What’s in a name? The ongoing tangle of chronic critical illness, persistent critical illness, and prolonged acute mechanical ventilation

Advancements in critical care delivery and life support interventions have increased our ability to rescue patients from acute critical illness. Since chronic critical illness was first described in the mid-1980s, researchers have voiced concerns about increases in a population of chronically or persistently critically ill individuals who experience high rates of short- and long-term mortality and prolonged health care use. Seeking to describe the population, studies employed variable terms with a range of definitions, with some focusing on duration of mechanical ventilation or need for tracheostomy and others on intensive care unit (ICU) length of stay (LOS).

A key advancement was the 2015 proposal to define the development of persistent critical illness (PerCI) as the moment when “the reason for being in the ICU [becomes] more related to ongoing critical illness than the original reason for admission to the ICU.” Derived empirically as the time point at which preexisting patient characteristics become better predictors of in-hospital mortality than admission diagnosis and physiologic parameters, the onset of PerCI has been found to occur between Days 5 and 15 of ICU stays in multiple population-level cohort studies. […]

In this issue of AnnalsATS, He and colleagues further advance our understanding of the longer-term prognoses of patients with PerCI by describing not only 3- and 6-month mortality but also 3- and 6-month rates of disability and a range of patient-centered outcomes at 6-month follow-up in a secondary analysis of a multicenter, prospective cohort study. This cohort study, conducted in six metropolitan ICUs in Australia, provides the first detailed insights into the recovery potential of individuals experiencing PerCI.

Catherine L Auriemma, Emily E Moin