Persistent systemic inflammation in chronic critical illness.

Chronic critical illness (CCI) is syndrome of neuromuscular weakness, brain dysfunction, malnutrition, endocrinopathies, and symptom distress. Two conceptual themes may be useful in discussing CCI. The first is a clinical roadmap in which a patient suffers an acute critical illness, survives the initial insult, but yet is unable to be liberated from the ventilator. The second framework considers the effect of systemic inflammation and CCI, linking acute CCI risk factors with the common clinical features of CCI. Given the association between common CCI antecedents and inflammation, attempts to control and balance the pro-inflammatory and anti-inflammatory mediators should begin as early as possible and continue throughout the ICU stay. Since surrogate measures such as biomarkers often fail to predict the effect of interventions, the focus should be on the outcomes patients experience. As of now, providing evidence-based, high quality ICU management of patients at risk for CCI appears to be the best strategy of care.