Background Increasing numbers of survivors of critical illness are at risk for physical, cognitive, and/or mental health impairments that may persist for months or years after hospital discharge. The post-intensive care syndrome framework encompassing these multidimensional morbidities was developed at the 2010 Society of Critical Care Medicine conference on improving long-term outcomes after critical illness for survivors and their families. Objectives To report on engagement with non-critical care providers and survivors during the 2012 Society of Critical Care Medicine post-intensive care syndrome stakeholder conference. Task groups developed strategies and resources required for raising awareness and education, understanding and addressing barriers to clinical practice, and identifying research gaps and resources, aimed at improving patient and family outcomes. Participants Representatives from 21 professional associations or health systems involved in the provision of both critical care and rehabilitation of ICU survivors in the United States and ICU survivors and family members. Design Stakeholder consensus meeting. Researchers presented summaries on morbidities for survivors and their families, whereas survivors presented their own experiences. Meeting outcomes Future steps were planned regarding 1) recognizing, preventing, and treating post-intensive care syndrome, 2) building strategies for institutional capacity to support and partner with survivors and families, and 3) understanding and addressing barriers to practice. There was recognition of the need for systematic and frequent assessment for post-intensive care syndrome across the continuum of care, including explicit "functional reconciliation" (assessing gaps between a patient's pre-ICU and current functional ability at all intra- and interinstitutional transitions of care). Future post-intensive care syndrome research topic areas were identified across the continuum of recovery: characterization of at-risk patients (including recognizing risk factors, mechanisms of injury, and optimal screening instruments), prevention and treatment interventions, and outcomes research for patients and families. Conclusions Raising awareness of post-intensive care syndrome for the public and both critical care and non-critical care clinicians will inform a more coordinated approach to treatment and support during recovery after critical illness. Continued conceptual development and engagement with additional stakeholders is required.

Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting.

The burden of caring for critically ill patients in the United States is massive, currently accounting for nearly 1% of the gross domestic product and affecting large sectors of the U.S. healthcare system including the emergency department (ED) (1–3). The majority of critical care in the United States are provided to patients over the age of 65, and this population is predicted to grow by 50% from 2000 to 2020 (4, 5). The rising demand for critical care in the face of already insufficient capacity has become an area of concern for clinicians, hospital administrators, and policymakers (6–9). In 2000, the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine Committee on Manpower for Pulmonary and Critical Care Societies forecast large shortfalls in the critical care workforce. A 2006 Health Resources and Services Administration report to Congress not only confirmed the predicted shortages, but also projected worsening shortages into the future (4). There currently exist little data on how system-wide increases in the demand for critical care are affecting U.S. EDs.

Most patients, critically ill patients in the United States are admitted from an ED (10). These patients typically require medically complex and resource intensive care often begins outside the ICU in the ED (2, 3, 10, 11). The provision of critical care in the ED is a potentially important factor in ED crowding. The Institute of Medicine report “Hospital-Based Emergency Care: At The Breaking Point” identified that the inability to promptly admit critically ill ED patients to inpatient beds can lead to boarding and contributes to ED crowding (12). Several studies suggest that the proportion of critically ill patients presenting to U.S. EDs is increasing (13–15). Additionally, other studies have questioned the ability of many EDs to provide optimal care for critically ill patients in crowded conditions and linked prolonged ED stays by critically ill patients with increased mortality (16–18).

This study investigates changes in the total hours of ED care provided to patients ultimately admitted to an ICU from U.S. EDs between 2001 and 2009. To evaluate the hypothesis that EDs are providing an increasing amount of critical care, we examined both trends in ED visit ICU admissions and trends in the median ED length of stay (EDLOS) for these patients. Additionally, we analyzed trends in the national ED capacity to estimate changes in the average daily hours of care provided to patients admitted to an ICU at an average U.S. ED.

Increasing Critical Care Admissions From U.S. Emergency Departments, 2001–2009*

Objectives
To examine the relationship between socio-economic status (SES), functional recovery and long-term mortality following acute myocardial infarction (AMI).

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Socioeconomic status, functional recovery, and long-term mortality among patients surviving acute myocardial infarction.

Background:Trauma patients are vulnerable to coagulopathy and inflammatory dysfunction associated with endotheliopathy of trauma (EoT). In vitro evidence has suggested that tranexamic acid (TXA) may ameliorate endotheliopathy. We aimed to investigate how soon after injury EoT occurs, its ass

/pdf/endotheliopathy-of-trauma-is-an-on-scene-phenomenon-and-is-2yyzugmeuk.pdf

Endotheliopathy of Trauma is an on-Scene Phenomenon, and is Associated with Multiple Organ Dysfunction Syndrome: A Prospective Observational Study

Cardiogenic shock is a common clinical condition with high in-hospital mortality. Early application of appropriate interventions for cardiogenic shock-including medical therapies, revascularization, temporary hemodynamic support devices, and durable mechanical circulatory support-may improve outcomes. The number and complexity of therapies for cardiogenic shock are increasing, making time-dependent decision-making more challenging. A multidisciplinary cardiogenic shock team is recommended to guide the rapid and efficient use of these available treatments. © 2015 Wiley Periodicals, Inc.

A team‐based approach to patients in cardiogenic shock

Purpose of review To emphasize the evolving body of evidence that supports the need for a more seamless and interconnected continuum of patient care for a growing compendium of critical care conditions, starting in the prehospital and emergency department (ED) phases of management and continuing through ICU and rehabilitation services. Recent findings The care of critically ill and injured patients has become increasingly complex. It now has been demonstrated that, for a number of such critical care conditions, optimal management not only relies heavily on the talents of highly coordinated, multidisciplinary teams, but it also may require shared responsibilities across a continuum of longitudinal care involving numerous specialties and departments. This continuum usually needs to begin in the prehospital and ED settings with management extending through specialized in-hospital diagnostic and interventional suites to traditional ICU and rehabilitation programs. In recent years, examples of these conditions have included the development of systems of care for trauma, cardiac arrest, myocardial infarction, stroke, sepsis syndromes, toxicology and other critical illnesses. Although the widespread implementation of such multidisciplinary, multispecialty critical care cascades of care has been achieved most commonly in trauma care, current healthcare delivery systems generally tend to employ compartmentalized organization for the majority of other critical care patients. Accordingly, optimal systematic care often breaks down in the management of these complex patients due to barriers such as lack of interoperable communication between teams, disjointed transfers between services, unnecessary time-consuming, re-evaluations and transitional pauses in time-dependent circumstances, deficiencies in cross-disciplinary education and quality assurance loops, and significant variability in patient care practices. Such barriers can lead to adverse outcomes in this fragile patient population. Summary This article discusses the basis and rationale for the 'critical care cascade' concept, which contends that the optimal management of critically ill patients should be a continuum of care through the healthcare system. In the critical care cascade, each patient is enrolled on a 'pathway' of management based on their working diagnosis and each and every healthcare provider engaged along that continuum acts as part of a interconnected coordinated team that ensures a specific endpoint for these patients in a bundled manner that seamlessly extends from the prehospital and ED phases to the ICU and rehabilitation services.

Rishi Ghosh

Papers

The critical care cascade: a systems approach.

Development of Machine Learning Algorithm for Characterization and Estimation of Energy Consumption of Various Stages during 3D Printing

Development and comparison of machine-learning algorithms for anomaly detection in 3D printing using vibration data