Critical Care, Critical Care, Intensive Care, Critical Care Medicine, Critical Illness, Recovery Outcomes
Conditions
Keywords
Persistant Critical Illness, Critical care, Critical Illness
Brief summary
Persistent Critical Illness (PCI) is a condition that affects some patients who remain in the Intensive Care Unit (ICU) for a long time, usually more than 10-14 days. It is estimated to occur in 5-20% of critically ill patients. A recent Portuguese study found that more than 14% of ICU patients stayed longer than 14 days. PCI is often associated with ongoing need for life support, such as mechanical ventilation or medications to maintain blood pressure. However, patients may also experience severe muscle weakness, repeated infections, or other complications, which makes this group very diverse. One of the main risk factors for prolonged ICU stay is sepsis, a severe infection that affects the whole body. Other factors-such as prior health conditions, use of corticosteroids, sedation practices, early versus late mobilization, fluid and antibiotic management, and delirium treatment-may also influence the development and course of PCI. This study aims to identify different clinical patterns ("clusters") among critically ill patients who remain in the ICU for more than 10 days. Patients will be followed until hospital discharge, and up to one year if data are available. Understanding these different patterns will help develop more personalized and effective care strategies for each patient profile. The study is a multicenter retrospective cohort including adult patients (≥18 years) admitted to participating ICUs for more than 5 days between 2021 and 2023. Data collected will include demographic, clinical, and laboratory information, details of organ support (such as mechanical ventilation or vasopressors), medications, nutrition, and rehabilitation practices. Statistical and machine learning methods will be used to identify groups of patients with similar clinical trajectories and to assess how these groups are related to outcomes such as survival, recovery of organ function, or long-term disability. Expected results are the identification of distinct clinical clusters of PCI that combine clinical and laboratory data, and the development of tailored management strategies to improve recovery and outcomes for patients with PCI.
Interventions
None listed
Sponsors
Lisbon Academic Medical Center - Centro Académico de Medicina de Lisboa
Centro Hospitalar de Vila Nova de Gaia/Espinho
Hospital Prof. Doutor Fernando Fonseca
Unidade Local de Saúde Almada-Seixal
Centro Hospitalar Lisboa Ocidental
Hospital Vila Franca de Xira
Centro Hospitalar De São João, E.P.E.
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients aged 18 years or older; * ICU length of stay equal to or greater than 5 days.
Exclusion criteria
* Patients with an ICU stay \< 5 days; * Patients discharged from the ICU early due to lack of ward availability, rather than clinical recovery; * Patients who do not survive the early phase of critical illness (i.e., early ICU deaths).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Need for one or more continuous organ support treatment at Day 10 | The first 10 days in the ICU | Data from patients who remain in the ICU for more than 10 days requiring ongoing organ support, such as invasive mechanical ventilation, renal replacement therapy or vasopressors, will be used to identify those who develop Persistent Critical Illness and to enable subsequent cluster analysis of their clinical trajectories. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| All cause mortality stratified by Persistent Critical Illness (PCI) clusters | From cluster identification (Day 10) until hospital discharge or up to 1-year follow-up if available. | Clinical outcomes will be assessed and reported according to clusters of Persistent Critical Illness (PCI) identified using unsupervised machine learning analysis at Day 10 of ICU stay. Outcome includes: • All-cause mortality, reported as the proportion of participants who die during hospitalization and up to 1 year after cluster identification. |
| Organ dysfunction stratified by Persistent Critical Illness | From cluster identification (Day 10) until hospital discharge or up to 1-year follow-up if available. | Clinical outcomes will be assessed and reported according to clusters of Persistent Critical Illness (PCI) identified using unsupervised machine learning analysis at Day 10 of ICU stay. Outcome includes: • Organ dysfunction, assessed using the Sequential Organ Failure Assessment (SOFA) score, reported as mean (± SD) or median (IQR) values after cluster identification. |
Countries
Portugal
Contacts
CONTACTSusana Fernandes, MD PhD.
CONTACTMariana Santos, PhD
PRINCIPAL_INVESTIGATORSusana Fernandes, MD PhD
Lisbon School of Medicine
Outcome results
None listed