Online Letters to the Editor
Letter to the Editor Korea; Joo Myung Lee, MD, MPH, Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Jongno-gu, Seoul, South Korea
ACKNOWLEDGMENTS We thank Soyeon Ahn, PhD, Medical Research Collaborating Center, Seoul National University Bundang Hospital; Kyung Hwa Seo, MBA, Research Institute for Healthcare Policy, Korean Medical Association; and Dr. Ein Soon Shin, PhD, Department of Preventive Medicine, EWHA Woman’s University School of Medicine, for statistical review and independent comment on this response letter.
REFERENCES
1. Iftikhar IH, Donley MA, Owens WB: Prone Positioning in Acute Respiratory Distress Syndrome. Crit Care Med 2015; 43:e55–e56 2. Lee JM, Bae W, Lee YJ, et al: The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: Updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med 2014; 42:1252–1262 3. Deeks JJ: Issues in the selection of a summary statistic for meta-analysis of clinical trials with binary outcomes. Stat Med 2002; 21:1575–1600 4. Hu SL, He HL, Pan C, et al: The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: A metaanalysis of randomized controlled trials. Crit Care 2014; 18:R109 5. Sud S, Friedrich JO, Adhikari NK, et al: Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: A systematic review and meta-analysis. CMAJ 2014; 186:E381–E390 6. Chan MC, Hsu JY, Liu HH, et al: Effects of prone position on inflammatory markers in patients with ARDS due to community-acquired pneumonia. J Formos Med Assoc 2007; 106:708–716 7. Lee JM, Cho YJ: The authors reply. Crit Care Med 2014; 42: e599–e601 8. Guérin C, Reignier J, Richard JC, et al; PROSEVA Study Group: Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368:2159–2168 9. Guerin C, Baboi L, Richard JC: Mechanisms of the effects of prone positioning in acute respiratory distress syndrome. Intensive Care Med 2014; 40:1634–1642 10. Richards JM, Deboisblanc BP: Over easy: An updated recipe for acute respiratory distress syndrome. Crit Care Med 2014; 42:1318–1319 DOI: 10.1097/CCM.0000000000000830
Chronic Critical Illness Should Be Considered in Long-Term Mortality Study Among Critical Illness Patients
outcome. The determination for long-term outcome of patients who survived from critical illness is still unknown. In another recent study by Allan Garland et al (2), it is suggested that shortterm mortality was mainly determined by the acute illness and the long-term mortality was mainly determined by age and comorbidity. However, in the study by Linder et al (1), acute critical illness contributes a lot to the long-term mortality, which is inconsistent with the study by Garland et al (2). We speculate that the different conclusion of those two studies is due to the varied percentage of patients with chronic critical illness (CCI). CCI is a nebulous term for the patients who survive a catastrophic illness or surgical procedure but are left with a prolonged need for mechanical ventilation (3). Of mechanically ventilated critical patients, CCI develops in 5–10% depending on the definition (4). Compared with non-CCI patients, the mortality of CCI patients is relatively high. Although patients with comorbidity are thought to be prior to CCI, the exact reasons for those acute illness patients for developing into CCI are still unknown. In their study, Linder et al (1) compared the long-term mortality between septic patients without underlying commodities and the age and gender comparable general population and concluded that sepsis contribute to the long-term mortality. In our view, we should take the impact of CCI into consideration. The author may make a comparison without CCI patients to see whether CCI is the main factor associated with long-term mortality or not. For this reason, we believe that studies with the numbers of patients with CCI will add confidence to their dataset. The authors have disclosed that their institutions received grant support from the National Natural Science Foundation of China (81270478). Qin Wu, MD, Dong Hu, MD, Jianan Ren, MD, FACS, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
REFERENCES
1. Linder A, Guh D, Boyd JH, et al: Long-Term (10-Year) Mortality of Younger Previously Healthy Patients With Severe Sepsis/Septic Shock Is Worse Than That of Patients With Nonseptic Critical Illness and of the General Population. Crit Care Med 2014; 42:2211–2218 2. Garland A, Olafson K, Ramsey CD, et al: Distinct determinants of long-term and short-term survival in critical illness. Intensive Care Med 2014; 40:1097–1105 3. Lamas D: Chronic critical illness. N Engl J Med 2014; 370:175–177 4. Maguire JM, Carson SS: Strategies to combat chronic critical illness. Curr Opin Crit Care 2013; 19:480–487 DOI: 10.1097/CCM.0000000000000762
To the Editor:
I
n a recent issue of Critical Care Medicine, we read with interest the article by Linder et al (1). In the study, the authors found that previously healthy patients suffering an episode of severe sepsis have increased long-term mortality compared with patients with nonseptic critical illness and a general population. With the development of life support techniques, more patients could survive from critical illness. Growing individuals place more value on long-term outcome than short-term Critical Care Medicine
The authors reply:
W
e would like to thank Wu et al (1) for their insightful comments regarding our study. We appreciate the importance of the impact of chronic critical illness (CCI) on outcome after critical illness. We did acknowledge that lack of information on cause of death, new comorbidities, and quality of life were weaknesses of our study (2). We did do some adjusted analyses to increase the robustness of our findings. www.ccmjournal.org
e57
Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letter to the Editor Korea; Joo Myung Lee, MD, MPH, Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Jongno-gu, Seoul, South Korea
ACKNOWLEDGMENTS We thank Soyeon Ahn, PhD, Medical Research Collaborating Center, Seoul National University Bundang Hospital; Kyung Hwa Seo, MBA, Research Institute for Healthcare Policy, Korean Medical Association; and Dr. Ein Soon Shin, PhD, Department of Preventive Medicine, EWHA Woman’s University School of Medicine, for statistical review and independent comment on this response letter.
REFERENCES
1. Iftikhar IH, Donley MA, Owens WB: Prone Positioning in Acute Respiratory Distress Syndrome. Crit Care Med 2015; 43:e55–e56 2. Lee JM, Bae W, Lee YJ, et al: The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: Updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med 2014; 42:1252–1262 3. Deeks JJ: Issues in the selection of a summary statistic for meta-analysis of clinical trials with binary outcomes. Stat Med 2002; 21:1575–1600 4. Hu SL, He HL, Pan C, et al: The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: A metaanalysis of randomized controlled trials. Crit Care 2014; 18:R109 5. Sud S, Friedrich JO, Adhikari NK, et al: Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: A systematic review and meta-analysis. CMAJ 2014; 186:E381–E390 6. Chan MC, Hsu JY, Liu HH, et al: Effects of prone position on inflammatory markers in patients with ARDS due to community-acquired pneumonia. J Formos Med Assoc 2007; 106:708–716 7. Lee JM, Cho YJ: The authors reply. Crit Care Med 2014; 42: e599–e601 8. Guérin C, Reignier J, Richard JC, et al; PROSEVA Study Group: Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368:2159–2168 9. Guerin C, Baboi L, Richard JC: Mechanisms of the effects of prone positioning in acute respiratory distress syndrome. Intensive Care Med 2014; 40:1634–1642 10. Richards JM, Deboisblanc BP: Over easy: An updated recipe for acute respiratory distress syndrome. Crit Care Med 2014; 42:1318–1319 DOI: 10.1097/CCM.0000000000000830
Chronic Critical Illness Should Be Considered in Long-Term Mortality Study Among Critical Illness Patients
outcome. The determination for long-term outcome of patients who survived from critical illness is still unknown. In another recent study by Allan Garland et al (2), it is suggested that shortterm mortality was mainly determined by the acute illness and the long-term mortality was mainly determined by age and comorbidity. However, in the study by Linder et al (1), acute critical illness contributes a lot to the long-term mortality, which is inconsistent with the study by Garland et al (2). We speculate that the different conclusion of those two studies is due to the varied percentage of patients with chronic critical illness (CCI). CCI is a nebulous term for the patients who survive a catastrophic illness or surgical procedure but are left with a prolonged need for mechanical ventilation (3). Of mechanically ventilated critical patients, CCI develops in 5–10% depending on the definition (4). Compared with non-CCI patients, the mortality of CCI patients is relatively high. Although patients with comorbidity are thought to be prior to CCI, the exact reasons for those acute illness patients for developing into CCI are still unknown. In their study, Linder et al (1) compared the long-term mortality between septic patients without underlying commodities and the age and gender comparable general population and concluded that sepsis contribute to the long-term mortality. In our view, we should take the impact of CCI into consideration. The author may make a comparison without CCI patients to see whether CCI is the main factor associated with long-term mortality or not. For this reason, we believe that studies with the numbers of patients with CCI will add confidence to their dataset. The authors have disclosed that their institutions received grant support from the National Natural Science Foundation of China (81270478). Qin Wu, MD, Dong Hu, MD, Jianan Ren, MD, FACS, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
REFERENCES
1. Linder A, Guh D, Boyd JH, et al: Long-Term (10-Year) Mortality of Younger Previously Healthy Patients With Severe Sepsis/Septic Shock Is Worse Than That of Patients With Nonseptic Critical Illness and of the General Population. Crit Care Med 2014; 42:2211–2218 2. Garland A, Olafson K, Ramsey CD, et al: Distinct determinants of long-term and short-term survival in critical illness. Intensive Care Med 2014; 40:1097–1105 3. Lamas D: Chronic critical illness. N Engl J Med 2014; 370:175–177 4. Maguire JM, Carson SS: Strategies to combat chronic critical illness. Curr Opin Crit Care 2013; 19:480–487 DOI: 10.1097/CCM.0000000000000762
To the Editor:
I
n a recent issue of Critical Care Medicine, we read with interest the article by Linder et al (1). In the study, the authors found that previously healthy patients suffering an episode of severe sepsis have increased long-term mortality compared with patients with nonseptic critical illness and a general population. With the development of life support techniques, more patients could survive from critical illness. Growing individuals place more value on long-term outcome than short-term Critical Care Medicine
The authors reply:
W
e would like to thank Wu et al (1) for their insightful comments regarding our study. We appreciate the importance of the impact of chronic critical illness (CCI) on outcome after critical illness. We did acknowledge that lack of information on cause of death, new comorbidities, and quality of life were weaknesses of our study (2). We did do some adjusted analyses to increase the robustness of our findings. www.ccmjournal.org
e57
Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
