title: Strategies to combat chronic critical illness.
abstract: OBJECTIVE
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Maguire
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Carson
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control*; D016638:Critical Illness; D003428:Cross Infection / Q000517:prevention & control; D003666:Decontamination / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D018529:Nutritional Support; D010348:Patient Care Team / Q000458:organization & administration; D010360:Patient Transfer; D018802:Patient-Centered Care; D012121:Respiration, Artificial / Q000009:adverse effects; D014139:Tracheostomy