Towards definitions of critical illness and critical care using concept analysis

Objective As “critical illness” and “critical care” lack consensus definitions, this study aims to explore how the concepts’ are used, describe their defining attributes and propose potential definitions. Design We used the Walker and Avant stepwise approach to concept analysis. The uses and definitions of the concepts were identified through a scoping review of the literature and an online survey of 114 global clinical experts. Through content analysis of the data we extracted codes, categories and themes to determine the concepts’ defining attributes and we proposed potential definitions. To assist understanding, we present model, related and contrary cases concerning the concepts, we identified antecedents and consequences to the concepts, and defined empirical referents. Results The defining attributes of critical illness were a high risk of imminent death; vital organ dysfunction; requirement for care to avoid death; and potential reversibility. The defining attributes of critical care were the identification, monitoring and treatment of critical illness; vital organ support; initial and sustained care; any care of critical illness; and specialized human and physical resources. Our proposed definition of critical illness is, “ a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility ”. Our proposed definition of critical care is, “ the identification, monitoring and treatment of patients with critical illness through the initial and sustained support of vital organ functions .” Conclusion The concepts critical illness and critical care lack consensus definitions and have varied uses. Through concept analysis of uses and definitions in the literature and among experts we have identified the defining attributes of the concepts and propose definitions that could aid clinical practice, research, and policy making. Strengths and Limitations of the Study This concept analysis is the first study to systematically describe the uses and definitions of the concepts critical illness and critical care The study uses a scoping review of the literature and input from over one hundred clinical experts from diverse settings globally to identify the defining attributes and provide proposed definitions of the concepts Some uses and definitions of the concepts in languages other than English, in unpublished grey literature and from clinical experts not included in the study may have been missed As current usage of the concepts is diverse, the proposed definitions may not be universally accepted and are aimed to stimulate further discussion