Are we creating survivors…or victims in critical care? Delivering targeted nutrition to improve outcomes.

Over the last 10 years, we are proud of the fact we have finally begun to reduce in-hospital mortality following severe sepsis in some countries worldwide [1]. Further, mortality from acute lung injury has fallen dramatically, as the control group mortality in a recent large Acute Respiratory Distress Syndrome Research Network (ARDSnet) trial was strikingly only 16% [2]. But the fundamental question that must be asked is ‘are we winning many battles in our ICUs, but ultimately losing the war?’ Despite these improvements in ICU outcome, the same data indicating we have reduced sepsis hospital mortality by half in the last 10 years, also reveal ‘we have tripled the number of patients going to rehabilitation settings’ [1]. Moreover, of these new ‘ICU survivors,’ how many even survived a year? Troubling data from recent years reveal as much as ‘40–50% of the mortality within 12 months of an ICU admission occurs after the patient leaves the ICU’ [3]. Commonly, patients are placed in nursing homes or rehabilitation centers, never to return home to their loved ones or return to a meaningful quality of life (QoL). Thus, leading authorities from large critical care trials groups are indicating given low ICU mortality and the high proportion of patients discharged to rehabilitation centers, that QoL, not mortality, should become the primary endpoint of future large ICU trials [1]. More practically, for all of us as ICU caregivers, we all must ask ourselves ‘Are we creating survivors. . .or victims’ in our ICU care.