Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit

  • Jamie Nicole LaBuzettaEmail author
  • Jonathan Rosand
  • Ana-Maria Vranceanu


Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.


Post-intensive care syndrome PICS PICS-family Critical care 



The following funding support is acknowledged: Henry and Allison McCance Center for Brain Health (support to Drs. Jonathan Rosand and Ana-Maria Vranceanu), Grant-in-Aid from American Heart Association (support to Dr. Ana-Maria Vranceanu) and 1R21NR017979 (support to Dr. Ana-Maria Vranceanu), National Institutes of Health (JR). Dr. Rosand reports serving as a consultant for Boehringer Ingelheim, Pfizer, and New Beta Innovation.

Author Contributions

JNL conception of review, primary review of literature, drafting of manuscript, final approval for manuscript submission. JR and A-MV reviewed manuscript and provided feedback, final approval for manuscript submission.

Source of Support

This manuscript was supported by a 1R21 NR017979 01A1 (AMV), by a Grant-in-Aid from the American Heart Association (AMV) and by the Henry and Allison McCance Center for Brain Health (AMV, JR).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Iwashyna TJ, Cooke CR, Wunsch H, Kahn JM. Population burden of long-term survivorship after severe sepsis in older Americans. J Am Geriatr Soc. 2012;60:1070–7.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Kuehn BM. Clinics aim to improve post-ICU recovery. JAMA. 2019;321(11):1036–8.PubMedGoogle Scholar
  3. 3.
    Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40:502–9.PubMedGoogle Scholar
  4. 4.
    Jackson JC, Pandharipande PP, Girard TD, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med. 2014;2:369–79.PubMedPubMedCentralGoogle Scholar
  5. 5.
    De Jonghe B, Sharshar T, Lefaucheur JP, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288:2859–67.PubMedGoogle Scholar
  6. 6.
    Major ME, Kwakman R, Kho ME, et al. Surviving critical illness: What is next? An expert consensus statement on physical rehabilitation after hospital discharge. Crit Care. 2016;20:354.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Clavet H, Hebert PC, Fergusson D, Doucette S, Trudel G. Joint contracture following prolonged stay in the intensive care unit. CMAJ. 2008;178:691–7.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Hermans G, Van Mechelen H, Clerckx B, et al. 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;190:410–20.PubMedGoogle Scholar
  9. 9.
    Jackson JC, Hart RP, Gordon SM, et al. Six-month neuropsychological outcome of medical intensive care unit patients. Crit Care Med. 2003;31:1226–34.PubMedGoogle Scholar
  10. 10.
    Jackson JC, Obremskey W, Bauer R, et al. Long-term cognitive, emotional, and functional outcomes in trauma intensive care unit survivors without intracranial hemorrhage. J Trauma. 2007;62:80–8.PubMedGoogle Scholar
  11. 11.
    Gunther ML, Morandi A, Krauskopf E, et al. The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: the VISIONS cohort magnetic resonance imaging study. Crit Care Med. 2012;40:2022–32.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Mikkelsen ME, Christie JD, Lanken PN, et al. The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med. 2012;185:1307–15.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369:1306–16.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Sukantarat KT, Burgess PW, Williamson RC, Brett SJ. Prolonged cognitive dysfunction in survivors of critical illness. Anaesthesia. 2005;60:847–53.PubMedGoogle Scholar
  15. 15.
    Hopkins RO, Gale SD, Weaver LK. Brain atrophy and cognitive impairment in survivors of acute respiratory distress syndrome. Brain Inj. 2006;20:263–71.PubMedGoogle Scholar
  16. 16.
    Morandi A, Rogers BP, Gunther ML, et al. The relationship between delirium duration, white matter integrity, and cognitive impairment in intensive care unit survivors as determined by diffusion tensor imaging: the visions prospective cohort magnetic resonance imaging study. Crit Care Med. 2012;40:2182–9.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Siegel MD, Hayes E, Vanderwerker LC, Loseth DB, Prigerson HG. Psychiatric illness in the next of kin of patients who die in the intensive care unit. Crit Care Med. 2008;36:1722–8.PubMedGoogle Scholar
  18. 18.
    Gries CJ, Engelberg RA, Kross EK, et al. Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU. Chest. 2010;137:280–7.PubMedGoogle Scholar
  19. 19.
    Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome-family. Crit Care Med. 2012;40:618–24.PubMedGoogle Scholar
  20. 20.
    Petrinec AB, Martin BR. Post-intensive care syndrome symptoms and health-related quality of life in family decision-makers of critically ill patients. Palliat Support Care. 2018;16(6):719–24.PubMedGoogle Scholar
  21. 21.
    Davydow DS, Hough CL, Langa KM, Iwashyna TJ. Depressive symptoms in spouses of older patients with severe sepsis. Crit Care Med. 2012;40:2335–41.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Wintermann GB, Weidner K, Strauss B, Rosendahl J, Petrowski K. Predictors of posttraumatic stress and quality of life in family members of chronically critically ill patients after intensive care. Ann Intensive Care. 2016;6:69.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Yehuda R. Post-traumatic stress disorder. N Engl J Med. 2002;346:108–14.PubMedGoogle Scholar
  24. 24.
    van Beusekom I, Bakhshi-Raiez F, de Keizer NF, Dongelmans DA, van der Schaaf M. Reported burden on informal caregivers of ICU survivors: a literature review. Crit Care. 2016;20:16.PubMedPubMedCentralGoogle Scholar
  25. 25.
    van den Born-van Zanten SA, Dongelmans DA, Dettling-Ihnenfeldt D, Vink R, van der Schaaf M. Caregiver strain and posttraumatic stress symptoms of informal caregivers of intensive care unit survivors. Rehabil Psychol. 2016;61:173–8.PubMedGoogle Scholar
  26. 26.
    Choi J, Donahoe MP, Hoffman LA. Psychological and physical health in family caregivers of intensive care unit survivors: current knowledge and future research strategies. J Korean Acad Nurs. 2016;46:159–67.PubMedGoogle Scholar
  27. 27.
    Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry. 2008;30:421–34.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Davydow DS, Katon WJ, Zatzick DF. Psychiatric morbidity and functional impairments in survivors of burns, traumatic injuries, and ICU stays for other critical illnesses: a review of the literature. Int Rev Psychiatry. 2009;21:531–8.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Myhren H, Ekeberg O, Toien K, Karlsson S, Stokland O. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care. 2010;14:R14.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Chung CR, Yoo HJ, Park J, Ryu S. Cognitive impairment and psychological distress at discharge from intensive care unit. Psychiatry Investig. 2017;14:376–9.PubMedPubMedCentralGoogle Scholar
  31. 31.
    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;43:1121–9.PubMedGoogle Scholar
  32. 32.
    Zimmerli M, Tisljar K, Balestra GM, Langewitz W, Marsch S, Hunziker S. Prevalence and risk factors for post-traumatic stress disorder in relatives of out-of-hospital cardiac arrest patients. Resuscitation. 2014;85:801–8.PubMedGoogle Scholar
  33. 33.
    Choi KW, Shaffer KM, Zale EL, et al. Early risk and resiliency factors predict chronic posttraumatic stress disorder in caregivers of patients admitted to a neuroscience ICU. Crit Care Med. 2018;46:713–9.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Dowdy DW, Dinglas V, Mendez-Tellez PA, et al. Intensive care unit hypoglycemia predicts depression during early recovery from acute lung injury. Crit Care Med. 2008;36:2726–33.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Hopkins RO, Key CW, Suchyta MR, Weaver LK, Orme JF Jr. Risk factors for depression and anxiety in survivors of acute respiratory distress syndrome. Gen Hosp Psychiatry. 2010;32:147–55.PubMedGoogle Scholar
  36. 36.
    Paparrigopoulos T, Melissaki A, Tzavellas E, Karaiskos D, Ilias I, Kokras N. Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: a two-year follow-up study. Int J Psychiatry Clin Pract. 2014;18:25–31.PubMedGoogle Scholar
  37. 37.
    Adhikari NKJ, Tansey CM, McAndrews MP, et al. Self-reported depressive symptoms and memory complaints in survivors five years after ARDS. Chest. 2011;140:1484–93.PubMedGoogle Scholar
  38. 38.
    Jackson JC, Archer KR, Bauer R, et al. A prospective investigation of long-term cognitive impairment and psychological distress in moderately versus severely injured trauma intensive care unit survivors without intracranial hemorrhage. J Trauma. 2011;71:860–6.PubMedGoogle Scholar
  39. 39.
    Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62:617–27.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Girard TD, Shintani AK, Jackson JC, et al. Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study. Crit Care. 2007;11:R28.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Cuthbertson BH, Hull A, Strachan M, Scott J. Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med. 2004;30:450–5.PubMedGoogle Scholar
  42. 42.
    Jones C, Backman C, Capuzzo M, Flaatten H, Rylander C, Griffiths RD. Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med. 2007;33:978–85.PubMedGoogle Scholar
  43. 43.
    Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304:1787–94.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Davis DH, Muniz Terrera G, Keage H, et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain. 2012;135:2809–16.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Akerman E, Granberg-Axell A, Ersson A, Fridlund B, Bergbom I. Use and practice of patient diaries in Swedish intensive care units: a national survey. Nurs Crit Care. 2010;15:26–33.PubMedGoogle Scholar
  46. 46.
    Egerod I, Christensen D. Analysis of patient diaries in Danish ICUs: a narrative approach. Intensive Crit Care Nurs. 2009;25:268–77.PubMedGoogle Scholar
  47. 47.
    Jones C, Backman C, Capuzzo M, et al. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care. 2010;14:R168.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Kredentser MS, Blouw M, Marten N, et al. Preventing posttraumatic stress in ICU survivors: a single-center pilot randomized controlled trial of ICU diaries and psychoeducation. Crit Care Med. 2018;46:1914–22.PubMedGoogle Scholar
  49. 49.
    McIlroy PA, King RS, Garrouste-Orgeas M, Tabah A, Ramanan M. The effect of ICU diaries on psychological outcomes and quality of life of survivors of critical illness and their relatives: a systematic review and meta-analysis. Crit Care Med. 2019;47:273–9.PubMedGoogle Scholar
  50. 50.
    Garrouste-Orgeas M, Flahault C, Fasse L, et al. The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs. Trials. 2017;18:542.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Jones C, Griffiths RD, Humphris G, Skirrow PM. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med. 2001;29:573–80.PubMedGoogle Scholar
  52. 52.
    Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471–7.PubMedGoogle Scholar
  53. 53.
    Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263–306.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Samuelson KA, Lundberg D, Fridlund B. Stressful memories and psychological distress in adult mechanically ventilated intensive care patients–a 2-month follow-up study. Acta Anaesthesiol Scand. 2007;51:671–8.PubMedGoogle Scholar
  55. 55.
    Kress JP, Gehlbach B, Lacy M, Pliskin N, Pohlman AS, Hall JB. The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med. 2003;168:1457–61.PubMedGoogle Scholar
  56. 56.
    Rattray JE, Johnston M, Wildsmith JA. Predictors of emotional outcomes of intensive care. Anaesthesia. 2005;60:1085–92.PubMedGoogle Scholar
  57. 57.
    Delavaran H, Jonsson AC, Lovkvist H, et al. Cognitive function in stroke survivors: a 10-year follow-up study. Acta Neurol Scand. 2017;136:187–94.PubMedGoogle Scholar
  58. 58.
    White JH, Attia J, Sturm J, Carter G, Magin P. Predictors of depression and anxiety in community dwelling stroke survivors: a cohort study. Disabil Rehabil. 2014;36:1975–82.PubMedGoogle Scholar
  59. 59.
    Power KN, Gramstad A, Gilhus NE, Hufthammer KO, Engelsen BA. Cognitive function after status epilepticus versus after multiple generalized tonic-clonic seizures. Epilepsy Res. 2018;140:39–45.PubMedGoogle Scholar
  60. 60.
    Power KN, Gramstad A, Gilhus NE, Engelsen BA. Adult nonconvulsive status epilepticus in a clinical setting: Semiology, aetiology, treatment and outcome. Seizure. 2015;24:102–6.PubMedGoogle Scholar
  61. 61.
    McKenna A, Wilson FC, Caldwell S, Curran D, Nagaria J, Convery F. Long-term neuropsychological and psychosocial outcomes of decompressive hemicraniectomy following malignant middle cerebral artery infarctions. Disabil Rehabil. 2012;34:1444–55.PubMedGoogle Scholar
  62. 62.
    Leonhardt G, Wilhelm H, Doerfler A, et al. Clinical outcome and neuropsychological deficits after right decompressive hemicraniectomy in MCA infarction. J Neurol. 2002;249:1433–40.PubMedGoogle Scholar
  63. 63.
    Christensen MC, Mayer SA, Ferran JM, Kissela B. Depressed mood after intracerebral hemorrhage: the FAST trial. Cerebrovasc Dis. 2009;27:353–60.PubMedGoogle Scholar
  64. 64.
    Garcia PY, Roussel M, Bugnicourt JM, et al. Cognitive impairment and dementia after intracerebral hemorrhage: a cross-sectional study of a hospital-based series. J Stroke Cerebrovasc Dis. 2013;22:80–6.PubMedGoogle Scholar
  65. 65.
    Rosenthal LJ, Francis BA, Beaumont JL, et al. Agitation, delirium, and cognitive outcomes in intracerebral hemorrhage. Psychosomatics. 2017;58:19–27.PubMedGoogle Scholar
  66. 66.
    Benedictus MR, Hochart A, Rossi C, et al. Prognostic factors for cognitive decline after intracerebral hemorrhage. Stroke. 2015;46:2773–8.PubMedGoogle Scholar
  67. 67.
    Biffi A, Bailey D, Anderson CD, et al. Risk factors associated with early versus delayed dementia after intracerebral hemorrhage. JAMA Neurol. 2016;73:969–76.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Passier PE, Visser-Meily JM, van Zandvoort MJ, Post MW, Rinkel GJ, van Heugten C. Prevalence and determinants of cognitive complaints after aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis. 2010;29:557–63.PubMedGoogle Scholar
  69. 69.
    Boerboom W, Heijenbrok-Kal MH, Khajeh L, van Kooten F, Ribbers GM. Differences in cognitive and emotional outcomes between patients with perimesencephalic and aneurysmal subarachnoid haemorrhage. J Rehabil Med. 2014;46:28–32.PubMedGoogle Scholar
  70. 70.
    Eagles ME, Tso MK, Macdonald RL. Cognitive impairment, functional outcome and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. World Neurosurg. 2019. Scholar
  71. 71.
    Mukerji N, Holliman D, Baisch S, Noble A, Schenk T, Nath F. Neuropsychologic impact of treatment modalities in subarachnoid hemorrhage: clipping is no different from coiling. World Neurosurg. 2010;74:129–38.PubMedGoogle Scholar
  72. 72.
    Scott RB, Eccles F, Molyneux AJ, Kerr RS, Rothwell PM, Carpenter K. Improved cognitive outcomes with endovascular coiling of ruptured intracranial aneurysms: neuropsychological outcomes from the International Subarachnoid Aneurysm Trial (ISAT). Stroke. 2010;41:1743–7.PubMedGoogle Scholar
  73. 73.
    Bornstein RA, Weir BK, Petruk KC, Disney LB. Neuropsychological function in patients after subarachnoid hemorrhage. Neurosurgery. 1987;21:651–4.PubMedGoogle Scholar
  74. 74.
    Samra SK, Giordani B, Caveney AF, et al. Recovery of cognitive function after surgery for aneurysmal subarachnoid hemorrhage. Stroke. 2007;38:1864–72.PubMedGoogle Scholar
  75. 75.
    Boerboom W, Heijenbrok-Kal MH, van Kooten F, Khajeh L, Ribbers GM. Unmet needs, community integration and employment status four years after subarachnoid haemorrhage. J Rehabil Med. 2016;48:529–34.PubMedGoogle Scholar
  76. 76.
    von Vogelsang AC, Forsberg C, Svensson M, Wengstrom Y. Patients experience high levels of anxiety 2 years following aneurysmal subarachnoid hemorrhage. World Neurosurg. 2015;83:1090–7.Google Scholar
  77. 77.
    Chahal N, Barker-Collo S, Feigin V. Cognitive and functional outcomes of 5-year subarachnoid haemorrhage survivors: comparison to matched healthy controls. Neuroepidemiology. 2011;37:31–8.PubMedGoogle Scholar
  78. 78.
    Visser-Meily JM, Rhebergen ML, Rinkel GJ, van Zandvoort MJ, Post MW. Long-term health-related quality of life after aneurysmal subarachnoid hemorrhage: relationship with psychological symptoms and personality characteristics. Stroke. 2009;40:1526–9.PubMedGoogle Scholar
  79. 79.
    Noble AJ, Baisch S, Mendelow AD, Allen L, Kane P, Schenk T. Posttraumatic stress disorder explains reduced quality of life in subarachnoid hemorrhage patients in both the short and long term. Neurosurgery. 2008;63:1095–104 discussion 04–5.PubMedGoogle Scholar
  80. 80.
    Alfieri A, Gazzeri R, Pircher M, Unterhuber V, Schwarz A. A prospective long-term study of return to work after nontraumatic nonaneurysmal subarachnoid hemorrhage. J Clin Neurosci. 2011;18:1478–80.PubMedGoogle Scholar
  81. 81.
    Boerboom W, van Zandvoort MJ, van Kooten F, et al. Long-term fatigue after perimesencephalic subarachnoid haemorrhage in relation to cognitive functioning, mood and comorbidity. Disabil Rehabil. 2017;39:928–33.PubMedGoogle Scholar
  82. 82.
    Di Paola M, Phillips O, Costa A, et al. Selective cognitive dysfunction is related to a specific pattern of cerebral damage in persons with severe traumatic brain injury. J Head Trauma Rehabil. 2015;30:402–10.PubMedGoogle Scholar
  83. 83.
    Hart T, Hoffman JM, Pretz C, Kennedy R, Clark AN, Brenner LA. A longitudinal study of major and minor depression following traumatic brain injury. Arch Phys Med Rehabil. 2012;93:1343–9.PubMedGoogle Scholar
  84. 84.
    de la Marquez Plata CD, Hart T, Hammond FM, et al. Impact of age on long-term recovery from traumatic brain injury. Arch Phys Med Rehabil. 2008;89:896–903.Google Scholar
  85. 85.
    Jourdan C, Bayen E, Pradat-Diehl P, et al. A comprehensive picture of 4-year outcome of severe brain injuries. Results from the PariS-TBI study. Ann Phys Rehabil Med. 2016;59:100–6.PubMedGoogle Scholar
  86. 86.
    Ruet A, Jourdan C, Bayen E, et al. Employment outcome four years after a severe traumatic brain injury: results of the Paris severe traumatic brain injury study. Disabil Rehabil. 2018;40:2200–7.PubMedGoogle Scholar
  87. 87.
    Al-Mufti F, Claassen J. Neurocritical care: status epilepticus review. Crit Care Clin. 2014;30:751–64.PubMedGoogle Scholar
  88. 88.
    Freeman WD. Management of intracranial pressure. continuum (Minneap Minn). 2015;21:1299–323.Google Scholar
  89. 89.
    Hocker SE. Status epilepticus. Continuum (Minneap Minn). 2015;21:1362–83.Google Scholar
  90. 90.
    Schmidt KJ, Doshi MR, Holzhausen JM, Natavio A, Cadiz M, Winegardner JE. Treatment of severe alcohol withdrawal. Ann Pharmacother. 2016;50:389–401.PubMedGoogle Scholar
  91. 91.
    Devlin JW, Skrobik Y, Gelinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46:e825–73.PubMedGoogle Scholar
  92. 92.
    Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit: executive summary. Am J Health Syst Pharm. 2013;70:53–8.PubMedGoogle Scholar
  93. 93.
    Figueroa-Ramos MI, Arroyo-Novoa CM, Lee KA, Padilla G, Puntillo KA. Sleep and delirium in ICU patients: a review of mechanisms and manifestations. Intensive Care Med. 2009;35:781–95.PubMedGoogle Scholar
  94. 94.
    Fuke R, Hifumi T, Kondo Y, et al. Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: a systematic review and meta-analysis. BMJ Open. 2018;8:e019998.PubMedPubMedCentralGoogle Scholar
  95. 95.
    Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012;23:5–13.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil. 2013;94:551–61.PubMedGoogle Scholar
  97. 97.
    Hopkins RO, Mitchell L, Thomsen GE, Schafer M, Link M, Brown SM. Implementing a mobility program to minimize post-intensive care syndrome. AACN Adv Crit Care. 2016;27:187–203.PubMedGoogle Scholar
  98. 98.
    Parker A, Sricharoenchai T, Needham DM. Early rehabilitation in the intensive care unit: preventing physical and mental health impairments. Curr Phys Med Rehabil Rep. 2013;1:307–14.PubMedPubMedCentralGoogle Scholar
  99. 99.
    Shaffer KM, Jacobs JM, Coleman JN, et al. Anxiety and depressive symptoms among two seriously medically Ill populations and their family caregivers: a comparison and clinical implications. Neurocrit Care. 2017;27:180–6.PubMedPubMedCentralGoogle Scholar
  100. 100.
    Hwang DY, Yagoda D, Perrey HM, et al. Anxiety and depression symptoms among families of adult intensive care unit survivors immediately following brief length of stay. J Crit Care. 2014;29:278–82.PubMedGoogle Scholar
  101. 101.
    Shaffer KM, Riklin E, Jacobs JM, Rosand J, Vranceanu AM. Psychosocial resiliency is associated with lower emotional distress among dyads of patients and their informal caregivers in the neuroscience intensive care unit. J Crit Care. 2016;36:154–9.PubMedGoogle Scholar
  102. 102.
    Trevick SA, Lord AS. Post-traumatic stress disorder and complicated grief are common in caregivers of neuro-ICU patients. Neurocrit Care. 2017;26:436–43.PubMedGoogle Scholar
  103. 103.
    Shaffer KM, Riklin E, Jacobs JM, Rosand J, Vranceanu AM. Mindfulness and coping are inversely related to psychiatric symptoms in patients and informal caregivers in the neuroscience ICU: implications for clinical care. Crit Care Med. 2016;44:2028–36.PubMedPubMedCentralGoogle Scholar
  104. 104.
    McCurley JL, Funes CJ, Zale EL, et al. Preventing chronic emotional distress in stroke survivors and their informal caregivers. Neurocrit Care. 2018;30(3):581–9.Google Scholar
  105. 105.
    Hwang D, Yagoda D, Perrey H, et al. Assessment of satisfaction with care among family members of survivors in a neuroscience intensive care unit. J Neurosci Nurs. 2014;46:106–16.PubMedPubMedCentralGoogle Scholar
  106. 106.
    Quinn T, Moskowitz J, Khan MW, et al. What families need and physicians deliver: contrasting communication preferences between surrogate decision-makers and physicians during outcome prognostication in critically Ill TBI patients. Neurocrit Care. 2017;27:154–62.PubMedPubMedCentralGoogle Scholar
  107. 107.
    Muehlschlegel S, Shutter L, Col N, Goldberg R. Decision aids and shared decision-making in neurocritical care: an unmet need in our neuroICUs. Neurocrit Care. 2015;23:127–30.PubMedPubMedCentralGoogle Scholar
  108. 108.
    Khan MW, Muehlschlegel S. Shared decision making in neurocritical care. Neurosurg Clin N Am. 2018;29:315–21.PubMedPubMedCentralGoogle Scholar
  109. 109.
    Hwang DY. Caring for patients’ families (or lack of family) in neurocritical care. Neurocrit Care. 2017;27:151–3.PubMedGoogle Scholar
  110. 110.
    Wade DM, Mouncey PR, Richards-Belle A, et al. Effect of a nurse-led preventive psychological intervention on symptoms of posttraumatic stress disorder among critically Ill patients: a randomized clinical trial. JAMA. 2019;321:665–75.PubMedPubMedCentralGoogle Scholar
  111. 111.
    Harvey MA. The truth about consequences–post-intensive care syndrome in intensive care unit survivors and their families. Crit Care Med. 2012;40:2506–7.PubMedGoogle Scholar
  112. 112.
    Scientific Program Joint Meeting DGNI & NCS. 2018. Accessed 9 Feb 2018.
  113. 113.
    Bautista CA, Nydahl P, Bader MK, Livesay S, Cassier-Woidasky AK, Olson DM. Executive summary: post-intensive care syndrome in the neurocritical intensive care unit. J Neurosci Nurs. 2019;51(4):158–61.PubMedGoogle Scholar
  114. 114.
    Elliott D, Davidson JE, Harvey MA, et al. 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;42:2518–26.PubMedGoogle Scholar
  115. 115.
    Gilmore EJ, Gaspard N, Choi HA, et al. Acute brain failure in severe sepsis: a prospective study in the medical intensive care unit utilizing continuous EEG monitoring. Intensive Care Med. 2015;41:686–94.PubMedGoogle Scholar
  116. 116.
    Semmler A, Widmann CN, Okulla T, et al. Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors. J Neurol Neurosurg Psychiatry. 2013;84:62–9.PubMedGoogle Scholar
  117. 117.
    Morandi A, Brummel NE, Ely EW. Sedation, delirium and mechanical ventilation: the ‘ABCDE’ approach. Curr Opin Crit Care. 2011;17:43–9.PubMedGoogle Scholar
  118. 118.
    Nedergaard HK, Jensen HI, Stylsvig M, Lauridsen JT, Toft P. Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation—effects on long-term cognitive function: study protocol for a randomized controlled trial, a substudy of the NONSEDA trial. Trials. 2016;17:269.PubMedPubMedCentralGoogle Scholar
  119. 119.
    O’Connor MF, Nunnally ME. Expect the unexpected: clinical trials are key to understanding post-intensive care syndrome. Crit Care. 2013;17:149.PubMedPubMedCentralGoogle Scholar
  120. 120.
    Clancy O, Edginton T, Casarin A, Vizcaychipi MP. The psychological and neurocognitive consequences of critical illness. A pragmatic review of current evidence. J Intensive Care Soc. 2015;16:226–33.PubMedPubMedCentralGoogle Scholar
  121. 121.
    Castillo MI, Aitken LM, Cooke ML. Adverse outcomes of critical illness from a dyadic perspective. Aust Crit Care. 2014;27:195–7.PubMedGoogle Scholar
  122. 122.
    Hinojosa MS, Rittman MR. Stroke caregiver information needs: comparison of Mainland and Puerto Rican caregivers. J Rehabil Res Dev. 2007;44:649–58.PubMedGoogle Scholar
  123. 123.
    Schubart JR, Kinzie MB, Farace E. Caring for the brain tumor patient: family caregiver burden and unmet needs. Neuro Oncol. 2008;10:61–72.PubMedPubMedCentralGoogle Scholar
  124. 124.
    Perrin PB, Heesacker M, Hinojosa MS, Uthe CE, Rittman MR. Identifying at-risk, ethnically diverse stroke caregivers for counseling: a longitudinal study of mental health. Rehabil Psychol. 2009;54:138–49.PubMedGoogle Scholar
  125. 125.
    Palmer S, Glass TA. Family function and stroke recovery: a review. Rehabilit Psychol. 2003;48:255–65.Google Scholar
  126. 126.
    Martire LM, Stephens MA, Druley JA, Wojno WC. Negative reactions to received spousal care: predictors and consequences of miscarried support. Health Psychol. 2002;21:167–76.PubMedGoogle Scholar
  127. 127.
    Newsom JT, Schulz R. Caregiving from the recipient’s perspective: negative reactions to being helped. Health Psychol. 1998;17:172–81.PubMedGoogle Scholar
  128. 128.
    Williamson GM, Shaffer DR. Relationship quality and potentially harmful behaviors by spousal caregivers: how we were then, how we are now. The family relationships in late life project. Psychol Aging. 2001;16:217–26.PubMedGoogle Scholar
  129. 129.
    Chio A, Gauthier A, Calvo A, Ghiglione P, Mutani R. Caregiver burden and patients’ perception of being a burden in ALS. Neurology. 2005;64:1780–2.PubMedGoogle Scholar
  130. 130.
    Thommessen B, Aarsland D, Braekhus A, Oksengaard AR, Engedal K, Laake K. The psychosocial burden on spouses of the elderly with stroke, dementia and Parkinson’s disease. Int J Geriatr Psychiatry. 2002;17:78–84.PubMedGoogle Scholar
  131. 131.
    Clyburn LD, Stones MJ, Hadjistavropoulos T, Tuokko H. Predicting caregiver burden and depression in Alzheimer’s disease. J Gerontol B Psychol Sci Soc Sci. 2000;55:S2–13.PubMedGoogle Scholar
  132. 132.
    Jiang W, Alexander J, Christopher E, et al. Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med. 2001;161:1849–56.PubMedGoogle Scholar
  133. 133.
    Karmilovich SE. Burden and stress associated with spousal caregiving for individuals with heart failure. Prog Cardiovasc Nurs. 1994;9:33–8.PubMedGoogle Scholar
  134. 134.
    Bakas T, Clark PC, Kelly-Hayes M, et al. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke. 2014;45:2836–52.PubMedGoogle Scholar
  135. 135.
    Bakas T, McCarthy M, Miller E. Update on the state of the evidence for stroke family caregiver and dyad interventions. Stroke. 2017;48:e122–5.PubMedPubMedCentralGoogle Scholar
  136. 136.
    Meyers E, McCurley J, Lin A, et al. Building resiliency in dyads of patients admitted to the Neuroscience Intensive Care Unit and their family caregivers: Lessons learned from William and Laura. Cognitive Behavioral Practice In Submission.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019

Authors and Affiliations

  1. 1.Division of Neurocritical Care, Department of NeurosciencesUniversity of California—San DiegoLa JollaUSA
  2. 2.Division of Neurocritical Care and Emergency NeurologyMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Henry and Allison McCance Center for Brain Health, Massachusetts General HospitalBostonUSA
  4. 4.Integrated Brain Health Clinical and Research Program, Department of PsychiatryMassachusetts General Hospital and Harvard Medical SchoolBostonUSA

Personalised recommendations