Long-term outcomes after critical illness relevant to randomized clinical trials

The traditional goal of intensive care has been to prevent death. Intensive care units (ICUs) are getting better at this with data from several sources suggesting that mortality rates are declining [1]. Many survivors have long-term, sometimes permanent, impairment of one or more aspects of physical, psychological or cognitive function [2–5]. Declining mortality rates may be producing a new and as yet unmet health care need: an increasing number of patients who have survived treatment in an ICU but with incomplete functional recovery leading to poor long-term outcomes [2, 6, 7].

In this context, there is an urgent need to accurately describe the longer term outcomes of ICU survivors to gain a more complete understanding of physical function, cognitive ability and other attributes. Specific tools may be already available or may need to be developed to meet the needs of the varied stakeholders involved – clinicians, researchers, patients, health care service providers and industry.

In this chapter, we highlight the need to be able to describe the long-term outcomes of patients who survive critical illness and highlight some early international initiatives to develop a standardized approach to this for clinical trials.