Netzer: Family Intensive Care Syndrome (FICUS)

Clinical Pearls (Assisted by Jessica Buchner, MD)

• Family
  • A group of individuals who share each other’s lives
  • SCCM does not require this to be a “blood relative”
• Majority of decision-making in ICU is made by surrogates
  • Need to collaborate and share decision making btw multiple members of families
  • Leads to stress, depression, even PTSD among family members
    • 44% of caregivers are depressed and possess low problem solving (correlates with depression)
• Good communication matters
  • Miscommunication increases length of stay, financial burden, family conflict, increased risk of PTSD
  • Treatment team must be aware of the cultural ideals held by the family (leads to effective communication)
• Communicators must anticipate the grief of the receivers (serves as a cognitive barrier)
  • Families often experience learned helplessness, maladaptive reasoning- “learned helplessness”
    • Stress that cannot be controlled → disengage → withdrawal
    • Level of stress correlates to “learned helplessness”
• High levels of stress cause family members to have excessive daytime sleepiness, and decreased quality of life (Int Care Med, 2014)
  • “Sleepiness” leads to cognitive blunting and decreased executive functioning
• Family members are often internally conflicted about feeling blame for the patient’s death
  • Worried about the reaction of other family members in regards to their decisions
• Families often misinterpret prognostic information:
  1. Optimism bias (“he’s a fighter”, faith-based hope, etc.)
  2. Framing bias (how data are presented changes interpretation)
  3. Emotional vs logical reasoning (in a highly emiotionally charged state you are not in a place to make adequate decisions)
• Conflict between providers and family members increases burnout rates
  • >40% of ICU physicians and nurses report conflict btw staff and families as a source of conflict
  • Futile care is often perceived as hurtful to patient and a waste of resources
• Family-centered care improves overall outcomes
  • Increased early mobilization and lessens ICU burden
• Family members must be thought of as a part of the treatment team
  • Majority of ICUs have visitor restrictions and instead should build more family presence into policy
• How to remedy the problems:
  • Open visitation (unlimited hours)
  • Dedicated family meeting room
    • “Family support zones”
  • Provision of basic needs for families
    • Dedicated areas near the ICU for vending machines, shower facilities, group kitchen
    • Hospital laundry access
    • Sleeping space in the room
  • Bedside rounds
    • Including bed side engagement
    • Decreases family stress
    • Increases satisfaction scores
  • More frequent family discussions
  • Utilize families to help with bedside treatments such as mouth care, talk therapy, passive range of motion
• With similar interventions there is decreased delirium and thus improved outcomes:

• Over the next several years we will see more ICU survivors (based on modern treatment techniques)
  • We need more resources dedicated to helping survivors and their families cope:
    • Post-intensive care syndrome
      • Cognitive and physical dysfunction, seen both in patients and their families
      • Critical illness neuropathy/myopathy

• SCCM THRIVE initiative: optimize care for ICU survivors while in the hospital and after discharge