Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 152 No. 1314 (2022)

Mortality 7 years after prolonged treatment on a surgical intensive care unit

  • Barbara Meyer-Zehnder
  • Tobias E. Erlanger
  • Hans Pargger
DOI
https://doi.org/10.4414/SMW.2022.w30144
Cite this as:
Swiss Med Wkly. 2022;152:w30144
Published
08.04.2022

Summary

AIMS OF THE STUDY: Long-term intensive care treatment confers a substantial physical, psychological and social burden on patients, their relatives and the treatment team. It is essential to know the outcome of patients with long-term treatment and to establish factors that possibly can predict mortality. Only few Swiss studies have previously addressed this issue.

METHODS: This retrospective observational study at a Swiss tertiary academic medical care centre included patients who were treated for ≥7 consecutive days at the surgical intensive care unit (ICU) between 1 January 2011 and 31 December 2012. Follow-up ended on 30 September 2018.

RESULTS: Two-hundred and fifty patients were included, and three were lost to follow-up. Fifty-two patients (21.1%) died in the ICU, 25 (10.1%) after transfer to the normal ward. Thirty-one patients (12.5%) died within one year after the beginning of intensive care treatment. Altogether, the one-year mortality was 43.7% (108 patients). At the end of follow-up, 99 patients (40.1%) were still alive. Polytrauma patients represent a special group with a survival of more than 90%. Median patient age was 66 years (interquartile range 56–75); two thirds were men. Patients who died within one year of beginning treatment in the ICU were significantly older (median 71 vs 63 years, p <0.001), had a higher Charlson comorbidity index (mean 2.3 vs 1.2, p <0.001), a longer intensive care stay (median 13.9 vs 10.6 days, p = 0.001), a higher SAPS-II score (mean 52.7 vs 45.6, p = 0.001), a higher NEMS score (mean 1772.4 vs 1230.4, p <0.001) and more complications (mean 2.9 vs 2.0, p <0.001) than patients who survived at least 1 year. Those who died within 1 year more often developed pneumonia (50.9% vs 29.5%, p = 0.001), pleural empyema (13.0% vs 2.9%, p = 0.005), septic shock (51.9% vs 20.1%, p <0.001) or critical illness polyneuropathy (16.7% vs 2.9%, p <0.001). Moreover, they more frequently (30.6% vs 15.1%, p = 0.006) required a renal replacement therapy.

CONCLUSIONS: Long-term mortality of patients with prolonged intensive-care treatment is high. Scores combined with factors shown to be associated with an increased short- and long-term mortality can help to identify patients at risk for death within one year after ICU treatment.

References

  1. Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz JV, Dorman T, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2017 Feb;37:270–6. https://doi.org/10.1016/j.jcrc.2016.07.015
  2. Carson SS. Definitions and epidemiology of the chronically critically ill. Respir Care. 2012 Jun;57(6):848–56. https://doi.org/10.4187/respcare.01736
  3. Desarmenien M, Blanchard-Courtois AL, Ricou B. The chronic critical illness: a new disease in intensive care. Swiss Med Wkly. 2016 Oct;146:w14336. https://doi.org/10.4414/smw.2016.14336
  4. Marchioni A, Fantini R, Antenora F, Clini E, Fabbri L. Chronic critical illness: the price of survival. Eur J Clin Invest. 2015 Dec;45(12):1341–9. https://doi.org/10.1111/eci.12547
  5. Iwashyna TJ, Viglianti EM. Patient and population-level approaches to persistent critical illness and prolonged intensive care unit stays. Crit Care Clin. 2018 Oct;34(4):493–500. https://doi.org/10.1016/j.ccc.2018.06.001
  6. Long AC, Kross EK, Davydow DS, Curtis JR. Posttraumatic stress disorder among survivors of critical illness: creation of a conceptual model addressing identification, prevention, and management. Intensive Care Med. 2014 Jun;40(6):820–9. https://doi.org/10.1007/s00134-014-3306-8
  7. Heyland DK, Konopad E, Noseworthy TW, Johnston R, Gafni A. Is it ‘worthwhile’ to continue treating patients with a prolonged stay (>14 days) in the ICU? An economic evaluation. Chest. 1998 Jul;114(1):192–8. https://doi.org/10.1378/chest.114.1.192
  8. Iwashyna TJ, Hodgson CL, Pilcher D, Bailey M, van Lint A, Chavan S, et al. Timing of onset and burden of persistent critical illness in Australia and New Zealand: a retrospective, population-based, observational study. Lancet Respir Med. 2016 Jul;4(7):566–73. https://doi.org/10.1016/S2213-2600(16)30098-4
  9. Trottier V, McKenney MG, Beninati M, Manning R, Schulman CI. Survival after prolonged length of stay in a trauma intensive care unit. J Trauma. 2007 Jan;62(1):147–50. https://doi.org/10.1097/01.ta.0000250496.99127.4a
  10. Stricker K, Rothen HU, Takala J. Resource use in the ICU: short- vs. long-term patients. Acta Anaesthesiol Scand. 2003 May;47(5):508–15. https://doi.org/10.1034/j.1399-6576.2003.00083.x
  11. Bashour CA, Yared JP, Ryan TA, Rady MY, Mascha E, Leventhal MJ, et al. Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care. Crit Care Med. 2000 Dec;28(12):3847–53. https://doi.org/10.1097/00003246-200012000-00018
  12. Gersbach P, Tevaearai H, Revelly JP, Bize P, Chioléro R, von Segesser LK. Are there accurate predictors of long-term vital and functional outcomes in cardiac surgical patients requiring prolonged intensive care? Eur J Cardiothorac Surg. 2006 Apr;29(4):466–72. https://doi.org/10.1016/j.ejcts.2005.12.040
  13. Merlani P, Chenaud C, Mariotti N, Ricou B. Long-term outcome of elderly patients requiring intensive care admission for abdominal pathologies: survival and quality of life. Acta Anaesthesiol Scand. 2007 May;51(5):530–7. https://doi.org/10.1111/j.1399-6576.2007.01273.x
  14. Marshall DC, Hatch RA, Gerry S, Young JD, Watkinson P. Conditional survival with increasing duration of ICU admission: an observational study of three intensive care databases. Crit Care Med. 2020 Jan;48(1):91–7. https://doi.org/10.1097/CCM.0000000000004082
  15. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993 Dec;270(24):2957–63. https://doi.org/10.1001/jama.270.24.2957 https://doi.org/10.1001/jama.1993.03510240069035
  16. Reis Miranda D, Moreno R, Iapichino G. Nine equivalents of nursing manpower use score (NEMS). Intensive Care Med. 1997 Jul;23(7):760–5. https://doi.org/10.1007/s001340050406
  17. Iwashyna TJ, Hodgson CL, Pilcher D, Bailey M, Bellomo R. Persistent critical illness characterised by Australian and New Zealand ICU clinicians. Crit Care Resusc. 2015 Sep;17(3):153–8.
  18. Williams TA, Ho KM, Dobb GJ, Finn JC, Knuiman M, Webb SA ; Royal Perth Hospital ICU Data Linkage Group. Effect of length of stay in intensive care unit on hospital and long-term mortality of critically ill adult patients. Br J Anaesth. 2010 Apr;104(4):459–64. https://doi.org/10.1093/bja/aeq025
  19. Bagshaw SM, Stelfox HT, Iwashyna TJ, Bellomo R, Zuege D, Wang X. Timing of onset of persistent critical illness: a multi-centre retrospective cohort study. Intensive Care Med. 2018 Dec;44(12):2134–44. https://doi.org/10.1007/s00134-018-5440-1
  20. Carson SS, Kahn JM, Hough CL, Seeley EJ, White DB, Douglas IS, et al.; ProVent Investigators. A multicenter mortality prediction model for patients receiving prolonged mechanical ventilation. Crit Care Med. 2012 Apr;40(4):1171–6. https://doi.org/10.1097/CCM.0b013e3182387d43
  21. Elfstrom KM, Hatefi D, Kilgo PD, Puskas JD, Thourani VH, Guyton RA, et al. What happens after discharge? An analysis of long-term survival in cardiac surgical patients requiring prolonged intensive care. J Card Surg. 2012 Jan;27(1):13–9. https://doi.org/10.1111/j.1540-8191.2011.01341.x
  22. Engoren M, Buderer NF, Zacharias A. Long-term survival and health status after prolonged mechanical ventilation after cardiac surgery. Crit Care Med. 2000 Aug;28(8):2742–9. https://doi.org/10.1097/00003246-200008000-00010
  23. Kisat MT, Latif A, Zogg CK, Haut ER, Zafar SN, Hashmi ZG, et al. Survival outcomes after prolonged intensive care unit length of stay among trauma patients: the evidence for never giving up. Surgery. 2016 Sep;160(3):771–80. https://doi.org/10.1016/j.surg.2016.04.024
  24. Miller RS, Patton M, Graham RM, Hollins D. Outcomes of trauma patients who survive prolonged lengths of stay in the intensive care unit. J Trauma. 2000 Feb;48(2):229–34. https://doi.org/10.1097/00005373-200002000-00006
  25. Yu PJ, Cassiere HA, Fishbein J, Esposito RA, Hartman AR. Outcomes of patients with prolonged intensive care unit length of stay after cardiac surgery. J Cardiothorac Vasc Anesth. 2016 Dec;30(6):1550–4. https://doi.org/10.1053/j.jvca.2016.03.145
  26. Ong AW, Omert LA, Vido D, Goodman BM, Protetch J, Rodriguez A, et al. Characteristics and outcomes of trauma patients with ICU lengths of stay 30 days and greater: a seven-year retrospective study. Crit Care. 2009;13(5):R154. https://doi.org/10.1186/cc8054
  27. Ryan TA, Rady MY, Bashour CA, Leventhal M, Lytle B, Starr NJ. Predictors of outcome in cardiac surgical patients with prolonged intensive care stay. Chest. 1997 Oct;112(4):1035–42. https://doi.org/10.1378/chest.112.4.1035
  28. Chaudhary MA, Schoenfeld AJ, Koehlmoos TP, Cooper Z, Haider AH. Prolonged ICU stay and its association with 1-year trauma mortality: an analysis of 19,000 American patients. Am J Surg. 2019 Jul;218(1):21–6. https://doi.org/10.1016/j.amjsurg.2019.01.025
  29. Grothusen C, Attmann T, Friedrich C, Freitag-Wolf S, Haake N, Cremer J, et al. Predictors for long-term outcome and quality of life of patients after cardiac surgery with prolonged intensive care unit stay. Interv Med Appl Sci. 2013 Mar;5(1):3–9. https://doi.org/10.1556/IMAS.5.2013.1.1 https://doi.org/10.1556/imas.5.2013.1.1
  30. Martini V, Lederer AK, Laessle C, Makowiec F, Utzolino S, Fichtner-Feigl S, et al. Clinical characteristics and outcomes of surgical patients with intensive care unit lengths of stay of 90 days and greater. Crit Care Res Pract. 2017;2017:9852017. https://doi.org/10.1155/2017/9852017
  31. Eschbach D, Bliemel C, Oberkircher L, Aigner R, Hack J, Bockmann B, et al. One-year outcome of geriatric hip-fracture patients following prolonged ICU treatment. BioMed Res Int. 2016;2016:8431213. https://doi.org/10.1155/2016/8431213
  32. Hartl WH, Wolf H, Schneider CP, Küchenhoff H, Jauch KW. Acute and long-term survival in chronically critically ill surgical patients: a retrospective observational study. Crit Care. 2007;11(3):R55. https://doi.org/10.1186/cc5915
  33. Schöttler J, Hagemann A, Grothusen C, Stohn S, Pleger D, von der Brelie M, et al. [Mid-term outcome of cardiac surgery patients with prolonged postoperative intensive care treatment]. Med Klin Intensivmed Notf Med. 2011 Sep;106(1):41–7. https://doi.org/10.1007/s00063-011-0025-6
  34. Weiler N, Waldmann J, Bartsch DK, Rolfes C, Fendrich V. Outcome in patients with long-term treatment in a surgical intensive care unit. Langenbecks Arch Surg. 2012 Aug;397(6):995–9. https://doi.org/10.1007/s00423-012-0966-0
  35. Arora RC, Manji RA, Singal RK, Hiebert B, Menkis AH. Outcomes of octogenarians discharged from the hospital after prolonged intensive care unit length of stay after cardiac surgery. J Thorac Cardiovasc Surg. 2017 Nov;154(5):1668–1678.e2. https://doi.org/10.1016/j.jtcvs.2017.04.083
  36. Friedrich JO, Wilson G, Chant C. Long-term outcomes and clinical predictors of hospital mortality in very long stay intensive care unit patients: a cohort study. Crit Care. 2006;10(2):R59. https://doi.org/10.1186/cc4888
  37. Manji RA, Arora RC, Singal RK, Hiebert B, Moon MC, Freed DH, et al. Long-term outcome and predictors of noninstitutionalized survival subsequent to prolonged intensive care unit stay after cardiac surgical procedures. Ann Thorac Surg. 2016 Jan;101(1):56–63. https://doi.org/10.1016/j.athoracsur.2015.07.004
  38. Hellgren L, Ståhle E. Quality of life after heart valve surgery with prolonged intensive care. Ann Thorac Surg. 2005 Nov;80(5):1693–8. https://doi.org/10.1016/j.athoracsur.2005.04.042
  39. Lagercrantz E, Lindblom D, Sartipy U. Survival and quality of life in cardiac surgery patients with prolonged intensive care. Ann Thorac Surg. 2010 Feb;89(2):490–5. https://doi.org/10.1016/j.athoracsur.2009.09.073
  40. Hughes M, MacKirdy FN, Norrie J, Grant IS. Outcome of long-stay intensive care patients. Intensive Care Med. 2001 Apr;27(4):779–82. https://doi.org/10.1007/s001340100896
  41. Pappalardo F, Franco A, Landoni G, Cardano P, Zangrillo A, Alfieri O. Long-term outcome and quality of life of patients requiring prolonged mechanical ventilation after cardiac surgery. Eur J Cardiothorac Surg. 2004 Apr;25(4):548–52. https://doi.org/10.1016/j.ejcts.2003.11.034
  42. Silberman S, Bitran D, Fink D, Tauber R, Merin O. Very prolonged stay in the intensive care unit after cardiac operations: early results and late survival. Ann Thorac Surg. 2013 Jul;96(1):15–21. https://doi.org/10.1016/j.athoracsur.2013.01.103
  43. Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C, et al. Morbidity, mortality, and quality-of-life outcomes of patients requiring >or=14 days of mechanical ventilation. Crit Care Med. 2003 May;31(5):1373–81. https://doi.org/10.1097/01.CCM.0000065188.87029.C3
  44. Delle Karth G, Meyer B, Bauer S, Nikfardjam M, Heinz G. Outcome and functional capacity after prolonged intensive care unit stay. Wien Klin Wochenschr. 2006 Jul;118(13-14):390–6. https://doi.org/10.1007/s00508-006-0616-z
  45. Hermans G, Van Aerde N, Meersseman P, Van Mechelen H, Debaveye Y, Wilmer A, et al. Five-year mortality and morbidity impact of prolonged versus brief ICU stay: a propensity score matched cohort study. Thorax. 2019 Nov;74(11):1037–45. https://doi.org/10.1136/thoraxjnl-2018-213020
  46. Carden GP, Graham JW, McLennan S, Celi LA. Long-term outcome of long stay ICU and HDU patients in a new zealand hospital. Crit Care Shock. 2008 Mar;11(1):26–34.
  47. Huang YC, Huang SJ, Tsauo JY, Ko WJ. Definition, risk factors and outcome of prolonged surgical intensive care unit stay. Anaesth Intensive Care. 2010 May;38(3):500–5. https://doi.org/10.1177/0310057X1003800314
  48. Steenbergen S, Rijkenberg S, Adonis T, Kroeze G, van Stijn I, Endeman H. Long-term treated intensive care patients outcomes: the one-year mortality rate, quality of life, health care use and long-term complications as reported by general practitioners. BMC Anesthesiol. 2015 Oct;15(1):142. https://doi.org/10.1186/s12871-015-0121-x
  49. Conti M, Merlani P, Ricou B. Prognosis and quality of life of elderly patients after intensive care. Swiss Med Wkly. 2012 Sep;142:w13671. https://doi.org/10.4414/smw.2012.13671
  50. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013 Mar;381(9868):752–62. https://doi.org/10.1016/S0140-6736(12)62167-9
  51. Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017 Aug;43(8):1105–22. https://doi.org/10.1007/s00134-017-4867-0
  52. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015 Aug;41(8):1411–23. https://doi.org/10.1007/s00134-015-3934-7
  53. Druml W. Systemic consequences of acute kidney injury. Curr Opin Crit Care. 2014 Dec;20(6):613–9. https://doi.org/10.1097/MCC.0000000000000150
  54. Joannidis M, Druml W, Forni LG, Groeneveld AB, Honore P, Oudemans-van Straaten HM, et al.; Critical Care Nephrology Working Group of the European Society of Intensive Care Medicine. Prevention of acute kidney injury and protection of renal function in the intensive care unit. Expert opinion of the Working Group for Nephrology, ESICM. Intensive Care Med. 2010 Mar;36(3):392–411. https://doi.org/10.1007/s00134-009-1678-y
  55. Joannidis M, Druml W, Forni LG, Groeneveld AB, Honore PM, Hoste E, et al. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 : Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med. 2017 Jun;43(6):730–49. https://doi.org/10.1007/s00134-017-4832-y
  56. Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015 Jun;350(may19 3):h2538. https://doi.org/10.1136/bmj.h2538
  57. Wesch C, Denhaerynck K, Barandun Schaefer U, Siegemund M, Wehrli M, Pargger H, et al. Development and validation of a multivariable risk score for prolonged length of stay in the surgical intensive care unit. Swiss Med Wkly. 2019 Sep;149:w20122. https://doi.org/10.4414/smw.2019.20122
  58. Meyer-Zehnder B, Barandun Schäfer U, Albisser Schleger H, Reiter-Theil S, Pargger H. Ethische Fallbesprechungen auf der Intensivstation : Vom Versuch zur Routine. Anaesthesist. 2014 Jun;63(6):477–87. https://doi.org/10.1007/s00101-014-2331-x
  59. Meyer-Zehnder B, Barandun Schäfer U, Wesch C, Reiter-Theil S, Pargger H. Weekly internal ethical case discussions in an ICU - Results based on 9 years of experience with a highly structured approach. Crit Care Explor. 2021;3(3):e0352. doi: https://doi.org/10.1097/cce.0000000000000352. PubMed PMID: 02107256-202103000-00019. https://doi.org/10.1097/CCE.0000000000000352

Most read articles by the same author(s)