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BACKGROUND: Skeletal muscle dysfunction occurring as a result of ICU admission associates with higher mortality. Although preadmission higher BMI correlates with better outcomes, the impact of baseline muscle and fat mass has not been defined. We therefore investigated the association of skeletal muscle and fat mass at ICU admission with survival and disability at hospital discharge.
METHODS: This single-center, prospective, observational cohort study included medical ICU (MICU) patients from an academic institution in the Unites States. A total of 401 patients were evaluated with pectoralis muscle area (PMA) and subcutaneous adipose tissue (SAT) determinations conducted by CT scanning at the time of ICU admission, which were later correlated with clinical outcomes accounting for potential confounders.
RESULTS: Larger admission PMA was associated with better outcomes, including higher 6month survival (OR, 1.03; 95% CI, 1.01-1.04; P < .001), lower hospital mortality (OR, 0.96; 95% CI, 0.93-0.98; P < .001), and more ICU-free days (slope, 0.044 0.019; P 1⁄4 .021). SAT was not significantly associated with any of the measured outcomes. In multivariable analyses, PMA association persisted with 6 months and hospital survival and ICU-free days, whereas SAT remained unassociated with survival or other outcomes. PMA was not associated with regaining of independence at the time of hospital discharge (OR, 0.99; 95% CI, 0.98-1.01; P 1⁄4 .56).
CONCLUSIONS: In this study cohort, ICU admission PMA was associated with survival during and following critical illness; it was unable to predict regaining an independent lifestyle following discharge. ICU admission SAT mass was not associated with survival or other measured outcomes.

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Objectives: To update the Society of Critical Care Medicine’s guidelines for ICU admission, discharge, and triage, providing a framework for clinical practice, the development of institutional policies, and further research.
Design: An appointed Task Force followed a standard, systematic, and evidence-based approach in reviewing the literature to develop these guidelines.
Measurements and Main Results: The assessment of the evidence and recommendations was based on the principles of the Grading of Recommendations Assessment, Development and Evaluation system. The general subject was addressed in sections: admission criteria and benefits of different levels of care, triage, discharge timing and strategies, use of outreach programs to supplement ICU care, quality assurance/improvement and metrics, non beneficial treatment in the ICU, and rationing considerations. The literature searches yielded 2,404 articles published from January 1998 to October 2013 for review. Following the appraisal of the literature, discussion, and consensus, recommendations were written.
Conclusion: Although these are administrative guidelines, the subjects addressed encompass complex ethical and medico-legal aspects of patient care that affect daily clinical practice. A limited amount of high-quality evidence made it difficult to answer all the questions asked related to ICU admission, discharge, and triage. Despite these limitations, the members of the Task Force believe that these recommendations provide a comprehensive framework to guide practitioners in making informed decisions during the admission, discharge, and triage process as well as in resolving issues of non beneficial treatment and rationing. We need to further develop preventive strategies to reduce the burden of critical illness, educate our noncritical care colleagues about these interventions, and improve our outreach, developing early identification and intervention systems.

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Background:
Psychologic symptoms of post traumatic stress disorder (PTSD) and depression are relatively common among family members of patients who die in the ICU. The patient-level risk factors for these family symptoms are not well understood but may help to target future interventions.
Methods:
We performed a cohort study of family members of patients who died in the ICU or within 30 h of ICU transfer. Outcomes included self-reported symptoms of PTSD and depression. Predictors included patient demographics and elements of palliative care.
Results:
Two hundred twenty-six patients had chart abstraction and family questionnaire data. Family members of older patients had lower scores for PTSD (P = .026). Family members that were present at the time of death (P = .021) and family members of patients with early family conferences (P = .012) reported higher symptoms of PTSD. When withdrawal of a ventilator was ordered, family members reported lower symptoms of depression (P = .033). There were no other patient characteristics or elements of palliative care associated with family symptoms.
Conclusions:
Family members of younger patients and those for whom mechanical ventilation is not withdrawn are at increased risk of psychologic symptoms and may represent an important group for intervention. Increased PTSD symptoms among family members present at the time of death may reflect a closer relationship with the patient or more involvement with the patient’s ICU care but also suggests that family should be offered the option of not being present.

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Delirium is one of the most common behavioral manifestations of acute brain dysfunction in Intensive Care Unit (ICU) and is a strong predictor of worse outcome. Routine monitoring for delirium is recommended for all ICU patients using validated tools (e.g., CAM-ICU, ICDSC). In delirious patients, a search for all reversible precipitants is the first line of action and pharmacological treatment should be considered when all causes have been ruled out, and not contraindicated. Long-term morbidity, in the forms of cognitive, physical and psychological impairments, has significant consequences for survivors of critical illness and for their caregivers. ICU patients may develop PTSD anchored to their critical illness experience, with ICU-related PTSD incidence rates of 10%. Using ICU diaries during a critical illness may minimize the occurrence of future ICU-related PTSD.

Brief description of media:

Delirium is one of the most common behavioral manifestations of acute brain dysfunction in Intensive Care Unit (ICU) and is a strong predictor of worse outcome. Routine monitoring for delirium is recommended for all ICU patients using validated tools (e.g., CAM-ICU, ICDSC). In delirious patients, a search for all reversible precipitants is the first line of action and pharmacological treatment should be considered when all causes have been ruled out, and not
contraindicated. Long-term morbidity, in the forms of cognitive, physical and psychological impairments, has significant consequences for survivors of critical illness and for their caregivers. ICU patients may develop PTSD anchored to their critical illness experience, with ICU-related PTSD incidence rates of 10%. Using ICU diaries during a critical illness may minimize the occurrence of future ICU-
related PTSD.

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For many people their first experience with an Intensive Care Unit may be when they find themselves or a loved one critically ill or injured. It can be an intensely stressful and scary time. It is not uncommon for those who experience critical illness or injury to later develop sleep disturbances such as insomnia, vivid dreams, and even nightmares. Many of the symptoms that former ICU patients experience are consistent with post-traumatic stress disorder and are included within the syndrome we are now calling Post Intensive Care Syndrome or PICS. Many interventions are being explored that address post-ICU recovery, however one intervention has already proven its usefulness in combating PTSD in post-ICU patients - ICU diaries.

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The learning objectives of this presentation is to teach the audience to be able to verbalize and understanding of the constructs of the ICU Diary: Written entries and photographs. The second learning objective is to teach the audience to understand the construct of post intensive care syndrome: Gap in memory, and PTSD.

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As an ICU nurse you’ve probably encountered the critically ill patient who is experiencing hallucinations, delusions, and confusion. Healthcare providers are learning just how detrimental this state of mind can be to the patient’s recovery process as he or she transitions from the ICU setting. One proposed intervention, the ICU diary, has been used in Europe since the 1980s but is not widely used in the United States. I conducted the first evidence-based practice (EBP) ICU diary pilot project in an acute care setting located in Central Texas.

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New research discovers post-traumatic stress disorder can occur after a stay in an intensive care unit.

PTSD is often associated with warfare, major catastrophes and assault, not hospitalization. However, in a new study Johns Hopkins researchers found the disorder is present in almost one-quarter of patients who survive a critical illness and stay in the intensive care unit (ICU).

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it is a guideline for the ICU medicine professional to monitor and treat patient who may have ICU delirium.

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Focused research over more than a decade by Meredith Mealer, Ph.D., RN and others has shown that Post-traumatic Stress Disorder (PTSD) is as prevalent among nurses working in ICU as in war veterans – but also that greater resilience protects against burnout (BOS) and PTSD. Resilience is being able to adapt effectively to major stress, and it can be learned. This means that you can start developing your resilience now to strengthen your psychological make-up for your future career in nursing.

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New study of 645 ARDS survivors has identified subgroups of ARDS survivors who suffer what's been called post-intensive care syndrome, a collection of symptoms that can linger for years.