Survivors of critical illness often experience new or worsening impairments of physical, cognitive, and/or mental health, referred to as Post-Intensive Care Syndrome (PICS). Such impairments can be long-lasting and negatively affect survivors’ quality of life. Early rehabilitation in the intensive care unit (ICU), while patients remain on life-support therapy, may reduce the complications associated with PICS. This article addresses evidence-based rehabilitation interventions to reduce the physical and mental health impairments associated with PICS. Implementation of effective early rehabilitation interventions targeting physical impairment requires consideration of five factors: barriers, benefits, feasibility, safety, and resources. Mental health impairments may be addressed by use of the following interventions: use of ICU diaries, early in-ICU psychological interventions, and post-ICU coping skills training. In both cases, a multidisciplinary team-based approach is paramount to successful incorporation of early rehabilitation into routine practice in the ICU.

Background: Admission of a patient in the Intensive Care Unit (ICU) and the recovery process may be stressful for family members.
Objectives: This study aimed to explore the families' psychological symptoms and their evolution over the 1st week of patients' ICU stay. Additional objectives were the estimation of the families' need for support and the estimation of satisfaction regarding the information provided by ICU physicians.
Methods: A total of 108 individuals were participated in the study. Participants were interviewed with the Hamilton Anxiety Rating Scale and filled the Beck Depression Scale II on days 1 and 7 of patients' ICU admission. They also filled a self-reported questionnaire which was created by the investigators, involving decision-making procedures; the satisfaction of the families of the patients' care; and the support of the families by medical and nursing staff.
Results: Anxiety levels were not significantly different among 2-time points, whereas rates of depressive symptoms raised significantly from 38% (day 1) to 58.3% (day 7). In cases of anxiety changes, age, education, closeness of relationship, and APACHE II score were the factors been associated. Changes in depressive symptoms were not associated with any of those factors. Over a week, there were significant differences in relatives' views on participating in the decision-making procedure, and on expressing their opinion and concerns regarding the treatment process. Their attitudes about receiving support by the ICU personnel and even by mental health specialists, such as psychologists also changed.
Conclusions: Over the 1st week of ICU admission, depressive symptoms in patients' relatives were gradually evolving, while anxiety symptoms fluctuated and they were affected by the severity of the patients' condition. Attitudes toward treatment procedures and the perceived need for support also changed. These findings should be taken into account by the ICU personnel.

Course Description:
5 million people enter ICUs in the USA each year and over 80% of survivors of critical illness experience post-intensive care syndrome (PICS) – a constellation of cognitive, psychological, and physical symptoms including prolonged muscle weakness, reduced performance of activities of daily living, diminished ambulation and strength, post
traumatic stress disorder, and anxiety. These symptoms persist for months and years following hospital discharge. This session will examine the etiology of symptoms comprising PICS and discuss evidence-based tests and measures to objectively examine individuals with PICS. Outcomes from recent clinical trials of interventions for people with PICS will be analyzed and sample intervention programs will be described. This course will conclude with an exploration of challenges associated with the transitions of care experienced by individuals with PICS and offer some solutions.