What Is Chronic Critical Illness and What Outcomes Can Be Expected
Chronic critical illness (CCI) occurs when a patient survives the acute phase of critical illness but experiences persistent organ dysfunction and is characterized by prolonged intensive care needs. Mortality for patients with CCI is high, with survivors experiencing poor functional and cognitive outcomes. Patients with CCI also experience frequent hospital readmission and transitions between health care settings. Patients with CCI and their family members experience significant emotional distress, with symptoms of anxiety, depression, and posttraumatic stress disorder being common in both groups. Due to a high incidence of delirium and other conditions that may interfere with decision-making capacity for patients with CCI, family members are often put into the role of surrogate decision maker, having to make complex decisions regarding the use of life-sustaining treatments in the face of great prognostic uncertainty. This prognostic uncertainty also creates challenges for providers in the intensive care unit as they try to meet the high informational needs of families, and many families report inadequate communication resulting in goal-discordant care. Given the inherent challenges created by CCI for patients, families, and providers, palliative care involvement offers many potential benefits in this unique and challenging disease process. Through expertise in communication, shared decision making, emotional support, and symptom management, the palliative care practitioner is in an optimal position to improve care for chronically critically ill patients and their family members.
