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Review
. 2017 Jan-Mar;29(1):87-95.
doi: 10.5935/0103-507X.20170013.

Chronic critical illness: are we saving patients or creating victims?

[Article in Portuguese, English]
Sergio Henrique Loss  1   2 , Diego Silva Leite Nunes  1 , Oellen Stuani Franzosi  1   3 , Gabriela Soranço Salazar  4 , Cassiano Teixeira  5 , Silvia Regina Rios Vieira  1   2   6
Affiliations
Review

Chronic critical illness: are we saving patients or creating victims?

[Article in Portuguese, English]
Sergio Henrique Loss et al. Rev Bras Ter Intensiva. 2017 Jan-Mar.

Abstract
in English, Portuguese

The technological advancements that allow support for organ dysfunction have led to an increase in survival rates for the most critically ill patients. Some of these patients survive the initial acute critical condition but continue to suffer from organ dysfunction and remain in an inflammatory state for long periods of time. This group of critically ill patients has been described since the 1980s and has had different diagnostic criteria over the years. These patients are known to have lengthy hospital stays, undergo significant alterations in muscle and bone metabolism, show immunodeficiency, consume substantial health resources, have reduced functional and cognitive capacity after discharge, create a sizable workload for caregivers, and present high long-term mortality rates. The aim of this review is to report on the most current evidence in terms of the definition, pathophysiology, clinical manifestations, treatment, and prognosis of persistent critical illness.

Os avanços tecnológicos que permitem dar suporte às disfunções de órgãos levaram a um aumento nas taxas de sobrevivência para a maioria dos pacientes críticos. Alguns destes pacientes sobrevivem à condição crítica inicial, porém continuam a sofrer com disfunções de órgãos e permanecem em estado inflamatório por longos períodos. Este grupo de pacientes críticos foi descrito desde os anos 1980 e teve diferentes critérios diagnósticos ao longo dos anos. Sabe-se que estes pacientes têm longas permanências no hospital, sofrem importantes alterações do metabolismo muscular e ósseo, apresentam imunodeficiência, consomem quantias substanciais de recursos de saúde, têm reduzida capacidade funcional e cognitiva após a alta, demandam uma considerável carga de trabalho para seus cuidadores, e apresentam elevadas taxas de mortalidade em longo prazo. O objetivo desta revisão foi apresentar as evidências atuais, em termos de definição, fisiopatologia, manifestações clínicas, tratamento e prognóstico da doença crítica persistente.

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Conflict of interest statement

Conflicts of interest: None

Figures

Figure 1
Figure 1
Injury, allostasis and allostatic overload. CCI - chronic critical illness.
See this image and copyright information in PMC

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