Chronically critically ill patients: different behavior in severe sepsis and septic shock?

Results We analyzed 352 cases of severe sepsis (33.2%) and septic shock (66.8%). The average age was 65 (range 18 to 98), and 53.1% were men. The APACHE II average score was 20.9. Lung (58% vs 43.3% p = 0.017) and bloodstream (25% vs 7.5% p < 0.001) were the most prevalent sepsis focuses in the chronic cohort, but in the acute cohort were abdomen (22.2% vs 1% p < 0.001) and urine (15.5% vs 5% p = 0.007). There was no significant difference comparing SOFA, leukocytes, lactate and PCR, except the maximum respiratory frequency and the maximum temperature, these variables tended to have larger average values in chronically critical patients (RF 26ipm vs 24ipm p = 0.006 / T 36,8oC vs 37,1oC p = 0.001). When comparing life support need, there was an increased use of mechanical ventilation (86.9% vs 73.3% p = 0.01) and lower use of dobutamine (7% vs 17.5% p = 0.019) by chronically critically ill patients. The most common class of antibiotics in the chronic cohort was carbapenems (56.6% vs 33.3%, p < 0.001) and in the acute cohort it was anti-Pseudomonas penicillin (31% vs 16.2% p = 0.007). The largest duration of antibiotic therapy was on chronically critically ill patients (7.3 days vs 9.6 days p < 0.001). Analyzing the outcomes, the length of stay in the chronic group was higher (27.1 days vs 11.9 days p < 0.001). Also, the mortality rate until the 21st day of stay in ICU was higher in the acute cohort than in the chronic cohort, although the mortality rate in 60 days was higher in the chronic cohort (53% vs 40.1% p = 0,037).