The heterogeneity of prolonged ICU hospitalisations

Prolonged intensive care unit (ICU) hospitalisations are costly, increasing in prevalence and strain ICU resources.1–4 One-year mortality is high and the recovery for survivors of prolonged ICU hospitalisations is typically long and marked by new morbidities.3 4 Thus, with advances in critical care technology, patients with prolonged ICU hospitalisations, their families and physicians are challenged to make complex, high-stakes decisions without clear guidance about long-term prognosis. Recent work has focused on who these patients are and why they remain in the ICU for prolonged periods of time.5–8 Commonly measured patient characteristics on admission such as age and comorbidities have not consistently been associated with the need for prolonged ICU hospitalisations. (Of note, other premorbid patient characteristics, such as frailty, have not been studied as a risk factor for persistent critical illness.) These findings have challenged preconceived beliefs that prolonged ICU hospitalisations only occur for older patients or those with multiple comorbidities.5 8 Instead, observational data suggest the development of new organ dysfunctions not present on admission contributes to the development of prolonged ICU hospitalisations.6 7 This finding moves our understanding of prolonged ICU hospitalisations beyond the prototype of chronic critical illness—a patient with unresolving respiratory failure—and towards a more complete picture of how prolonged ICU hospitalisations emerge over time in the ICU.3 (figure 1) Figure 1 New framework of prolonged ICU hospitalisations. Hermans et al describe the long-term mortality and morbidity of patients with prolonged ICU hospitalisations who are matched to short-stayers (patients who remained in the ICU for <8 days).9 The authors created three different matched cohorts to evaluate long-term mortality (total and post-28-day 5-year mortality) and morbidity. The authors performed a re-analysis of prospectively collected data of the EPaNIC-trial, which was a randomised control trial conducted in seven …