Intensivists Fail to Reliably Predict Late-Onset Shock or Respiratory Failure

Background: Despite the importance of prognostication in ICU care, multiple studies have shown limitation to our ability to prognosticate outcomes such as mortality. The ability of the intensivists to prognosticate the development of persistent critical illness or late-onset organ failures has not been previously studied. Objective: To measure attending intensivists’ ability to prognosticate persistent critical illness (PerCI) and determine if accuracy of prognostication improved on ICU day 3 compared to ICU day 1. Design: Prospective cohort study. Participants: Medical ICU attendings at a single academic institution. Methods: Intensivists were surveyed on day 1 and day 3 about prognosis for PerCI, late-onset shock, and late-onset acute hypoxemic respiratory failure. If a new intensivist took over case, a day 3 survey was not done. Persistent critical illness was defined as ICU stay of ≥10 consecutive days. Late-onset shock was defined by new vasopressor use on days 4 to 10 more...