WAITING FOR THE CRISIS

Aim of the study: Experience in daily routine reveals that most of ICU patients usually go through ''crisis'' within 14 days of admission. O nly few patients need remarkable more time to get to this point and it seems there is hardly anything to be done therapeutically to change t he course of it. We therefore examined a large group of ICU patients i n order to find reasons for this course or to spot them as an ''entity of their own''. Methods: 1,861 ICU patients all being on IPPV for mor e than three days were included in the study. Every day 18 variables w ere taken down in a standardised way until the day IPPV was finished. We extracted 170 patients who were artificially ventilated for more th an 40 days. For these patients we established mean values for each of the 18 variables during the first and the last 40 days of ventilation. In both groups we compared survivors to non-survivors. Results: Morta lity was almost the same in both groups (IPPV <40 days vs. IPPV >40 da ys). Survivors and non-survivors showed remarkable differences regardi ng extrapulmonary factors in terms of total fluid amount and transfusi on, state of abdomen, brain, liver and kidney function and circulation problems. Pulmonary factors revealed major differences only towards t he end of the observation period. Conclusions: There seems to be an '' entity of ist own'', a small population of patients who arrive at the crucial turning point later. Pulmonary complications (pneumonia, ARDS) is not the reason but the expression of cause for prolonged ventilati on. The key to the extrapulmonary origin of the crisis remains unknown , the only thing we can do is alleviate its manifestations.