Who Survive Intensive Care

THE SUCCESS OF INTENSIVE CARE, which is designed to mitigate life-threatening critical illness, traditionallyhasbeengaugedby the proportion of patients alive at hospital discharge or at day 28. With technological advances, many patients now survive what were previously fatal critical illnesses, in turngeneratinganenlarging population of intensive care unit (ICU) survivors. There are increasing concerns that these ICU survivors may have ongoing risk for increased mortality and morbidity, raising the questionofwhethertheneedfor intensivecare tends to constitute an acute event, with minimal sequelae, or has the hallmarks of a chronic illness, with increased risk of long-term morbidity and mortality. Many studies have demonstrated that short-term survivors of conditions classically requiring intensive care, such as acute lung injury or sepsis, often have significant health problems in subsequent months. But studies from Finland and the United Kingdom reported that mortality for ICU survivors was similar to that of the general population after 2 to 4 years, while data from Canada showed that long-term survival was similar to that of patients hospitalized who did not require intensive care. Differences in the provision of intensive care services and patient selection confound international comparisons, and there are no nationally representative follow-up studies from the United States. Intensive care unit services have grown significantly in the United States and are now routinely provided to a broad population. Patients older than 65 years now make up more than half of all ICU admissions. Information is needed to understand the patterns of mortality, morbidity, and health care resource use in the months and years that follow critical illness to allow for better targeting of follow-up care. This study examines the3-yearoutcomesandhealth care resource use of ICU survivors older than 65 years, and identifies the sub-