Evidence map›Paper›PMID 41809588›Full record

ArticleCHEST critical care2026

The Challenges of Prognosticating Persistent Critical Illness: A Qualitative Study.

Kaitland M Byrd, Madeline M Lagina, Kathleen T Lee, Ashwatha Thenappan, Jacqueline M Kruser, Theodore J Iwashyna, Hallie C Prescott, Elizabeth M Viglianti

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CHEST critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Kaitland M ByrdDivision of Pulmonary and Critical Care Medicine (K. M. B., M. M. L., K. T. L., H. C. P., and E. M. V.), Department of Internal Medicine, University of Michigan; the HSR Center of Innovation (H. C. P. and E. M. V.), Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; the Department of Internal Medicine (A. T.), University of Pittsburgh Medical Center, Pittsburgh, PA; the Division of Allergy, Pulmonary and Critical Care Medicine (J. M. K.), Department of Medicine, University of Wisconsin, Madison, WI; the Division of Pulmonary and Critical Care (T. J. I.), School of Medicine, and the Department of Health Policy and Management (T. J. I.), School of Public Health, John Hopkins University, Baltimore, MD.
Madeline M LaginaDivision of Pulmonary and Critical Care Medicine (K. M. B., M. M. L., K. T. L., H. C. P., and E. M. V.), Department of Internal Medicine, University of Michigan; the HSR Center of Innovation (H. C. P. and E. M. V.), Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; the Department of Internal Medicine (A. T.), University of Pittsburgh Medical Center, Pittsburgh, PA; the Division of Allergy, Pulmonary and Critical Care Medicine (J. M. K.), Department of Medicine, University of Wisconsin, Madison, WI; the Division of Pulmonary and Critical Care (T. J. I.), School of Medicine, and the Department of Health Policy and Management (T. J. I.), School of Public Health, John Hopkins University, Baltimore, MD.
Kathleen T LeeDivision of Pulmonary and Critical Care Medicine (K. M. B., M. M. L., K. T. L., H. C. P., and E. M. V.), Department of Internal Medicine, University of Michigan; the HSR Center of Innovation (H. C. P. and E. M. V.), Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; the Department of Internal Medicine (A. T.), University of Pittsburgh Medical Center, Pittsburgh, PA; the Division of Allergy, Pulmonary and Critical Care Medicine (J. M. K.), Department of Medicine, University of Wisconsin, Madison, WI; the Division of Pulmonary and Critical Care (T. J. I.), School of Medicine, and the Department of Health Policy and Management (T. J. I.), School of Public Health, John Hopkins University, Baltimore, MD.
Ashwatha ThenappanDivision of Pulmonary and Critical Care Medicine (K. M. B., M. M. L., K. T. L., H. C. P., and E. M. V.), Department of Internal Medicine, University of Michigan; the HSR Center of Innovation (H. C. P. and E. M. V.), Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; the Department of Internal Medicine (A. T.), University of Pittsburgh Medical Center, Pittsburgh, PA; the Division of Allergy, Pulmonary and Critical Care Medicine (J. M. K.), Department of Medicine, University of Wisconsin, Madison, WI; the Division of Pulmonary and Critical Care (T. J. I.), School of Medicine, and the Department of Health Policy and Management (T. J. I.), School of Public Health, John Hopkins University, Baltimore, MD.
Jacqueline M KruserDivision of Pulmonary and Critical Care Medicine (K. M. B., M. M. L., K. T. L., H. C. P., and E. M. V.), Department of Internal Medicine, University of Michigan; the HSR Center of Innovation (H. C. P. and E. M. V.), Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; the Department of Internal Medicine (A. T.), University of Pittsburgh Medical Center, Pittsburgh, PA; the Division of Allergy, Pulmonary and Critical Care Medicine (J. M. K.), Department of Medicine, University of Wisconsin, Madison, WI; the Division of Pulmonary and Critical Care (T. J. I.), School of Medicine, and the Department of Health Policy and Management (T. J. I.), School of Public Health, John Hopkins University, Baltimore, MD.
Theodore J IwashynaDivision of Pulmonary and Critical Care Medicine (K. M. B., M. M. L., K. T. L., H. C. P., and E. M. V.), Department of Internal Medicine, University of Michigan; the HSR Center of Innovation (H. C. P. and E. M. V.), Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; the Department of Internal Medicine (A. T.), University of Pittsburgh Medical Center, Pittsburgh, PA; the Division of Allergy, Pulmonary and Critical Care Medicine (J. M. K.), Department of Medicine, University of Wisconsin, Madison, WI; the Division of Pulmonary and Critical Care (T. J. I.), School of Medicine, and the Department of Health Policy and Management (T. J. I.), School of Public Health, John Hopkins University, Baltimore, MD.
Hallie C PrescottDivision of Pulmonary and Critical Care Medicine (K. M. B., M. M. L., K. T. L., H. C. P., and E. M. V.), Department of Internal Medicine, University of Michigan; the HSR Center of Innovation (H. C. P. and E. M. V.), Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; the Department of Internal Medicine (A. T.), University of Pittsburgh Medical Center, Pittsburgh, PA; the Division of Allergy, Pulmonary and Critical Care Medicine (J. M. K.), Department of Medicine, University of Wisconsin, Madison, WI; the Division of Pulmonary and Critical Care (T. J. I.), School of Medicine, and the Department of Health Policy and Management (T. J. I.), School of Public Health, John Hopkins University, Baltimore, MD.
Elizabeth M VigliantiDivision of Pulmonary and Critical Care Medicine (K. M. B., M. M. L., K. T. L., H. C. P., and E. M. V.), Department of Internal Medicine, University of Michigan; the HSR Center of Innovation (H. C. P. and E. M. V.), Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; the Department of Internal Medicine (A. T.), University of Pittsburgh Medical Center, Pittsburgh, PA; the Division of Allergy, Pulmonary and Critical Care Medicine (J. M. K.), Department of Medicine, University of Wisconsin, Madison, WI; the Division of Pulmonary and Critical Care (T. J. I.), School of Medicine, and the Department of Health Policy and Management (T. J. I.), School of Public Health, John Hopkins University, Baltimore, MD.

Funding

Improving Risk-Stratification in Patients with Prolonged ICU StaysK23HL157364 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI VIGLIANTI, ELIZABETH MARIE · 2021 to 2025
$913k
CHANGE OF GRANTEE INSTITUTION K23 HL146890 A Systems Approach to Align ICU Care with Patient Treatment GoalsK23HL146890 · NHLBI · UNIVERSITY OF WISCONSIN-MADISON · PI KRUSER, JACQUELINE MARIE · 2019 to 2023
$877k
NHLBI NIH HHS K23 HL146890NHLBI NIH HHS K23 HL157364
6 · The paper itself

Abstract

backgroundMedical decision-making in the ICU is influenced by a patient's anticipated clinical course. However, intensivists struggle to identify accurately which patients will experience within-ICU events-such as new late-onset shock or acute hypoxic respiratory failure (AHRF)-that contribute to the development of persistent critical illness (PerCI). Given the uniqueness of patients who experience PerCI, understanding how intensivists process and incorporate evolving clinical information into their prognostication remains unknown for this population. RESEARCH QUESTION: What processes do intensivists use to prognosticate a patient's risk of new shock or AHRF and PerCI developing and what challenges are encountered? STUDY DESIGN AND

methodsWe conducted semistructured interviews with 17 intensivists at a quaternary academic medical center from July 2022 through January 2023. Interviews occurred within 4 weeks of completing medical ICU service and lasted 30 to 60 minutes. Each interview focused on 2 real-world patient cases treated by the intensivist, using chart-stimulated recall to examine the information used to prognosticate each patient's risk of new shock or AHRF and PerCI developing across the ICU course and the challenges of prognostication. We performed qualitative content analysis to explore the themes discussed by the intensivists.

resultsWe identified 3 major themes about how intensivists formulate prognostic estimates about the risk of new shock or AHRF and PerCI: first, the contextualization of patient factors at ICU admission; second, the type of illness script or mental model of disease, including those within and outside of the intensivists' expertise; and third, the impact of clinical setbacks and consultant input on the patient's predicted clinical trajectory.

interpretationThis study shows that intensivists rely on patient factors and the illness script to shape their prognostication. However, clinical setbacks and consultant recommendations were common, leading to changes in prognostication and subsequent medical decision-making. Future research should explore the value of time-limited trials in guiding treatment decisions in the context of prognostic uncertainty.

Indexed as

intensivistsmedical decision-makingpersistent critical illnessprognosticationqualitative

Identifiers

PMID41809588
PMCPMC12971083

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.