As a Nurse in the medical critical care setting, there is not one particular chronic disease that is most relevant in my practice. The medical intensive care unit (ICU) sees a vast range of diseases amongst the patients but one is often not thought of which is the chronic critical illness post ICU stays; the chronic illnesses we create by saving your life. A prolonged ICU stay leaves survivors with medium to long-term morbidities due to their critical illness (Rousseau et al,2021). Advancements in critical care diagnostics, treatments, and organizational structures have decreased intensive care unit and in-hospital mortality, despite increase illness severity (Loftus et al., 2021). The term chronic critical illness is often referred to many new types of illnesses accrued during the patients stay in the ICU. A patient might have come in initially with influenza and required long term use of a ventilator with difficulty to wean. During the recovery phase the patient could have developed a kidney injury which will lead to long term dialysis. The patient also was susceptible to skin breakdowns, which lead to infection and subsequently the patient suffered from sepsis while in our care, along with another infection associated from prolonged ventilator use; despite following the best practice protocols such as the Ventilator Associated Pneumonia (VAP) bundle. Unfortunately, due to prolonged immobility, the patient then formed a blood clot, to which they needed to be anticoagulated, but that caused a secondary issue of gastrointestinal bleeding.
The financial burden of chronic critical illness can be upwards of more than 60% of the total cost of the ICU stay (Loss et al.,2017). Early multidisciplinary involvement in the patient’s care has been shown to decease the probability of sequential events from the patient’s original diagnosis, such as dieticians and physiotherapy (Loss et al.,2017). According to Rousseau et al. (2021), ICU survivors are complex patients and, after hospital discharge, may become lost in the healthcare system with delays in accessing clinical care that recognizes and proactively addresses their unique limitations and needs.
References
Loftus, T. J., Filiberto, A. C., Ozrazgat‐Baslanti, T., Gopal, S., & Bïhorac, A. (2021). Cardiovascular and renal disease in chronic critical illness. Journal of Clinical Medicine, 10(8), 1601. https://doi.org/10.3390/jcm10081601
Loss, S. H., Nunes, D. S. L., Franzosi, O. S., Salazar, G. S., Teixeira, C., & Vieira, S. R. R. (2017). Chronic critical illness: are we saving patients or creating victims? Revista Brasileira De Terapia Intensiva, 29(1). https://doi.org/10.5935/0103-507x.20170013
Rousseau, A., Prescott, H. C., Brett, S., Weiß, B., Azoulay, É., Créteur, J., Latronico, N., Hough, C. C., Weber‐Carstens, S., Vincent, J. L., & Preiser, J. (2021). Long-term outcomes after critical illness: recent insights. Critical Care, 25(1). https://doi.org/10.1186/s13054-021-03535-3
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