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EVERY YEAR, ABOUT 6 million people are admitted to intensive care units with a life-threatening illness. As medical technology advances, more people survive conditions that once would have been fatal. However, about half of these ICU survivors develop some form of cognitive, psychosocial and physical deficits in a condition known as post-intensive care syndrome, or PICS.

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To describe the duration of fever, fever management, and outcomes among intensive care patients with fever and known or suspected infection. Prospective observational trial in three tertiary intensive care units over 6 weeks in 2010. Adult patients were screened for eligibility and inclusion if they had a fever of ≥38.0°C and known or suspected infection being treated with antimicrobials; those with neurological injury or elective surgery within 72 hours were excluded. Mean and peak daily temperatures were recorded and the use of antipyretics and other cooling measures were recorded over the first 7 days. Mortality, ICU-free survival, ventilator-free survival and renal replacement therapy-free survival were determined at Day 28. 51/565 patients (9.0%) were included. The mean daily peak temperature and the proportion of patients with a documented temperature of ≥38.0°C decreased over the first 3 days after first documented fever. Thereafter, the proportion of patients who had daily peak temperatures ≥38.0°C remained about 20%. Paracetamol was administered to 58%-70% of patients per day. Physical cooling was used at least once for 12% of patients. Mean ICU-free survival to Day 28 in eligible patients was 16.0 (SD, 9.2) days. The mortality rate of eligible patients was more than double that of ineligible patients (8/51 [16%] v 36/514 [7%]; P = 0.05). We have described the typical time course of fever in an easily identified cohort of patients with known or suspected infection and have determined that these patients have significant morbidity and mortality. This information is vital to the design of interventional studies for the treatment of fever in ICU.

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The Patient Communicator app by the Society of Critical Care Medicine is designed to improve communication among patients, families, and caregivers. The app can help ease the stress of a hospital stay.

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Survivors of critical illness frequently experience a post–intensive care syndrome comprising physical, psychological, and cognitive disabilities. In this randomized clinical trial,Walsh and colleagues developed a rehabilitation strategy that used a dedicated therapist to increase the frequency and intensity of mobilization and exercise therapy, dietetic review and advice, and referral for other therapies using predefined triggers, together with providing greater illness-specific information.

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In the power point, the author explained the long-term cognitive impairment, delirium and how to prevent them using the ABCDE bundle.

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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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Family members and friends who have been identified by patients as their care partners, together with you and other staff, are integral members of the health care team. These family members and friends provides provide comfort and assistance for patients. As care partners, they can also help you share information, by participating in aspect of care, and by helping make decisions. They can be spokesperson, advocate, and supporter, especially if patients are too sick or too overwhelmed to do this for themselves. They are essential to ensuring quality, safe transition to home and ongoing care and recovery once a patient leaves the hospital. The following suggestions are offered to guide you as you become PARTNERS together

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Understanding your ICU stay, information for patients and families

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A steadily increasing number of patients survive their stay in the Intensive Care Unit (ICU), and a significant percentage become chronic cases. Patient post-intensive care syndrome (PICS-P) is a recently described condition that affects an
important number of patients (30---50%). It encompasses the physical (mainly respiratory and neuromuscular), cognitive (memory and attention) and psychological sequelae (depression, anxiety, stress and/or post traumatic stress syndrome) at discharge from the ICU, and which have a negative impact
upon patient quality of life.
This syndrome also affects the family of the patient(PICS-F). In effect, the patient relatives constitute a vulnerable and often forgotten group of individuals that nevertheless suffer negative physical, psychological and social effects
that worsen their quality of life.

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Objective: To examine the potential of a questionnaire (CQI ‘R-ICU’) to measure the quality of care from the perspective of relatives in the Intensive Care Unit (ICU).
Methods: A quantitative survey study has been undertaken to explore the psychometric properties of the instrument, which was sent to 282 relatives of ICU patients from the Erasmus MC, an academic hospital in Rotterdam, the Netherlands. Factor-analyses were performed to explore the underlying theoretical
structure.
Results: Survey data from 211 relatives (response rate 78%) were used for the analysis. The overall reliability of the questionnaire was sufficiently high; two of the four underlying factors, namely ‘Communication’ and ‘Involvement’, were significant predictors. Two specific aspects of care that needed the most improvement were missing information about meals and offering an ICU diary. There is a significant difference in mean communication with nurses among the four wards in Erasmus MC.
Conclusions: The CQI ‘R-ICU’ seems to be a valid, reliable and usable instrument. The theoretical fundament appears to be related to communication.
Practice implications: The newly developed instrument can be used to provide feedback to health care professionals and policy makers in order to evaluate quality improvement projects with regard to relatives in the ICU.

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Background: Long-term survival outcome of critically ill patients is important in assessing effectiveness of new treatments
and making treatment decisions. We developed a prognostic model for estimation of long-term survival of critically ill
patients.

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Major depressive disorder (MDD) is a common condition following treatment in the Intensive Care Unit (ICU). Long-term data on MDD in chronically critically ill (CCI) patients are scarce. Hence, the primary aim of the present study was to investigate the frequency and predictors of MDD after intensive care of CCI patients.