Chronic Critical Patient: A challenge hronic Critical Patient: A challenge for modern Critical Care Medicine or modern Critical Care Medicine

Tomislav Ružman, Nataša Ružman, Snježana Benko, Nikolina Marić



Introduction: Cronic critical patients need long term care and multidiscilinary approach.

Aim: To show clinical features of chronic critical illness and possible solutions for long term care.

Materials and methods: Electronic searches of literature using words related to critical illness, chronic disease, physiotherapy.

Results: Most of critically ill patients need prolonged mechanical ventilation and/or tracheostomy. Agressive intensive care treatment, advanced age and comorbidities are major risk factors for development of chronic critical illness. Chronic critical illness except prolonged mechanical ventilation and/or tracheostomy includes severe complications in almost all organs and organ systems (severe neuromyopathy, metabolic disorders, generalized oedema, pressure sores, reccurent infections, hormonal changes, emotional changes, etc.). Prolonged specialized care is associated with high costs for medical equipment and consumable medical supplies. Also, prolonged critical care is a burden for their families due to economic and emotional issues.

Conclusion: Chronic critical illness becomes a real problem in the all developed world including Croatia. Multidisciplinary approach is a cornerstone of the care for the chronic critical ill patient and respiratory physiotherapist should be a team leader in that team. Regular early physiotherapy can improve fi nal outcome and decrease the number of complications. National service for prolonged critical care treatment out of acute hospitals and clear guidelines might improve the care for these patients. Long term home treatment is the best way of care, so it is very important to involve family members early at the beginning of intensive care treatment, educate and train them for the taking care of sick family member. Ensuring fi nancial, medical and technical support to the family is important also.

Key words: critical illness, chronic disease, physiotherapy