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Objective: To provide clinicians with evidence-based strategies to optimize support of the family of critically ill patients in the ICU.Methods: We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis and family-centered care to revise the 2007 Clinical Practice Guidelines for Support of the Family in the Patient-Centered Intensive Care Unit. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome (PICO) question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre-established voting thresholds. No industry funding was associated with guideline development.Results: The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and PICO question development. The systematic review search yielded 4158 reports after de-duplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice.Conclusions: These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care.

Medical professionals are expected to prioritize patient interests, and most patients trust physicians to act in their best interest. However, a single patient is never a physician's sole concern. The competing interests of other patients, clinicians, family members, hospital administrators, regulators, insurers, and trainees are omnipresent. While prioritizing patient interests is always a struggle, it is especially challenging and important in the ICU setting where most patients lack the ability to advocate for themselves or seek alternative sources of care. This review explores factors that increase the risk, or the perception, that an ICU physician will reason, recommend, or act in a way that is not in their patient's best interest and discusses steps that could help minimize the impact of these factors on patient care., Author(s): Alison E. Turnbull [sup.1] [sup.2] [sup.3], Sarina K. Sahetya [sup.1], E. Lee Daugherty Biddison [sup.1], Christiane S. Hartog [sup.4] [sup.5] [sup.6], Gordon D. Rubenfeld [sup.7] [sup.8], Dominique D. Benoit [...]

Author(s): Rik T. Gerritsen [sup.1], Christiane S. Hartog [sup.2] [sup.3], J. Randall Curtis [sup.4] Author Affiliations: (1) 0000 0004 0419 3743, grid.414846.b, Center of Intensive Care, Medisch Centrum Leeuwarden, , [...]

Author(s): Alison E. Turnbull [sup.1] [sup.2] [sup.3], Christiane S. Hartog [sup.4] [sup.5] Author Affiliations: (1) 0000 0001 2171 9311, grid.21107.35, Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins [...]

Rationale: Sepsis often leads to long-term functional deficits and increased mortality in survivors. Postacute rehabilitation can decrease long-term sepsis mortality, but its impact on nursing care dependency, health care use, and costs is insufficiently understood. Objectives: To assess the short-term (7-12 months postdischarge) and long-term (13-36 months postdischarge) effect of inpatient rehabilitation within 6 months after hospitalization on mortality, nursing care dependency, health care use, and costs. Methods: An observational cohort study used health claims data from the health insurer AOK (Allgemeine Ortskrankenkasse). Among 23.0 million AOK beneficiaries, adult beneficiaries hospitalized with sepsis in 2013-2014 were identified by explicit codes from the International Classification of Diseases, Tenth Revision. The study included patients who were nonemployed presepsis, for whom rehabilitation is reimbursed by the AOK and thus included in the dataset, and who survived at least 6 months postdischarge. The effect of rehabilitation was estimated by statistical comparisons of patients with rehabilitation (treatment group) and those without (reference group). Possible differential effects were investigated for the subgroup of ICU-treated sepsis survivors. The study used inverse probability of treatment weighting based on propensity scores to adjust for differences in relevant covariates. Costs for rehabilitation in the 6 months postsepsis were not included in the cost analysis. Results: Among 41,918 6-month sepsis survivors, 17.2% (n = 7,224) received rehabilitation. There was no significant difference in short-term survival between survivors with and without rehabilitation. Long-term survival rates were significantly higher in the rehabilitation group (90.4% vs. 88.7%; odds ratio [OR] = 1.2; 95% confidence interval [95% CI] = 1.1-1.3; P = 0.003). Survivors with rehabilitation had a higher mean number of hospital readmissions (7-12 months after sepsis: 0.82 vs. 0.76; P=0.014) and were more frequently dependent on nursing care (7-12 months after sepsis: 47.8% vs. 42.3%; OR=1.2; 95% CI=1.2-1.3; P,0.001; 13-36 months after sepsis: 52.5% vs. 47.5%; OR=1.2; 95% CI=1.1-1.3; P,0.001) compared with those without rehabilitation, whereas total health care costs at 7-36 months after sepsis did not differ between groups. ICUtreated sepsis patients with rehabilitation had higher short- and long-term survival rates (short-term: 93.5% vs. 90.9%; OR= 1.5; 95% CI=1.2-1.7; P,0.001; long-term: 89.1% vs. 86.3%; OR=1.3; 95% CI=1.1-1.5; P,0.001) than ICU-treated sepsis patients without rehabilitation. Conclusions: Rehabilitation within the first 6 months after ICU- and non-ICU-treated sepsis is associated with increased long-term survival within 3 years after sepsis without added total health care costs. Future work should aim to confirm and explain these exploratory findings. [ABSTRACT FROM AUTHOR]