Determining the optimal protein intake for intensive care unit (ICU) and post-ICU patients is a multifaceted challenge. Firstly, it is essential to avoid both underdosing (<1.0 g/kg) and overdosing (>1.6 g/kg) of actual...Determining the optimal protein intake for intensive care unit (ICU) and post-ICU patients is a multifaceted challenge. Firstly, it is essential to avoid both underdosing (<1.0 g/kg) and overdosing (>1.6 g/kg) of actual protein intake. Secondly, the actual protein intake may deviate from the prescribed amount. Thirdly, phenotyping and endotyping are becoming increasingly crucial in tailoring protein targets. Additionally, a gradual increase in protein intake is essential during the first 4 to 5 days of ICU stay. Furthermore, no established protein targets exist for post-ICU patients, indicating the need for nutritional intervention research to identify optimal protein intake strategies.
The aim to avoid underfeeding has resulted in relative overfeeding of patients in the early phase of critical illness, worsening instead of improving outcomes. Negative randomised controlled trials have triggered mechani...The aim to avoid underfeeding has resulted in relative overfeeding of patients in the early phase of critical illness, worsening instead of improving outcomes. Negative randomised controlled trials have triggered mechanistic studies to investigate possible mechanisms explaining harm, allowing more scientific interpretation of many unexpected results during the last decades. Whereas individualized evidence-based approach to nutrition is still only rarely available, discussing and understanding of pathophysiological mechanisms should assist in decision-making in clinical practice. Further exploration of mechanisms of harm and benefit, as well as development of new technologies are needed to better plan future nutrition studies.
In its infancy during the formation of the specialty of critical care medicine, the need for safe and effective nutritional therapy was recognized as a key component of the care for severely ill patients admitted to an i...In its infancy during the formation of the specialty of critical care medicine, the need for safe and effective nutritional therapy was recognized as a key component of the care for severely ill patients admitted to an intensive care unit. The origin of modern critical care nutrition can be traced back to the invention of total parenteral nutrition, which enabled the delivery of long-term nutritional support to critically ill adults who had insufficient absorption or access to the gastrointestinal tract. This report discusses the rationale for these innovations and summarizes the events leading up to our current state of patient management in critical care nutrition.
Vrettou CS, Jolley SE, Mantziou V
… +1 more, Dimopoulou I
Crit Care Clin
· 2025 Jan · PMID 39547729
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Post-intensive care syndrome (PICS) encompasses persistent physical, psychological, and cognitive impairments. The coronavirus disease of 2019 (COVID-19) pandemic highlighted parallels between PICS and "long COVID". Ther...Post-intensive care syndrome (PICS) encompasses persistent physical, psychological, and cognitive impairments. The coronavirus disease of 2019 (COVID-19) pandemic highlighted parallels between PICS and "long COVID". There is an overlap between the 2 in risk factors, symptoms, and pathophysiology. Physical impairments in both include weakness and fatigue. Cognitive impairments include executive dysfunction in PICS and "brain fog" in long COVID. Mental health issues consist of depression, anxiety, and posttraumatic stress disorder in both disease states. Long COVID and PICS impact families, with multifaceted effects on physical health, mental well-being, and socioeconomic stability. Understanding these syndromes is crucial for comprehensive patient care and family support.
Smith AC, Ferguson HN, Russell RM
… +2 more, Savsani P, Wang S
Crit Care Clin
· 2025 Jan · PMID 39547728
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Family members of patients admitted to intensive care units often experience psychological distress, including depression, anxiety, and trauma symptoms, known as post-intensive care syndrome-family (PICS-F), due to the s...Family members of patients admitted to intensive care units often experience psychological distress, including depression, anxiety, and trauma symptoms, known as post-intensive care syndrome-family (PICS-F), due to the stress from having a critically ill loved one and resultant caregiver burden. Awareness of this syndrome is needed, as are prevention and management strategies, to improve outcomes.
Crit Care Clin
· 2025 Jan · PMID 39547727
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Post-intensive care syndrome (PICS) impacts most pediatric critical care survivors. PICS spans physical, cognitive, emotional, and social health domains and is increasingly recognized in survivorship literature. Children...Post-intensive care syndrome (PICS) impacts most pediatric critical care survivors. PICS spans physical, cognitive, emotional, and social health domains and is increasingly recognized in survivorship literature. Children pose unique challenges in identifying and treating PICS given the inherent population heterogeneity in pediatric samples with biological differences across ages and neurodevelopmental stages, unique disease pathophysiology, strong environmental influences on disease and recovery, and lack of standardized measurements to identify morbidities or track response to intervention. Emerging literature and the recent development of specialized multidisciplinary clinics highlight opportunities for intervention across PICS domains in inpatient and outpatient settings.
Crit Care Clin
· 2025 Jan · PMID 39547726
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Cognitive impairment is common after critical illness and persists beyond the period of acute illness. Clinicians caring for this patient population are encouraged to screen for cognitive impairment and provide supportiv...Cognitive impairment is common after critical illness and persists beyond the period of acute illness. Clinicians caring for this patient population are encouraged to screen for cognitive impairment and provide supportive measures to mitigate its distressing effects. Further research is needed to evaluate the laboratory and neuroimaging correlates of post-intensive care unit (ICU) cognitive impairment, which may in turn lead to personalized interventions to address this debilitating complication of critical illness. Further research is needed to evaluate the laboratory and neuroimaging correlates of post-ICU cognitive impairment, which may, in turn, lead to personalized interventions to address this debilitating complication of critical illness.
Crit Care Clin
· 2025 Jan · PMID 39547725
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Intensive care unit (ICU) survivors experience longstanding psychological impairments that persist in the months to years following ICU discharge, regardless of severity of illness or extent of physical recovery. Risk fa...Intensive care unit (ICU) survivors experience longstanding psychological impairments that persist in the months to years following ICU discharge, regardless of severity of illness or extent of physical recovery. Risk factors for psychological problems following critical illness have been identified including early symptoms of acute stress. Assessment of psychological symptoms in ICU patients and survivors remains inconsistent and many do not receive appropriate psychological evaluation, diagnosis, or treatment. Screening patients for psychological impairments early and serially following hospitalization is crucial to addressing patients' needs and mitigating long-term distress, as is connecting patients to outpatient mental health follow-up for treatment.
Crit Care Clin
· 2025 Jan · PMID 39547724
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There is evidence that people who fare worse in recovery do so, not only because of their illness, but also because of social and structural determinants. For example, food insecurity and poor nutrition, unemployment, po...There is evidence that people who fare worse in recovery do so, not only because of their illness, but also because of social and structural determinants. For example, food insecurity and poor nutrition, unemployment, poverty, social isolation and loneliness, limited social support, and poor access to medical care represent marked obstacles to recovery. Those who experience social or structural disadvantage have a poor start to their critical illness journey and are more vulnerable to adverse material conditions that contribute to and worsen their health outcomes.
MacDonald J, Mastalerz N, Wells A
… +1 more, Jackson JC
Crit Care Clin
· 2025 Jan · PMID 39547723
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The number of intensive care unit (ICU) survivors continues to grow, largely due to the emergence of more sophisticated treatment options. Yet despite this remarkable life-saving progress, far too little attention is pai...The number of intensive care unit (ICU) survivors continues to grow, largely due to the emergence of more sophisticated treatment options. Yet despite this remarkable life-saving progress, far too little attention is paid to the survivor's long-term quality of life after discharge. Post-Intensive Care Syndrome continues to impact many survivors' physical, cognitive, and mental health, as well as their social functioning related to these new impairments. In light of this knowledge, there is room to enhance compassionate care, both in and after the ICU, starting with improved collaboration with the patient, their caregivers, and other providers on the patient's care team.
Crit Care Clin
· 2025 Jan · PMID 39547722
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As the recognition of Post-Intensive Care Syndrome (PICS_ grows, providers and health systems have sought ways to assess for treat PICS after hospitalization. Multidisciplinary ICU recovery clinics represent a centralize...As the recognition of Post-Intensive Care Syndrome (PICS_ grows, providers and health systems have sought ways to assess for treat PICS after hospitalization. Multidisciplinary ICU recovery clinics represent a centralized approach for care delivery after critical illness. These clinics provide care in a variety of models, depending on resources and the needs of a particular patient population.
Crit Care Clin
· 2025 Jan · PMID 39547721
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Patients and their caregivers navigate multiple transitions of care across the health system as they recover from their critical illness. Current research supports the development of integrated models of care to improve...Patients and their caregivers navigate multiple transitions of care across the health system as they recover from their critical illness. Current research supports the development of integrated models of care to improve patient outcomes after critical illness. Future research to ensure the development of integrated models across different regions and to understand the optimal mode of delivery of these is required.
Dayton K, Lindroth H, Engel HJ
… +5 more, Fuchita M, Gonzalez P, Nydahl P, Stollings JL, Boehm LM
Crit Care Clin
· 2025 Jan · PMID 39547720
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The ABCDEF bundle and Awake and Walking intensive care unit (ICU) approach aim to prevent the long-term consequences of critical illness (ie, post-intensive care syndrome) by promoting patient wakefulness, cognition, and...The ABCDEF bundle and Awake and Walking intensive care unit (ICU) approach aim to prevent the long-term consequences of critical illness (ie, post-intensive care syndrome) by promoting patient wakefulness, cognition, and mobility. Humanizing the ICU experience is the key, preserving patients' function and autonomy. Successful implementation requires cultivating an ICU culture focused on avoiding sedatives and initiating prompt mobilization, addressing organizational barriers through tailored strategies. Overall, these patient-centered, mobility-focused models offer a holistic solution to the complex challenge of preventing post-intensive care syndrome and supporting critical illness survivors.
Su H, Fuentes AL, Chen H
… +5 more, Malhotra A, Gallo LC, Song Y, Moore RC, Kamdar BB
Crit Care Clin
· 2025 Jan · PMID 39547719
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This review explores the financial consequences that survivors of critical illness often face following hospitalization in an intensive care unit (ICU). As part of the "post-intensive care syndrome" (PICS), these survivo...This review explores the financial consequences that survivors of critical illness often face following hospitalization in an intensive care unit (ICU). As part of the "post-intensive care syndrome" (PICS), these survivors often experience, in addition to physical and emotional challenges of PICS, major financial burdens resulting from their prolonged ICU treatments. The escalating costs of ICU care, coupled with the potential long-term effects on survivors' ability to work and maintain financial stability, have brought financial toxicity to the forefront of health care discussions. The current review examines the causes and consequences of financial toxicity.
Fresenko LE, Rivera ZC, Parry SM
… +1 more, Mayer KP
Crit Care Clin
· 2025 Jan · PMID 39547718
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Patients surviving critical illness are at risk of persistent physical impairments related to Post Intensive Care Syndrome. Physical impairments and symptoms have potential for recovery, but frequently impact quality of...Patients surviving critical illness are at risk of persistent physical impairments related to Post Intensive Care Syndrome. Physical impairments and symptoms have potential for recovery, but frequently impact quality of life, performance of activities of daily living and participation in societal roles. Patient and illness-related risk factors directly relate and may predict physical functional outcomes providing opportunity for clinicians and scientist to develop targeted intervention strategies. Clinicians and scientists should screen and assess physical impairments and symptoms early following Intensive care unit discharge with a serial approach to promote for targeted and individualized treatment.
Matos J, Gallifant J, Chowdhury A
… +7 more, Economou-Zavlanos N, Charpignon ML, Gichoya J, Celi LA, Nazer L, King H, Wong AI
Crit Care Clin
· 2024 Oct · PMID 39218488
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This narrative review focuses on the role of clinical prediction models in supporting informed decision-making in critical care, emphasizing their 2 forms: traditional scores and artificial intelligence (AI)-based models...This narrative review focuses on the role of clinical prediction models in supporting informed decision-making in critical care, emphasizing their 2 forms: traditional scores and artificial intelligence (AI)-based models. Acknowledging the potential for both types to embed biases, the authors underscore the importance of critical appraisal to increase our trust in models. The authors outline recommendations and critical care examples to manage risk of bias in AI models. The authors advocate for enhanced interdisciplinary training for clinicians, who are encouraged to explore various resources (books, journals, news Web sites, and social media) and events (Datathons) to deepen their understanding of risk of bias.
Crit Care Clin
· 2024 Oct · PMID 39218487
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The coronavirus disease 2019 (COVID-19) pandemic raised new considerations for social disparities in critical illness including hospital capacity and access to personal protective equipment, access to evolving therapies,...The coronavirus disease 2019 (COVID-19) pandemic raised new considerations for social disparities in critical illness including hospital capacity and access to personal protective equipment, access to evolving therapies, vaccinations, virtual care, and restrictions on family visitation. This narrative review aims to explore evidence about racial/ethnic and socioeconomic differences in critical illness during the COVID-19 pandemic, factors driving those differences and promising solutions for mitigating inequities in the future. We apply a patient journey framework to identify social disparities at various stages before, during, and after patient interactions with critical care services and discuss recommendations for policy and practice.
Crit Care Clin
· 2024 Oct · PMID 39218486
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Pulmonary and Critical Care Medicine (PCCM) fellowship training faces increasing competition but lacks diversity, hindering health care excellence. Despite a growing interest in the field, programs lack diverse represent...Pulmonary and Critical Care Medicine (PCCM) fellowship training faces increasing competition but lacks diversity, hindering health care excellence. Despite a growing interest in the field, programs lack diverse representation. Addressing this issue is crucial to combat health disparities and bias, benefiting trainees, practitioners, and patients. Sustainable solutions are vital for achieving diversity, equity, and inclusion in PCCM. Strategies for achieving equity among training programs include adopting inclusive recruitment practices, recognizing differential attainment, addressing bias, fostering an equitable academic climate, and implementing multifaceted strategic processes to enhance diversity in mentorship including recognition and compensation for diversity and equity work.