Summary
Introduction: Chronic critical patients need long term care and multidisciplinary approach.
Aim: To show clinical features of chronic critical illness and possible solutions for long term care.
Materials and methods: Electronic searches of literature using words related to critical illness, chronic disease, physiotherapy.
Results: Most of critically ill patients need prolonged mechanical ventilation and/or tracheostomy. Aggressive intensive care treatment, advanced age and comorbidities are major risk factors for development of chronic critical illness. Chronic critical illness except prolonged mechanical ventilation and/or tracheostomy includes severe complications in almost all organs and organ
systems (severe neuromyopathy, metabolic disorders, generalized oedema, pressure sores, recurrent infections, hormonal changes, emotional changes, etc.). Prolonged specialized care is associated with high costs for medical equipment and consumable medical supplies. Also, prolonged critical care is a burden for their families due to economic and emotional issues.
Conclusion: Chronic critical illness becomes a real problem in the all developed world including Croatia. Multidisciplinary approach is a cornerstone of the care for the chronic critical ill patient and respiratory physiotherapist should be a team leader in that team. Regular early physiotherapy can improve final outcome and decrease the number of complications. National service for prolonged critical care treatment out of acute hospitals and clear guidelines might improve the care for these patients. Long term home treatment is the best way of care, so it is very important to involve family members early at the beginning of intensive care treatment, educate and train them for the taking care of sick family member. Ensuring financial, medical and technical support
to the family is important also.

Relevance
In the developed world as a whole, including Croatia, chronic critical illness becomes a significant issue. Regular psychological practice and physical treatment can lessen difficulties and enhance outcomes. Clear rules and a national program for long-term critical care outside of acute hospitals could help these patients receive better care. It is crucial to involve family members early at the beginning of intensive care therapy and to educate them to enforce physical activity to prevent complications and improve the quality of life for patients with chronic pulmonary diseases.