Berto Paula Pinheiro, Teixeira Cassiano, Vianna Marina Verçoza, Rosa Regis Goulart, Sganzerla Daniel, Lisboa Thiago Costa, Friedman Gilberto
Postgraduate Program in Pulmonary Sciences, Universidade Federal do Rio - Porto Alegre (RS), Brazil.
Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil.
Crit Care Sci. 2025 Aug 4;37:e20250388. doi: 10.62675/2965-2774.20250388. eCollection 2025.
There are notable gaps in the understanding of the underlying pathophysiology of persistent critical illness (PerCI) and its extensive implications for patient outcomes. In this context, whether different PerCI definitions could yield distinct long-term outcomes for intensive care unit survivors is currently unknown.
This prospective cohort study spanned 10 Brazilian hospitals from March 2015 to December 2017. We enrolled emergency medical and surgical patients with intensive care unit stays exceeding 72 hours and tracked them for more than 12 months after intensive care unit discharge. Chronic patients were classified using four widely recognized persistent critical illness definitions from the literature: 1) mechanical ventilation > 21 days or tracheostomy for mechanical ventilation weaning; 2) mechanical ventilation duration > 14 days; 3) intensive care unit stay > 10 days; and 4) intensive care unit stay > 8 days accompanied by specific clinical conditions warranting extended intensive care unit care. Additionally, the data were compared to those of survivors who did not meet any of the four persistent critical illness criteria.
The study enrolled 1,616 patients, with 609 (37.7%) fulfilling one or more persistent critical illness definitions. The twelve-month survival rates among persistent critical illness patients varied by definition. At 12 months, patients with PerCI definitions centered on mechanical ventilation duration had markedly lower survival rates than non-persistent critical illness patients did (definition 1: HR: 1.49, 95%CI: 1.10 - 2.02; definition 2: HR: 1.66, 95%CI: 1.20 - 2.30). In contrast, definitions based on intensive care unit length of stay produced survival rates more aligned with non-persistent critical illness patients (definition 3: HR: 1.01, 95%CI: 0.82 - 1.25; definition 4: HR: 1.10, 95%CI: 0.88 - 1.30).
Compared with other critically ill patients, patients with persistent critical illness definitions that are based on the duration of mechanical ventilation are associated with reduced 12-month survival, highlighting the impact of prolonged respiratory support on patient outcomes.
在对持续性危重病（PerCI）的潜在病理生理学及其对患者预后的广泛影响的理解方面存在显著差距。在此背景下，不同的PerCI定义是否会为重症监护病房幸存者带来不同的长期预后目前尚不清楚。
这项前瞻性队列研究于2015年3月至2017年12月在巴西的10家医院开展。我们纳入了在重症监护病房停留超过72小时的急诊内科和外科患者，并在其重症监护病房出院后对他们进行了超过12个月的跟踪。使用文献中四种广泛认可的持续性危重病定义对慢性病患者进行分类：1）机械通气>21天或为脱机进行气管切开术；2）机械通气持续时间>14天；3）重症监护病房停留>10天；4）重症监护病房停留>8天并伴有需要延长重症监护病房护理的特定临床情况。此外，将这些数据与不符合这四种持续性危重病标准中任何一项的幸存者的数据进行比较。
该研究纳入了1616名患者，其中609名（37.7%）符合一种或多种持续性危重病定义。持续性危重病患者的12个月生存率因定义而异。在12个月时，以机械通气持续时间为中心的PerCI定义的患者生存率明显低于非持续性危重病患者（定义1：HR：1.49，95%CI：1.10 - 2.02；定义2：HR：1.66，95%CI：1.20 - 2.30）。相比之下，基于重症监护病房住院时间的定义所产生的生存率与非持续性危重病患者更为接近（定义3：HR：1.01，95%CI：0.82 - 1.25；定义4：HR：1.10，95%CI：0.88 - 1.30）。
与其他危重病患者相比，基于机械通气持续时间定义的持续性危重病患者12个月生存率降低，这突出了延长呼吸支持对患者预后的影响。
