Strategies to combat chronic critical illness.
Strategies to combat chronic critical illness.
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DOI：
10.1097/mcc.0b013e328364d65e
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发表时间：
2013-10
影响因子：
3.3
通讯作者：
Carson SS
中科院分区：
文献类型：
--
作者：
Maguire JM;Carson SS
随着重症监护管理的进步提高了危重病急性期的生存率，慢性危重病患者的人数正在增加。这些患者的特点是医疗需求复杂，资源利用率高。本文回顾了支持慢性危重病（CCI）预防和管理的综合方法的证据。在长期急性护理医院中，CCI患者脱机的最有效方法是通过气管造口项圈进行每日无辅助呼吸试验。然而，大量转移到长期急性护理医院的患者通过了自发脱机试验。转移到长期急性护理医院与更高的急性护理成本和支付相关，但在整个疾病期间的成本较低。普遍去污比有针对性的去污或筛查和隔离更有效地预防医院内血流感染。防治CCI始于疾病急性期的预防。管理策略包括一系列的治疗、营养和康复支持。需要在这一特定人群中进一步开展以患者为中心的基于结果的研究，以继续帮助指导最佳护理。
The population of chronically critically ill patients is growing as advances in intensive care management improve survival from the acute phase of critical illness. These patients are characterized by complex medical needs and heavy resource utilization. This article reviews evidence supporting a comprehensive approach to the prevention and management of chronic critical illness (CCI). The most efficient approach to weaning patients with CCI at long-term acute care hospitals is daily unassisted breathing trials through a tracheostomy collar. However, a substantial number of patients transferred to long-term acute care hospitals pass their spontaneous weaning trials. Transfer to long-term acute care hospitals is associated with higher acute care costs and payments, but lower costs through the entire episode of illness. Universal decontamination is more effective than targeted decontamination or screening and isolation for preventing nosocomial bloodstream infections. Combating CCI begins with prevention in the acute phase of illness. Management strategies include a spectrum of ventilatory, nutritional, and rehabilitation support. Further patient-centered outcome-based research in this specific population is needed to continue to help guide optimal care.