Prevalence and development of chronic critical illness in acute patients admitted to a respiratory intensive care setting
A. Marchioni,
R. Tonelli,
A. Sdanganelli,
F. Gozzi,
L. Musarò,
R. Fantini,
L. Tabbì,
A. Andreani,
G. Cappiello,
S. Costi,
I. Castaniere,
E. Clini
Affiliations
A. Marchioni
University Hospital of Modena, Pneumology Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Largo del Pozzo 71, 41124, Modena, Italy
R. Tonelli
University Hospital of Modena, Pneumology Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Largo del Pozzo 71, 41124, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, via Università, 4 - 41121 Modena, Italy; Corresponding author at: Respiratory Diseases Unit and Center for Rare Lung Disease, University Hospital of Modena, Department of Surgical and Medical Sciences, University of Modena & Reggio Emilia, Via del Pozzo, 71 - 41125 Modena, Italy.
A. Sdanganelli
Respiratory Disease Unit, S.G. Moscati Hospital, Via per Martina Franca, 74010 Statte Taranto, Italy
F. Gozzi
University Hospital of Modena, Pneumology Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Largo del Pozzo 71, 41124, Modena, Italy
L. Musarò
School of Medicine, University of Modena Reggio Emilia, Largo del Pozzo 71, 41124, Modena, Italy
R. Fantini
University Hospital of Modena, Pneumology Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Largo del Pozzo 71, 41124, Modena, Italy
L. Tabbì
University Hospital of Modena, Pneumology Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Largo del Pozzo 71, 41124, Modena, Italy
A. Andreani
University Hospital of Modena, Pneumology Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Largo del Pozzo 71, 41124, Modena, Italy
G. Cappiello
University Hospital of Modena, Pneumology Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Largo del Pozzo 71, 41124, Modena, Italy
S. Costi
Department of Surgical, Medical and Dental Department of Morphological Sciences related to Transplants Oncology and Regenerative Medicine-University of Modena and Reggio Emilia and Azienda Unità Sanitaria Locale - IRCCS, Viale Risorgimento, 80, 42123 Reggio Emilia RE, Italy
I. Castaniere
University Hospital of Modena, Pneumology Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Largo del Pozzo 71, 41124, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, via Università, 4 - 41121 Modena, Italy
E. Clini
University Hospital of Modena, Pneumology Unit and Centre for Rare Lung Diseases, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Largo del Pozzo 71, 41124, Modena, Italy
Introduction: Chronic Critical Illness (chronic CI) is a condition associated to patients surviving an episode of acute respiratory failure (ARF). The prevalence and the factors associated with the development of chronic CI in the population admitted to a Respiratory Intensive Care Unit (RICU) have not yet been clarified. Methods: An observational prospective cohort study was undertaken at the RICU of the University Hospital of Modena (Italy). Patients mechanically ventilated with ARF in RICU were enrolled. Demographics, severity scores (APACHEII, SOFA, SAPSII), and clinical condition (septic shock, pneumonia, ARDS) were recorded on admission. Respiratory mechanics and inflammatory-metabolic blood parameters were measured both on admission and over the first week of stay. All variables were tested as predictors of chronic CI through univariate and multivariate analysis. Results: Chronic CI occurred in 33 out of 100 patients observed. Higher APACHEII, the presence of septic shock, diaphragmatic dysfunction (DD) at sonography, multidrug-resistant (MDR) bacterial infection, the occurrence of a second infection during stay, and a C-reactive protein (CRP) serum level inceasing 7 days over admission were associated with chronic CI. Septic shock was the strongest predictor of chronic CI (AUC = 0.92 p < 0.0001). Conclusions: Chronic CI is frequent in patients admitted to RICU and mechanically ventilated due to ARF. Infection-related factors seem to play a major role as predictors of this syndrome.
