Abstract
The chronic critical illness is a health condition characterized by extreme weakness and deconditioning; commonly tracheostomy has been placed and prolonged mechanical ventilation is needed. Its incidence has doubled over the past ten years, but there is a lack of Italian data after 2007. Aim of our study was to evaluate, in patients admitted to our Respiratory Intensive Care Unit (RICU), how weaning success rate and duration, rehabilitative step reached, location after discharge and in-RICU mortality changed over the years. Secondary aim was to search for predictors of changes. Data from 1313 consecutive patients admitted to our RICU from 2000 to 2014 were retrospectively analyzed, dividing the observational time in 5-year periods. Across the years the weaning success rate decreased (79.8% in 2000-2004, 73.3% in 2005-2009 and 55.7% in 2010-2014, p<0.01). The median duration of weaning increased, mainly in the last period (10 days in 2010-2014 vs 6 days in 2000-2004, p=1x10-5 and vs 7 days of 2005-2009, p=2x10-5).Oppositely, over the years the rehabilitative level at discharge improved (p=5x10-19), but with no impact on the discharge destination, which did not change significantly (p=0.77). Mortality rate was 13.79% and remained stable over time. In conclusion, with the exception of the rehabilitative level, the clinical outcomes of our patients worsened over the years, particularly in the last 5 years. This is likely a consequence of the increased patient complexity and chronicity. These findings, even if limited to a single center, probably reflect a global health condition and appear relevant in addressing future changes both at structural and individual caregiving level.
- Copyright ©ERS 2015
