramer@med.umich.edu.
³ Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan Ann Arbor, MI 48109, USA. Electronic address: ajadmon@med.umich.edu.
⁴ Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan Ann Arbor, MI 48109, USA. Electronic address: msjoding@med.umich.edu.
⁵ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Physiotherapy, Alfred Hospital, Melbourne, VIC, Australia. Electronic address: carol.hodgson@monash.edu.
⁶ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia. Electronic address: rinaldo.bellomo@austin.org.au.
⁷ Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan Ann Arbor, MI 48109, USA; Veterans Affairs Ann Arbor Health System Center for Clinical Management Research, Ann Arbor, MI 48109, USA; Institute for Social Research, Ann Arbor, MI, USA. Electronic address: tiwashyn@umich.edu.

Abstract

Purpose: The purpose of this study was to characterize the organ failures that develop among patients with prolonged ICU stays, defined as those who spent a minimum of 14 days in an ICU.

Methods: We retrospectively studied a cohort of consecutive patients from a university hospital who were in an ICU for a minimum of 14 days during 2014-2016. We calculated daily Sequential Organ Failure Assessment (SOFA) scores from admission to ICU day 14. The primary outcome was the number of new late organ failures, defined as occurring on ICU day 4 through 14.

Results: In a retrospective cohort of 3777 consecutive patients in six ICUs, 50 patients had prolonged ICU stays. Of those 50, new cardiovascular failure occurred in 24 (62%) on day 4 or later; persistent mechanical ventilation was present in only 28 (56%).

Conclusions: Strategies aiming to reduce the development of new late organ failures may be a novel target for preventing persistent critical illness.

Keywords: Chronic critical illness; Outcomes; Persistent critical illness; Prolonged ICU stay; Prolonged mechanical ventilation.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aged
Comorbidity
Critical Illness*
Female
Hospitalization
Humans
Intensive Care Units*
Length of Stay*
Male
Middle Aged
Multiple Organ Failure / complications*
Multiple Organ Failure / epidemiology
Patient Discharge
Respiration, Artificial / statistics & numerical data
Respiratory Insufficiency
Retrospective Studies

Abstract

Publication types

MeSH terms

Grants and funding