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Over the past several decades, advances in pediatric critical care have saved many lives. As such, contemporary care has broadened its focus to also include minimizing morbidity. Post Intensive Care Syndrome, also known as “PICS,” is a group of cognitive, physical, and mental health impairments that commonly occur in patients after ICU discharge. Post Intensive Care Syndrome has been well-conceptualized in the adult population but not in children

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The objective of this study was to refine the APACHE (Acute Physiology, Age, Chronic Health Evaluation) methodology in order to more accurately predict hospital mortality risk for critically ill hospitalized adults. We prospectively collected data on 17,440 unselected adult medical/surgical intensive care unit (ICU) admissions at 40 US hospitals (14 volunteer tertiary-care institutions and 26 hospitals randomly chosen to represent intensive care services nationwide). We analyzed the relationship between the patient's likelihood of surviving to hospital discharge and the following predictive variables: major medical and surgical disease categories, acute physiologic abnormalities, age, preexisting functional limitations, major comorbidities, and treatment location immediately prior to ICU admission. The APACHE III prognostic system consists of two options: (1) an APACHE III score, which can provide initial risk stratification for severely ill hospitalized patients within independently defined patient groups; and (2) an APACHE III predictive equation, which uses APACHE III score and reference data on major disease categories and treatment location immediately prior to ICU admission to provide risk estimates for hospital mortality for individual ICU patients. A five-point increase in APACHE III score (range, 0 to 299) is independently associated with a statistically significant increase in the relative risk of hospital death (odds ratio, 1.10 to 1.78) within each of 78 major medical and surgical disease categories. The overall predictive accuracy of the first-day APACHE III equation was such that, within 24 h of ICU admission, 95 percent of ICU admissions could be given a risk estimate for hospital death that was within 3 percent of that actually observed (r2 = 0.41; receiver operating characteristic = 0.90). Recording changes in the APACHE III score on each subsequent day of ICU therapy provided daily updates in these risk estimates. When applied across the individual ICUs, the first-day APACHE III equation accounted for the majority of variation in observed death rates (r2 = 0.90, p<0.0001).

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Muscle weakness is common in the surgical intensive care unit (ICU). Low muscle mass at ICU admission is a significant predictor of adverse outcomes. The consequences of ICU-acquired muscle weakness depend on the underlying mechanism. Temporary drug-induced weakness when properly managed may not affect outcome. Severe perioperative acquired weakness that is associated with adverse outcomes (prolonged mechanical ventilation, increases in ICU length of stay, and mortality) occurs with persistent (time frame: days) activation of protein degradation pathways, decreases in the drive to the skeletal muscle, and impaired muscular homeostasis. ICU-acquired muscle weakness can be prevented by early treatment of the underlying disease, goal-directed therapy, restrictive use of immobilizing medications, optimal nutrition, activating ventilatory modes, early rehabilitation, and preventive drug therapy. In this article, the authors review the nosology, epidemiology, diagnosis, and prevention of ICU-acquired weakness in surgical ICU patients.

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The family is one of the basic units of society and has a great influence on its members. When a family member becomes ill, the illness affects the well-being of other family members, causing changes in the life of the whole family. Critical illness often occurs without warning and there is little time for patients and their families to prepare. If family members’ immediate needs can be met, desirable consequences for both family members and patients can be achieved. In order to meet family member’s needs, critical care units’ nurses must be able to identify their needs accurately [1, 2]. Every year in the United States, approximately 20% of all deaths occur in an intensive care unit (ICU), and family members suffer from being withdrawn or withheld. Many of patients are unable to communicate because of sedation, mechanical ventilation, confusion, and comatose. This results in much of the burden of decision-making and treatment choices on the patients’ family members. This may affect family members by increasing their stress levels and increasing their risk for psychological and physical symptoms [3].

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Short term memory loss. Word finding difficulty. Trouble concentrating. Difficulty with work or school. These are some of the symptoms that patients with Post Intensive Care Syndrome describe having following critical illness/injury. These symptoms can vary on the spectrum of severity, but for those who suffer from the cognitive effects of PICS even subtle difficulties can be life-changing. Loss of work, poor academic performance, and disrupted personal lives are unfortunately a reality for many people affected by PICS.

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Spouse admitted into the intensive care unit (ICU) may make a person more prone to have a heart attack or cardiac-related hospitalization in few weeks of the ICU admission, according to the research published in the journal Circulation.
"Spouses of ICU patients should pay attention to their own physical health, especially in terms of cardiovascular disease," said the study's senior author Hiroyuki Ohbe, M.D., M.P.H., a Ph.D. student in the department of clinical epidemiology and health economics in the School of Public Health at The University of Tokyo in Japan.

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The diagnosis and treatment of psychiatric disorders in intensive care patients have been for a long time neglected. They are nowadays better recognized and managed. These disorders are mainly: delirium; anxiety disorders, from simple anxiety to panic disorder with agitation; adaptation disorders with depressive mood; brief psychotic disorders with persecution ideas. The manifestations of psychiatric disorders occur not only during the stay in intensive care unit (ICU) but also after transfer from ICU and several months after discharge from hospital. Part of psychiatric disorders is caused by organic or toxic causes (metabolic disturbances, electrolyte imbalance, withdrawal syndromes, infection, vascular disorders and head trauma). Nevertheless some authors estimate that they are due to the particular environment of ICU. The particularities of these units are: a high sound level (noise level average between 50 and 60 dBA), the absence of normal day-night cycle, a sleep deprivation, a sensory deprivation, the inability for intubated patients to talk, the pain provoked by some medical procedures, the possibility to witness other patients' death. Although most patients feel secure in ICU, some of them perceive ICU's environment as threatening. Simple environmental modifications could prevent the apparition of some psychiatric manifestations: efforts should be made to decrease noise generated by equipment and staff conversations, to provide external windows, visible clocks and calendar, to ensure adequate sleep with normal day-night cycle and to encourage more human contact. Psychotropic drugs are useful but a warm and empathetic attitude can be very helpful. Some authors described specific psychotherapeutic interventions in ICU (hypnosis, coping strategies.). To face anxiety, many patients have defense attitudes as psychological regression and denial. Patient's family is suffering too. Relative's hospitalization causes a crisis in family. Unpredicted illnesses often force family members to reorganize in order to regain their equilibrium. Every family should be proposed a psychological support. Caregivers can be distressed as well. This stress is due to their high responsibility and the fact that they face disease and death. Simple measures can lessen stress'effect and prevent the burn-out syndrome . In conclusion, the importance of a liaison psychiatrist-intensive care physician collaboration must be emphasized in order that patients and their family have a better psychological support. Psychological management should be proposed during the hospitalization and after discharge from hospital.

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This slides present information regarding the updated Guidelines for family centered care in 4 sections:
First, the guideline development process focusing on changes and novel approaches taken. Next, the recommendations, sorted not in the order you would find them in the manuscript, but instead by which recommendations are retained from the 2007 Guidelines, and then new recommendations. Tools that were simultaneously developed by a combined team of guidelines writing members and members of a task force from the SCCM Patient/Education Committee,
Finally topics for future research in family centered care: What we know we do not know.

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Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long‐term prognoses. Post‐intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long‐term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS‐p) and the mental status of their family (PICS‐F). Intensive care unit‐acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow‐up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.

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Each year, millions of patients throughout the world survive a hospitalization that included a stay in an intensive care unit (ICU). ICU survivors can experience a variety of physical, cognitive, and emotional sequelae. In particular, mental health disorders associated with an ICU stay include anxiety, depression symptoms, post traumatic stress disorder (PTSD) symptoms, and complicated grief for families.

It is possible that impaired recall of the ICU stay, potentially accompanied by hallucinations or delusions, contributes to the post traumatic stress. Thus, use of an ICU diary given to the patient at discharge to consult at will could offer benefit. By providing objective information to patients, which could help fill in memory gaps, ICU diaries have allowed them to abandon unrealistic experiences, reconstruct their experience, gain a sense of reality, and resolve differences in experience with their families. However, studies exploring the usefulness of ICU diaries in preventing psychological post–intensive care syndrome were often conducted with small numbers of patients or select samples or with various design characteristics, outcome measures, and length of follow-up that compromised comparision.
This multicenter study was designed to assess the effect of an ICU diary on the occurrence of mental health consequences in patients and their families in the ICU setting.

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Health professionals have been aware of the incidence of post-intensive care syndrome (PICS) for some time. However, there has not been a clear or definitive way of administering treatment or nursing care to help patients suffering from PICS in their recovery. This paper suggests some ideas for the care of patients from the nursing point of view.

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This guide is for:People who have survived a frightening medical experience, such as being admitted to critical care (intensive care).People who have been hospitalized with severe medical problems related to COVID-19.Their family and friends.Mental health and medical professionals who want to understand more about how to help.