PICS

The hidden faces of
sepsis, what do they tell us? 
Focal points for improving patient outcome 

ICU_v17_i3_Nutma-Bade_HiddenFaces_1.pdf

Idelette Nutma September 2017 


Het Post-Intensive Care syndroom.

Een Presentatie van de werkgroep nazorg FCIC maart 2016 http://player.slideplayer.nl/33/10172646/#

 

MONITOR-IC studie

Onderzoek naar PICS bij 12.000 ex- IC patiënten 2016-2021  

Jaarlijks worden in Nederland meer dan 80.000 mensen op de IC opgenomen, van wie ruim 80% de IC- opname overleeft. Maar hoe gaat het met deze patiënten nadat ze ontslagen zijn? Herstellen patiënten weer volledig? Wat is hun kwaliteit van leven? Kunnen ze bijvoorbeeld hun baan weer oppakken? 

De laatste jaren wordt steeds duidelijker dat een IC- opname verregaande en langdurige gevolgen kan hebben. Een jaar na IC- opname heeft 50-75% van alle patiënten nog lichamelijke, psychische, cognitieve klachten of een combinatie hiervan, ook wel Post Intensive Care Syndroom (PICS) genoemd.

Echter, voor de Nederlandse situatie ontbreken gegevens over deze langetermijngevolgen van een IC- opname. Bovendien is er weinig bekend over de patiënt- en IC gerelateerde oorzaken van de lichamelijke en psychische gevolgen na een IC opname.

In juli 2016 zijn we daarom gestart met de MONITOR-IC studie in het Radboudumc. Vijf jaar lang worden patiënten en hun familieleden bij dit onderzoek betrokken. Door middel van vragenlijsten willen we inzicht krijgen in de kwaliteit van leven van patiënten, hun kwetsbaarheid, stress en vermoeidheid. Tevens willen we in kaart brengen wat de (na)zorg behoeften zijn en welke zorg patiënten gebruiken.

Komende maanden zal de studie van start gaan in het CWZ (Nijmegen) en Ziekenhuis Pantein (Boxmeer). We verwachten dat ongeveer 12.000 patiënten zullen meedoen aan de studie. De FCIC is intensief bij de MONITOR-IC studie betrokken.

Door de studie komen zorgverleners op de IC meer te weten over de langetermijneffecten van een IC opname en behandeling. Hierdoor kunnen ze de zorg verbeteren en patiënten en familie beter informeren.

Voor meer informatie zie de website www.monitor-ic.nl en volg de studie ook via deze FCIC site 

Het MONITOR- IC team

Afdeling Intensive Care

Radboudumc, Nijmegen

MONITOR-IC@radboudumc.nl 


IC-survivor levert fors in op kwaliteit van leven.

In het vakblad voor Acute Zorg; Venticare Magazine van februari 2017 staat een informatief artikel over het Post Intensive Care Syndroom(PICS)

De titel is al veelzeggend; IC-survivor levert fors in op kwaliteit van leven. Een informatief artikel, geschreven door Linda de Waart, waarin de zorgprofessional en de ervaringsdeskundigen samen aan het woord zijn over wat een kritieke ziekte en opname op de intensive care op de lange termijn betekent voor de patiënt.

Venticare_Magazine1-2017_PICS.pdf


THE POST-INTENSIVE CARE SYNDROME (PICS): IMPACT OF ICU-STAY ON FUNCTIONING AND IMPLICATIONS FOR REHABILITATION CARE

Daniela Dettling

In deze link PICS; impact of ...D. Dettling_Ihnenfeldt   vinden jullie het proefschrift van Daniela Dettling.

Ze zal haar proefschrift op 16 februari 2017 verdedigen aan de Universiteit van Amsterdam.  

2016_ddettling-1.jpg


Aandacht voor PICS vanuit het AMC Amsterdam

In de onderstaande documenten leest u over een aantal pr activiteiten rond PICS: een interview dat zojuist in het AMC Magazine heeft gestaan,een artikel in het Parool ( mei 2016) en een praktisch stukje in het Ned. tijdschrift voor fysiotherapie en de lectorale rede van Dr Marike van der Schaaf.  

Binnenkort verwachten wij een artikel over  PICS van Marjolein Siebel en Marike van der Schaaf in Nursing Academy

amcmagazinenr.5juni2016.12-13.pdf

2016_Lectorale-rede-zorg-voor-kwaliteit-van-overleving---dr.-marike-van-der-schaaf.pdfFilmpje lectorale rede dr. van der Schaaf: premiere-films-lectorale-rede-marike-van-der-schaaf.html

2016_Sommers-Schaaf_Fysiopraxis__2016_pg22-25.pdf

2016_Parool1_20160522.pdf 2016_Parool2_20160522.pdf

Lees hier meer artikelen van Marike van der Schaaf :  https://www.researchgate.net/profile/Marike_Schaaf_Van_Der/publications


Het post-intensivecare-syndroom; verborgen ziekte na IC-opname 

Artikel geschreven in 2016 door leden van de werkgroep Nazorg FCIC

Marjolein Meijnaar-Siebel, verpleegkundige (niet praktiserend) en ex IC-patiënt
dr. Marike van der Schaaf, onderzoeker/fysiotherapeut, afdeling Revalidatiegeneeskunde, AMC; bijzonder lector Revalidatie in de acute zorg, Faculteit Gezondheid, Hogeschool van Amsterdam 
 


Preventie van het post-ic-syndroom (PICS)

De gevolgen van een kritieke ziekte blijken groot en het aantal ic-overlevers dat problemen ervaart loopt in Nederland in de honderdduizenden. Onbekendheid met PICS maakt dat vele patiënten zich eenzaam voelen in hun zoektocht waarom ze het oude leven maar niet op kunnen pakken: hun klachten op fysiek, cognitief en psychisch gebied worden niet herkend. Daar moet verandering in komen! Gelukkig zijn er vele preventieve mogelijkheden waardoor een enorme winst in kwaliteit van overleven gehaald kan worden.

Marianne Brackel, patiëntervaringsdeskundige, heeft een artikel geschreven waarin ze pleit voor preventie van het post-ic-syndroom (PICS) voor betere nazorg aan patiënt en familie: Post IC Syndroom wordt niet herkend Lees Meer 

Ook schreef zij het artikel: Nazorg_intensive_care_moet_uit_de_kinderschoenen.pdf 


After The ICU

Seeing Ghosts

Lees Meer 

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After the ICU: Nancy Andrews at TEDxDirigo Generate

door TEDx Talks

Dit is het indrukwekkende verhaal van Nancy Andrews over het post intensive care syndroom en haar doorgemaakt delier na een lange ziekenhuisopname in Boston Ze is filmmaker en kunstenaar en heeft een eigen website ontwikkeld : klik op de video om te bekijken 

         

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Abstract PTSD after ICU Stay - news story & video

http://bit.ly/1j7NxAv 

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Dr. Alison Clay, Intensivist, deelt haar ervaringsverhaal over pijn, aggitatie, delirium en het post intensive care syndroom  

 Klik op het plaatje om de video te bekijken 
 
         
Recovering from the ICU: A Survivor's Story
door Critical Care
 
 

Intensivist Alison Clay, deelt haar ervaring als ICU patiënt en overlevende tijdens de Society of Critical CareMedicine 43 Critical Care Congress .Dr. Clay deelt haar verhaal als onderdeel van het ICU Liberation initiatief, dat bedoeld is om informatie over pijn, agitatie, delirium en mobiliteit aan intensive care professionals te verspreiden.

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MdCCProject GioraNetzer on Family ICU Syndrome.

An incredibly important & eye opening topic. http://marylandccproject.org/core-content/giora-netzer-family-intensive-care-unit-syndrome/ …#FOAMcc #FOAMed Jan 2015

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Acute Stress Symptoms in Families of Patients Admitted to the Intensive Care Apr 21 http://t.co/XEBjmeJ9pq

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Kwart van de mensen die Intensive care overleven zou last hebben van Post Traumatic Stress Disorder.

Het bijhouden van een dagboek kan daarbij een succesvolle interventie zijn http://t.co/qRS1XAHrmW 

The use of diaries in psychological recovery from intensive care: klik op het plaatje om de film te zien.

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When intensive care is just too intense

Lees Meer

--------------------------------------------------------------------------------------------------------------------Crit Care Med: PTSD in Critical Illness Survivors: A Metaanalysis- 20% of ICU survivors have PTSD symptoms 1 year out http://journals.lww.com/ccmjournal/Fulltext/2015/05000/Posttraumatic_Stress_Disorder_in_Critical_Illness.25.aspx …

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Craig M. Coopersmith @SCCMPresident

Provocative... Propranolol, PTSD, and intensive care: incorporating new advances in psychiatry into the ICU http://ccforum.com/content/pdf/s13054-014-0698-3.pdf …

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Psychiatric Problems in Patients Who Survive Critical Illnesses," by Joseph O. Bienvenu, MD, PhD and Dale M. Needham, MD, PhD | PsychiatricTimes.com | December 17, 2012

"Psychiatrische Problemen bij patiënten na overleving van een kritieke ziekte," door Joseph O. Bienvenu, MD, PhD en Dale M. Needham, Intensivists, en Psychiater

Weinig psychiaters kennen het fenomeen waarbij waanvoorstellingen enhallucinerende ervaringen van patiënten  voorkomen na overleving van kritischeziekten. Patienten komen vaak uit de Intensive Care met gruwelijke herinneringen(gemarteld, verkracht, aangerand of opgesloten) en weten niet wat er met hen gebeurd is. Niet alleen zijn de patiënten verzwakt door de lichamelijke ziekte, ze zijn ookgetraumatiseerd door de valse herinneringen als gevolg van het delirium.

  • Drs. Bienvenu and Needham discuss the effects of critical illness and the need for collaborative interventions in the ICU that will improve long-term patient outcomes.
  • Part 1 /  Part 2  of the interview.

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MdCCProject GioraNetzer on Family ICU Syndrome. An incredibly important & eye opening topic. Jan 2015

by MarylandCCProject.org / 3 months ago

Dr. Giora Netzer heeft uitgebreid onderzoek naar het Acute Respiratory Distress Syndrome gedaan, maar heeft ook een passie voor de manier waarop we de zorg verlenen aan patiënten en hun families in de ICU. In deze lezing presenteert Dr. Netzer zijn innovatief onderzoek en advies over een fenomeen dat hij beschreven heeft als het Family ICU Syndrome (Ficus ) Een syndroom dat grote invloed heeft op de zorg die wij leveren aan de ernstig zieke patient .Klik op het plaatje om de video te zien.

 
Eerste Nederlandse inventarisatie van omvang post IC-syndroom

25-11-2014 Mednet / Jenneke van de Streek. News Auteur Adri van Beelen 

De Universiteit Maastricht gaat in Nederland de kwaliteit van leven na een IC-opname en de omvang van het post intensive care syndroom (PICS) in kaart brengen. Dat kondigde Paul Roekaerts, hoogleraar Intensive Care Geneeskunde aan de Universiteit Maastricht aan in zijn inaugurele rede. Buitenlands onderzoek geeft aan dat 30 tot 50 procent te kampen heeft met ernstige fysieke beperkingen en/of psychische aandoeningen.

“Het Post Intensive Care syndroom (PICS) verdient dringend meer aandacht in de Nederlandse gezondheidszorg”, zegt Roekaerts in zijn rede ‘Elke dag telt’. In Nederland is niets bekend over de kwaliteit van leven van ex-IC-patiënten op de korte en langere termijn. Terwijl toch bijna driekwart van de patiënten die langer dan 48 uur op een IC- verblijven levend het ziekenhuis verlaat.

IC-overlevers

Buitenlands onderzoek geeft aan dat 30 tot 50 procent van de voormalige IC-patiënten lijdt aan fysieke beperkingen waardoor dagelijkse zaken als zich wassen of wandelen moeilijk tot onmogelijk wordt. Ook heeft ongeveer 40 procent een psychische aandoening, zoals depressie, angst of PTSS. Ook komen vaak persoonlijkheidsveranderingen en boosheid voor bij IC-overlevers.

Brandende oven

Roekaerts noemt een paar veelvoorkomende angsten, die hij in zijn praktijk tegenkomt. Een patiënt  die herhaalde CT- en MRI-scans heeft ondergaan denkt dat hij voortdurend levend in een brandende oven geschoven wordt. Of patiënten denken dat er een verpleegkundige rondloopt die hem wil vermoorden.

Begrip

Volgens Roekaerts maken  de symptomen van PICS een terugkeer in een normaal en professioneel leven haast onmogelijk. Hij wil graag beter begrijpen hoe de lichamelijke en mentale stoornissen tot stand komen en hoe ze voorkomen, behandeld of  draaglijker gemaakt kunnen worden.

Lees hier de inaugurele rede van Prof.dr. Paul Roekaerts, hoogleraar Intensive Care Geneeskunde aan de Universiteit Maastricht  ASSET1.pdf

Klik op de afbeelding om de youTube-video Elkedag telt te bekijken 
 
Elke dag telt! Prof. dr. P.M.H.J. Roekaerts
 
 
 

Interview met Dale Needham over PTSD en Postintensive Care Syndrome

Dale Needham gave an interview to Jill Bennett on CKNW and talked about the situation of critically ill patients on ICUs and their recovery. He explains in common words PTSD and Post Intensive Care Syndrome and he recommends ICU diaries to reduce the psychological risks of the ICU stay. 

https://soundcloud.com/cknw/jill-bennett-show-ptsd-in-intensive-care-units-with-dale-needham-october-10-2016

Video : Patient's Perspective on Survivorship after Critical Illness 

U hebt Adobe Flash nodig om deze content te bekijken.

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Interview with Drs. Bienvenu and Jackson regarding PTSD in Post-Intensive Care Syndrome

U hebt Adobe Flash nodig om deze content te bekijken.


Video van James Jackson over wat PICS is : https://youtu.be/K8ZYKISRy8k of klik op foto 

16-04 SEGMENT 1: ICU PTSD

Audio Player https://radiohealthjournal.wordpress.com/2016/01/24/16-04-segment-1-icu-ptsd/
 
Synopsis: A surprisingly high percentage of people who’ve been treated in intensive care units later suffer from post-traumatic stress disorder, often including hallucinations recalling horrible ICU incidents. This has led to coining a new syndrome–PICS, or post intensive care syndrome. Experts discuss why the syndrome appears to occur and what’s being done to treat and prevent it.

Host: Reed Pence. Guests: Dr. Joe Bienvenu, Associate Professor of Psychiatry, Johns Hopkins University; Dr. James Jackson, Assistant Professor of Medicine, Vanderbilt University

Lane-Fall: After the ICU: post-intensive care syndrome

Dr. Lane-Fall is Assistent Professor  Anesthesiologie en Critical Care bij het universiteitsziekenhuis Pennsylvania Zij publiceerde meerdere artikelen over het post intensive care syndroom en is een ware expert op dit gebied . Juni 2016 Klik op ; Watch on vimeo om de video te zien 


THRIVE: Life After the Intensive Care Unit

Every year, millions of Americans survive critical illness. But, despite the efforts of their ICU, many are left with ongoing problems. Learn more about Post-Intensive Care Syndrome (PICS) and what the Society of Critical Care Medicine is doing to reach out to patients and clinical professionals to raise awareness.

Klik op de afbeelding om het you tube filmpje te bekijken. 

thrive.jpg

Klik hier om naar de site te gaan http://www.myicucare.org/thrive/Pages/default.aspx

 


Patient Outcomes

Research studies

de Letter MA, Schmitz PI, Visser LH, Verheul FA, Schellens RL, Op de Coul DA, van der Meché FG. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med. 2001 Dec;29(12):2281-6

De Jonghe B, Shanshar T, Lefaucheur JP et al.  Paresis acquired in the intensive care unit: A prospective multicenter study.  JAMA 2002; 288:2859-2867 free full text

Fletcher SN, Kennedy DD, Ghosh IR et al.  Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med 2003; 31:1012-1016

Herridge MS, Cheung AM, Tansey CM et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 2003; 348:683-693 free full text

Hopkins RO, Weaver LK, Collingridge D et al.  Two year neurocognitive, emotional, and quality of life outcomes in survivors of acute respiratory distress syndrome.  AJRCCM  2005; 171:340-347 free full text

Needham DM, Bronskill SE, Calinawan JR et al. Projected incidence of mechanical ventilation in Ontario to 2026: Preparing for the aging baby boomers. Crit Care Med 2005; 33:574-579

Hough CL. Neuromuscular sequelae in survivors of acute lung injury. Clin Chest Med. 2006 Dec;27(4):691-703

De Jonghe B, Bashuji-Garin S, Durand MC et al: Respiratory weakness is associated with limb weakness and delayed weaning in critical illness.  Crit Care Med 2007; 35:2007-2015

Jones C, Bäckman C, Capuzzo M et al. Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med 2007; 33:978-985

Ali NA, O”Brien JM, Hoffman SP et al.  Acquired weakness, handgrip strength, and mortality in critically ill patients. AJRCCM  2008; 178:261-268 free full text

Cox CE et al. Expectations and outcomes of prolonged mechanical ventilation. Crit Care Med 2009;37:2888-2894 free text

Cuthbertson, BH, Rattray J, Campbell MK et al.  The PRaCTRiCaL study of nurse led, intensive care follow-up programmes fro improving long term outcomes from critical illness: A pragmatic randomised controlled trial.  BMJ 2009; 339:b3921 free text online

Hauer D, Weis F, Krauseneck T et al.  Traumatic memories, post-traumatic stress disorder and serum cortisol levels in long-term survivors of the acute respiratory distress syndrome. Brain Res 2009; 1293:114-20. Epub 2009 Apr 17

Sharshar T et al. Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality. Crit Care Med 2009;37:3047-3053

Poulsen JB, Moller K, Kelet H, Perner A. Long-term physical outcome in patients with septic shock. Acta Anaesthsiol Scand 2009;53:724-730

Ehlenbach WJ, Hough CL, Crane PK et al.  Association between acute care and critical illness hospitalization and cognitive function in older adults. JAMA. 2010; 303:763-70 free full text

Wunsch H, Guerra C, Barnato AE et al. Three-year outcomes for Medicare beneficiaries who survive intensive care. JAMA 2010; 303:849-856 free full text

Girard TD, Jackson JC, Pandharipande PP et al. Delirium as a predictor of long-term cognitive impairments in survivors of critical illness. Crit Care Med 2010; 38:1513-1520

Hopkins RO, Suchyta MR, Snow GL et al. Blood glucose dysregulation and cognitive outcome in ARDS survivors. Brain Injury 2010; 24; 1478-1484

Hopkins RO, Key CW, Suchyta MR et al.   Risk factors for depression and anxiety in survivors of acute respiratory distress syndrome. General Hospital Psychiatry 2010 ; 32;147-155

Iwashyna TJ, Ely EW et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis.  JAMA 2010; 304:1787-1794 free full text

Jones C, Bäckman C, Capuzzo M et al. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomized, controlled trial. Crit Care 2010; 14:R168 free full text

Jackson JC, Girard TD, Gordon SM et al. Long-term cognitive and psychological outcomes in the Awakening and Breathing controlled Trial. AJRCCM  2010; 182:183-191

Myhren H, Ekeberg O, Tøien K et al.  Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care 2010; 14:R14. free full text

Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM; Canadian Critical Care Trials Group. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011 Apr 7;364(14):1293-304.

Morris PE, Griffin L, Berry M, Thompson C, Hite RD, Winkelman C, Hopkins RO, Ross A, Dixon L, Leach S, Haponik E. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci. 2011 May;341(5):373-7.

Davidson JE, Jones C & Bienvenue OJ. Family response to critical illness: Postintensive care syndrome–family. Crit Care Med 2012 Vol. 40, No. 2, 618-24

Desai, Law & Needham. Long-term complications of critical care. Crit Care Med 2011 (39) 2: 371-379

Needham et al. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders’ conference. Crit Care Med 2012 Vol. 40, No. 2. 502-509

Herridge M, Cox C. Linking ICU Practice to Long-Term Outcome: Fostering a Longitudinal Vision for ICU-acquired Morbidity. Am J Respir Crit Care Med. 2012 Aug 15;186(4):299-300

Bienvenu OJ, Williams J, Yang A, Hopkins R, Needham DM. Posttraumatic stress disorder in acute lung injury survivors: evaluating the Impact of Event Scale-Revised. Chest.  In press.

Hopkins RO, Suchyta MR, Farrer TJ, Needham DM.  Improving post-ICU neuropsychiatric outcomes: understanding cognitive effects of physical activity. American Journal of Respiratory and Critical Care Medicine.  In press (epublished)

Woon FL, Dunn CB, Hopkins RO. Predicting cognitive sequelae in survivors of critical illness with cognitive screening tests. Am J Respir Crit Care Med. 2012 Aug 15;186(4):333-40.

Denehy L, Berney S, Whitburn L, Edbrooke L. Quantifying Physical Activity Levels of Survivors of Intensive Care: A Prospective Observational Study. Phys Ther. 2012, 92:1507-1517.

Needham DM, Dinglas VD, Bienvenu OJ, Colantuoni E, Wozniak AW, Rice TW, Hopkins RO (2013). One year outcomes in patients with acute lung injury randomised to initial trophic or full enteral feeding: prospective follow-up of EDEN randomised trial. BMJ 2013;346:f1532 doi: 10.1136/bmj.f1532.

Fan E, Dowdy DW, Colantuoni E, Mendez-Tellez PA, Sevransky JE, Shanholtz C, Himmelfarb CR, Desai SV, Ciesla N, Herridge MS, Pronovost PJ, Needham DM. Physical Complications in Acute Lung Injury Survivors: A 2-Year Longitudinal Prospective Study. Crit Care Med. 2013, in press

Casaer MP, Langouche L, Coudyzer W, Vanbeckevoort D, De Dobbelaer B, Güiza FG, Wouters PJ, Mesotten D, Van den Berghe G. Impact of early parenteral nutrition on muscle and adipose tissue compartments during critical illness. Crit Care Med. 2013 Oct;41(10):2298-309.

Hoyer EH, Needham DM, Miller J, Deutschendorf A, Friedman M, Brotman DJ. Functional status impairment is associated with unplanned readmissions. Arch Phys Med Rehabil. 2013 Oct;94(10):1951-8

Davydow DS, Hough CL, Langa KM, Iwashyna TJ. Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans. Am J Geriatr Psychiatry. 2013 Sep;21(9):887-97

Parsons EC, Kross EK, Ali NA, Vandevusse LK, Caldwell ES, Watkins TR, Heckbert SR, Hough CL. Red blood cell transfusion is associated with decreased in-hospital muscle strength among critically ill patients requiring mechanical ventilation. J Crit Care. 2013 Dec;28(6):1079-85.

Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW; the BRAIN-ICU Study Investigators. Long-Term Cognitive Impairment after Critical Illness. N Engl J Med. 2013 Oct 3;369(14):1306-1316.

Bagshaw SM, Stelfox HT, McDermid RC, Rolfson DB, Tsuyuki RT, Baig N, Artiuch B, Ibrahim Q, Stollery DE, Rokosh E, Majumdar SR. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ. 2014 Feb 4;186(2):E95-102.

Brodsky MB, Gellar JE, Dinglas VD, Colantuoni E, Mendez-Tellez PA, Shanholtz C, Palmer JB, Needham DM. Duration of oral endotracheal intubation is associated with dysphagia symptoms in acute lung injury patients. J Crit Care. 2014 Aug;29(4):574-9.

Needham DM1, Wozniak AW, Hough CL, Morris PE, Dinglas VD, Jackson JC, Mendez-Tellez PA, Shanholtz C, Ely EW, Colantuoni E, Hopkins RO; National Institutes of Health NHLBI ARDS Network. Risk factors for physical impairment after acute lung injury in a national, multicenter study. Am J Respir Crit Care Med. 2014 May 15;189(10):1214-24.

Man WD, Kon SS, Maddocks M. Rehabilitation after an exacerbation of chronic respiratory disease. BMJ. 2014 Jul 8;349:g4370.

Hermans G, Van Mechelen H, Clerckx B, Vanhullebusch T, Mesotten D, Wilmer A, Casaer MP, Meersseman P, Debaveye Y, Van Cromphaut S, Wouters PJ, Gosselink R, Van den Berghe G. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2014 Aug 15;190(4):410-20.

Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014 May;9(5):277-82.

Corner EJ, Wood H, Englebretsen C, Thomas A, Grant RL, Nikoletou D, Soni N. The Chelsea critical care physical assessment tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy. 2013 Mar;99(1):33-41.

Corner EJ, Soni N, Handy JM, Brett SJ. Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness. Crit Care. 2014 Mar 27;18(2):R55.

Greysen SR, Covinsky KE. Functional status--an important but overlooked variable in the readmissions equation. J Hosp Med. 2014 May;9(5):330-1.

Agård AS, Lomborg K, Tønnesen E, Egerod I. Rehabilitation activities, out-patient visits and employment in patients and partners the first year after ICU: a descriptive study. Intensive Crit Care Nurs. 2014 Apr;30(2):101-10.

Adler D, Dupuis-Lozeron E, Richard JC, Janssens JP, Brochard L. Does inspiratory muscle dysfunction predict readmission after intensive care unit discharge? Am J Respir Crit Care Med. 2014 Aug 1;190(3):347-50.

Legrand D, Vaes B, Matheï C, Adriaensen W, Van Pottelbergh G, Degryse JM. Muscle strength and physical performance as predictors of mortality, hospitalization, and disability in the oldest old. J Am Geriatr Soc. 2014 Jun;62(6):1030-8.

Nordon-Craft A, Schenkman M, Edbrooke L, Malone DJ, Moss M, Denehy L. The physical function intensive care test: implementation in survivors of critical illness. Phys Ther. 2014 Oct;94(10):1499-507.

Elliott D, Davidson JE, Harvey MA, Bemis-Dougherty A, Hopkins RO, Iwashyna TJ, Wagner J, Weinert C, Wunsch H, Bienvenu OJ, Black G, Brady S, Brodsky MB, Deutschman C, Doepp D, Flatley C, Fosnight S, Gittler M, Gomez BT, Hyzy R, Louis D, Mandel R, Maxwell C, Muldoon SR, Perme CS, Reilly C, Robinson MR, Rubin E, Schmidt DM, Schuller J, Scruth E, Siegal E, Spill GR, Sprenger S, Straumanis JP, Sutton P, Swoboda SM, Twaddle ML, Needham DM. Exploring the Scope of Post-Intensive Care Syndrome Therapy and Care: Engagement of Non-Critical Care Providers and Survivors in a Second Stakeholders Meeting. Crit Care Med. 2014 Dec;42(12):2518-2526.

Chao PW, Shih CJ, Lee YJ, Tseng CM, Kuo SC, Shih YN, Chou KT, Tarng DC, Li SY, Ou SM, Chen YT. Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis. Am J Respir Crit Care Med. 2014 Nov 1;190(9):1003-11.

Wade DM, Hankins M, Smyth DA, Rhone EE, Mythen MG, Howell D, Weinman JA. Detecting acute distress and risk of future psychological morbidity in critically ill patients: Validation of the Intensive care psychological assessment tool. Crit Care. 2014 Sep 24;18(5):519.

Koch S, Wollersheim T, Bierbrauer J, Haas K, Mörgeli R, Deja M, Spies CD, Spuler S, Krebs M, Weber-Carstens S. Long-term recovery In critical illness myopathy is complete, contrary to polyneuropathy. Muscle Nerve. 2014 Sep;50(3):431-6.

Han JH, Vasilevskis EE, Shintani A, Graves AJ, Schnelle JF, Dittus RS, Powers JS, Wilson A, Storrow AB, Ely EW. Impaired arousal at initial presentation predicts 6-month mortality: An analysis of 1084 acutely ill older patients. J Hosp Med. 2014 Oct 29.

Brown CH , Neufeld KJ, Needham DM. Delirium, steroids, and cardiac surgery. Anesth Analg. 2014 Nov;119(5):1011-3.

Ahasic AM, Van Ness PH, Murphy TE, Araujo KL, Pisani MA. Functional status after critical illness: agreement between patient and proxy assessments. Age Ageing. 2014 Oct 16.

Gay PC. Sleep and sleep-disordered breathing in the hospitalized patient. Respir Care. 2010 Sep;55(9):1240-54.

Aitken LM, Burmeister E, McKinley S, Alison J, King M, Leslie G, Elliott D. Physical recovery in intensive care unit survivors: a cohort analysis. Am J Crit Care. 2015 Jan;24(1):33-40.

Ferrante LE, Pisani MA, Murphy TE, Gahbauer EA, Leo-Summers LS, Gill TM. Functional Trajectories Among Older Persons Before and After Critical Illness. JAMA Intern Med. 2015 Feb 9.

Zisberg A, Shadmi E, Gur-Yaish N, Tonkikh O, Sinoff G. Hospital-associated functional decline: the role of hospitalization processes beyond individual risk factors. J Am Geriatr Soc. 2015 Jan;63(1):55-62.

Naidech AM, Beaumont JL, Berman M, Liotta E, Maas MB, Prabhakaran S, Kording K, Holl J, Cella D. Web-Based Assessment of Outcomes After Subarachnoid and Intracerebral Hemorrhage: A New Patient Centered Option for Outcomes Assessment. Neurocrit Care. 2014 Dec 16

Bienvenu OJ, Colantuoni E, Mendez-Tellez PA, Shanholtz C, Dennison-Himmelfarb CR, Pronovost PJ, Needham DM. Co-occurrence of and Remission From General Anxiety, Depression, and Posttraumatic Stress Disorder Symptoms After Acute Lung Injury: A 2-Year Longitudinal Study. Crit Care Med. 2014 Dec 15.

Magnette C, De Saint Hubert M, Swine C, Bouhon S, Jamart J, Dive A, Michaux I. Functional status and medium-term prognosis of very elderly patients after an ICU stay: a prospective observational study. Minerva Anestesiol. 2015 Jan 30.

Pape TL, Rosenow JM, Steiner M, Parrish T, Guernon A, Harton B, Patil V, Bhaumik DK, McNamee S, Walker M, Froehlich K, Burress C, Odle C, Wang X, Herrold AA, Zhao W, Reda D, Mallinson T, Conneely M, Nemeth AJ. Placebo-Controlled Trial of Familiar Auditory Sensory Training for Acute Severe Traumatic Brain Injury: A Preliminary Report. Neurorehabil Neural Repair. 2015 Jan 22.

Ruhl AP, Lord RK, Panek JA, Colantuoni E, Sepulveda KA, Chong A, Dinglas VD, Shanholtz CB, Pronovost PJ, Steinwachs DM, Needham DM. Health care resource use and costs of two-year survivors of acute lung injury. An observational cohort study. Ann Am Thorac Soc. 2015 Mar;12(3):392-401.

Lone NI. Counting the cost of intensive care unit survivorship after acute lung injury.Ann Am Thorac Soc. 2015 Mar;12(3):295-6.

Quasim T, Brown J, Kinsella J. Employment, social dependency and return to work after intensive care. JICS 2014.

Brummel NE, Balas MC, Morandi A, Ferrante LE, Gill TM, Ely EW. Understanding and Reducing Disability in Older Adults Following Critical Illness. Crit Care Med. 2015 Mar 9.

Kutner NG, Zhang R, Huang Y, Painter P. Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study. Am J Kidney Dis. 2015 Mar 27.

Wintermann GB, Brunkhorst FM, Petrowski K, Strauss B, Oehmichen F, Pohl M, Rosendahl J. Stress Disorders Following Prolonged Critical Illness in Survivors of Severe Sepsis. Crit Care Med. 2015 Mar 10.

Corner EJ, Hichens LV, Attrill KM, Vizcaychipi MP, Brett SJ, Handy JM. The responsiveness of the Chelsea Critical Care Physical Assessment tool in measuring functional recovery in the burns critical care population: an observational study. Burns. 2015 Mar;41(2):241-7.

Walsh TS, Salisbury LG, Merriweather JL, Boyd JA, Griffith DM, Huby G, Kean S, Mackenzie SJ, Krishan A, Lewis SC, Murray GD, Forbes JF, Smith J, Rattray JE, Hull AM, Ramsay P; RECOVER Investigators. Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge: The RECOVER Randomized Clinical Trial. JAMA Intern Med. 2015 Apr 13.

Cox CE, Hough CL. Improving Functional Recovery After Critical Illness. (Editorial) JAMA Intern Med. 2015 Apr 13.

Jones C, Eddleston J, McCairn A, Dowling S, McWilliams D, Coughlan E, Griffiths RD. Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: A randomized controlled trial. J Crit Care. 2015 May 9. pii: S0883-9441(15)00264-6.

Chan KS, Pfoh ER, Denehy L, Elliott D, Holland AE, Dinglas VD, Needham DM. Construct validity and minimal important difference of 6-minute walk distance in survivors of acute respiratory failure. Chest. 2015 May 1;147(5):1316-26.

Pfoh ER, Chan KS, Dinglas VD, Girard TD, Jackson JC, Morris PE, Hough CL, Mendez-Tellez PA, Ely EW, Huang M, Needham DM, Hopkins RO; with the NIH NHLBI ARDS Network. Cognitive screening among acute respiratory failure survivors: a cross-sectional evaluation of the Mini Mental State Examination. Crit Care. 2015 May 5;19(1):220.

Honselmann KC, Buthut F, Heuwer B, Karadag S, Sayk F, Kurowski V, Thiele H, Droemann D, Wolfrum S. Long-term mortality and quality of life in intensive care patients treated for pneumonia and/or sepsis: Predictors of mortality and quality of life in patients with sepsis/pneumonia. J Crit Care. 2015 Aug;30(4):721-6.

Jutte JE, Needham DM, Pfoh ER, Bienvenu OJ. Psychometric evaluation of the Hospital Anxiety and Depression Scale 3 months after acute lung injury. J Crit Care. 2015 Aug;30(4):793-8.

Borges RC, Carvalho CR, Colombo AS, da Silva Borges MP, Soriano FG. Physical activity, muscle strength, and exercise capacity 3 months after severe sepsis and septic shock. Intensive Care Med. 2015 Aug;41(8):1433-44

Bocci MG, Grieco DL, Lochi S, Minguell Del Lungo L, Pintaudi G, Caricato A, Murri R, Calabrese C, De Belvis AG, Avolio M, Sandroni C, Antonelli M. Defining needs and goals of post-ICU care for trauma patients: preliminary study. Minerva Anestesiol. 2015 Apr 15.

Hope AA, Gong MN, Guerra C, Wunsch H. Frailty Before Critical Illness and Mortality for Elderly Medicare Beneficiaries. J Am Geriatr Soc. 2015 Jun;63(6):1121-8.

Heyland DK, Garland A, Bagshaw SM, Cook D, Rockwood K, Stelfox HT, Dodek P, Fowler RA, Turgeon AF, Burns K, Muscedere J, Kutsogiannis J, Albert M, Mehta S, Jiang X, Day AG. Recovery after critical illness in patients aged 80 years or older: a multi-center prospective observational cohort study. Intensive Care Med. 2015 Aug 26.

Davies H, McKenzie N, Williams TA, Leslie GD, McConigley R, Dobb GJ, Aoun SM. Challenges during long-term follow-up of ICU patients with and without chronic disease. Aust Crit Care. 2015 May 1

Reviews

Hopkins RO and Jackson JC.  Long term neurocognitive function after critical illness.  Chest, 2006; 130:896-878 free full text

Dowdy DW, Eid MP, Dennison CR, Mendez-Tellez PA, Herridge MS, Guallar E, Pronovost PJ, Needham DM. Quality of life after acute respiratory distress syndrome: a meta-analysis. Intensive Care Med. 2006 Aug;32(8):1115-24

Jackson JC, Hart RP, Gordon SM et al. Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical ICU patients: Assessing the magnitude of the problem.  Crit Care 2007; 11:R27, 118 free full text

Davydow DS, Desai SV, Needham DM et al. Psychiatric morbidity in survivors of the acute respiratory distress syndrome: a systematic review. Psychosom Med 2008; 70:512-519 free full text

Davydow DS, Gifford JM, Desai SV et al. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry 2008; 30:421-434. free full text

Davydow DS, Gifford JM, Desai SV et al. Depression in general intensive care unit survivors: a systematic review. Intensive Care Med 2009; 35:796-809

Shanshar T, Bastuji-Garin S, Stevens RD et al.  Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality.  Crit Care Med 2009; 37:3047-3053

Bienvenu OJ and Neufeld KJ.  Post-traumatic stress disorder in medical settings: focus on the critically ill. Curr Psychiatry Rep 2011; Oct 28

Kiekkas P, Theodorakopoulou G, Spyratos F and Baltopoulos GI: Psychological distress and delusional memories after critical care: a literature review. Int Nurs Rev 2010; 57:288-96

Desai SV, Law TF and Needham DM.  Long-term complications of critical care.  Crit Care Med  2011; 39

Denehy L, Elliott D. Strategies for post ICU rehabilitation. Curr Opin Crit Care. 2012 Oct;18(5):503-8.

Vanpee G, Hermans G, Segers J, Gosselink R. Assessment of limb muscle strength in critically ill patients: a systematic review. Crit Care Med. 2014 Mar;42(3):701-11.

Karnatovskaia LV, Johnson MM, Benzo RP, Gajic O. The spectrum of psychocognitive morbidity in the critically ill: A review of the literature and call for improvement. J Crit Care. 2015 Feb;30(1):130-137.

Koroshetz W. A core set of trial outcomes for every medical discipline? BMJ. 2015 Jan 26;350:h85.

Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med. 2015 May;43(5):1121-9.

Guidelines

National Institute for Health and Clinical Excellence (NICE):  Rehabilitation after critical illness. NICE Clinical Guideline No. 83, January 2009 http://www.nice.org.uk/CG83

Fan E, Cheek F, Chlan L, Gosselink R, Hart N, Herridge MS, Hopkins RO, Hough CL, Kress JP, Latronico N, Moss M, Needham DM, Rich MM, Stevens RD, Wilson KC, Winkelman C, Zochodne DW, Ali NA; ATS Committee on ICU-acquired Weakness in Adults. An Official American Thoracic Society Clinical Practice Guideline: The Diagnosis of Intensive Care Unit-acquired Weakness in Adults. Am J Respir Crit Care Med. 2014 Dec 15;190(12):1437-46

Patients Experiences

Research studies

Happ MB. Interpretation of nonvocal behavior and the meaning of voicelessness in critical care. Soc Sci Med. 2000 May;50(9):1247-55.

Misak CJ. The critical care experience: a patient's view. Am J Respir Crit Care Med. 2004 Aug 15;170(4):357-9. Epub 2004 Apr 22. free full text

Sheen L, Oates J.: A phenomenological study of medically induced unconsciousness in intensive care. Aust Crit Care. 2005 Feb;18 (1):25-9, 31-2

Johannson, Fjellmann-Wiklund (2005): Ventilated patients experiences of body awareness at an intensive care unit. Advances in Physiotherapy. 2005; 7: 154-161

Karlsson V, Forsberg V. Health is yearning—–Experiences of being conscious during ventilator treatment in a critical care unit. Intensive and Critical Care Nursing (2008) 24, 41—50

Schou L, Egerod I (2008): A qualitative study into the lived experience of post-CABG patients during mechanical ventilator weaning. Intensive and Critical Care Nursing 24, 171-179

Carroll SM. Silent, slow lifeworld: the communication experience of nonvocal ventilated patients. Qual Health Res. 2007 Nov;17(9):1165-77.

Perrier E. Intensive care. BMJ. 2007 Apr 14;334(7597):796-7. (link is free full text)

Cox CE, Docherty SL, Brandon DH, Whaley C, Attix DK, Clay AS, Dore DV, Hough CL, White DB, Tulsky JA. Surviving critical illness: acute respiratory distress syndrome as experienced by patients and their caregivers. Crit Care Med. 2009 Oct;37(10):2702-8. free full text

Lee CM, Herridge MS, Matte A, Cameron JI. Education and support needs during recovery in acute respiratory distress syndrome survivors. Crit Care. 2009;13(5):R153. Epub 2009 Sep 23. free full text

Tonelli MR, Misak CJ. Compromised Autonomy and the Seriously Ill Patient. Chest 2010;137;926-931 free full text

Tanzman ES. Survivor. Ann Intern Med. 2010 Sep 21;153(6):416-7.

Misak CJ. ICU-Acquired Weakness: Obstacles and Interventions for Rehabilitation. Am J Respir Crit Care Med. 2011 Apr 1;183(7):845-6. Epub 2010 Oct 22.

Tate JA, Devito Dabbs A, Hoffman LA, Milbrandt E, Happ MB. Anxiety and agitation in mechanically ventilated patients. Qual Health Res. 2012 Feb;22(2):157-73.

Bienvenu OJ, Williams JB, Yang A, Hopkins RO, Needham DM. Posttraumatic stress disorder in acute lung injury survivors: evaluating the Impact of Event Scale-Revised.Chest. 2012 Nov 22. doi: 10.1378/chest.12-0908

Aitken LM, Rattray J, Hull A, Kenardy JA, Le Brocque R, Ullman AJ. The use of diaries in psychological recovery from intensive care. Crit Care. 2013 Dec 18;17(6):253. PubMed PMID: 24351578; PubMed Central PMCID: PMC4056894

Schelling G, Kapfhammer H-P. Surviving ICU does mean that the war is over. Editorial. Chest 144 July 1-3.

Pandian V, Smith CP, Cole TK, Bhatti NI, Mirski MA, Yarmus LB, Feller-Kopman DJ. Optimizing Communication in Mechanically Ventilated Patients. J Med Speech Lang Pathol. 2014;21(4):309-318

Rier DA. From three sides now: reflections on an ICU journey as patient, parent, and researcher. Intensive Care Med. 2014 Aug;40(8):1162-3.

Fenn B. Coma alarm dreams on paediatric intensive care. Intensive Care Med. 2014 Oct;40(10):1568-9.

Regensburg AM. Use of iPads by occupational therapists in a medical intensive care unit. Physical Disabilities Special Interest Section Quarterly Section. 2014; 37(3):1-3

Walker W, Wright J, Danjoux G, Howell SJ, Martin D, Bonner S. Project Post Intensive Care eXercise (PIX): A qualitative exploration of intensive care unit survivors’ perceptions of quality of life post-discharge and experience of exercise rehabilitation Journal of the Intensive Care Society 2014 doi:10.1177/1751143714554896

Czerwonka AI, Herridge MS, Chan L, Chu LM, Matte A, Cameron JI. Changing support needs of survivors of complex critical illness and their family caregivers across the care continuum: A qualitative pilot study of Towards RECOVER. J Crit Care. 2015 Apr;30(2):242-9.

Sottile PD, Nordon-Craft A, Malone D, Schenkman M, Moss M. Patient and family perceptions of physical therapy in the medical intensive care unit. J Crit Care. 2015 May 8. pii: S0883-9441(15)00266-X.

Wintermann GB, Brunkhorst FM, Petrowski K, Strauss B, Oehmichen F, Pohl M, Rosendahl J. Stress disorders following prolonged critical illness in survivors of severe sepsis. Crit Care Med. 2015 Jun;43(6):1213-22.

Reviews

Cook DJ, Meade MO, Perry AG. Qualitative studies on the patient's experience of weaning from mechanical ventilation. Chest. 2001 Dec;120(6 Suppl):469S-73S. free full text

Carroll SM. Nonvocal ventilated patients perceptions of being understood. West J Nurs Res. 2004 Feb;26(1):85-103

Curtis JR, White DB. Practical guidance for evidence-based ICU family conferences. Chest. 2008 Oct;134(4):835-43. free full text

Guidelines

National Institute for Health and Clinical Excellence (NICE):  Rehabilitation after critical illness. NICE Clinical Guideline No. 83, January 2009 http://www.nice.org.uk/CG83

Relatives & families

Research studies

Jones C,  Skirrow P, Griffins RD et al. Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Medicine 2004; 30:456-60

Melnyk BM, Alpert-Gillis L, Feinstein NF et al. Creating opportunities for parent empowerment: program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics 2004; 113: e597-607

Azoulay E, Pochard F, Kentish-Barnes N et al.  Risk of post-traumatic stress symptoms in family members of intensive care unit patients.AJRCCM 2005; 171: 987-94 free full text

Lautrette A, Darmon M, Megarbane B et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Eng J Med 2007; 356:469-78. [Erratum appears in N Eng J Med 2007; 357:203] free full text

Siegel MD, Hayes E, Vanderwerker LC et al.  Psychiatric illness in the next of kin of patients who die in the intensive care unit. Crit Care Med 2008; 36:1722-8

Davidson JE, Daly BJ, Agan D et al. Facilitated sensemaking: a feasibility study for the provision of a family support program in the intensive care unit. Critical Care Nursing Quarterly 2010; 33:177-189

Pape TL, Rosenow JM, Steiner M, Parrish T, Guernon A, Harton B, Patil V, Bhaumik DK, McNamee S, Walker M, Froehlich K, Burress C, Odle C, Wang X, Herrold AA, Zhao W, Reda D, Mallinson T, Conneely M, Nemeth AJ. Placebo-Controlled Trial of Familiar Auditory Sensory Training for Acute Severe Traumatic Brain Injury: A Preliminary Report. Neurorehabil Neural Repair. 2015 Jan 22

Petrinec AB, Mazanec PM, Burant CJ, Hoffer A, Daly BJ. Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers. Crit Care Med. 2015 Mar 17

Sottile PD, Nordon-Craft A, Malone D, Schenkman M, Moss M. Patient and family perceptions of physical therapy in the medical intensive care unit. J Crit Care. 2015 May 8.

Petrinec AB, Mazanec PM, Burant CJ, Hoffer A, Daly BJ. Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers. Crit Care Med. 2015 Jun;43(6):1205-12.

Reviews

Davidson JE. Facilitated Sensemaking: A strategy and new middle-range theory to support families of intensive care unit patients Critical Care Nurse. 2010

Guidelines

Davidson JE, Powers K, Hedayat KM et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med 2007; 35:605-622.

National Institute for Health and Clinical Excellence (NICE):  Rehabilitation after critical illness. NICE Clinical Guideline No. 83, January 2009 http://www.nice.org.uk/CG83