Families in the Intensive Care Unit: A Guide to Understanding, Engaging, and Supporting at the Bedside

Abstract

Since its inception, critical care medicine has seen tremendous clinical and scientific progress, with measurable benefits to morbidity and mortality. As more patients survive to discharge from an intensive care unit (ICU), insights have been gained on the serious and complex long-term consequences of critical illness. Patients do not exist in isolation. Many are spouses, parents, and children of individuals who are suffering alongside. The intensive care and treatment provided for patients in a critically ill state have real and measurable effects on loved ones. Unfortunately, these aspects can be overlooked in the busy environment of an ICU, where attention and many resources are focused on complex diagnostic and therapeutic modalities. This observation led to the creation of Families in the Intensive Care Unit, edited by Giora Netzer, associate professor of medicine and epidemiology at the University of Maryland School of Medicine, and an experienced critical care physician who has dedicated particular attention to patient and caregiver experiences in such a setting. This is a welcome book that aims to address the way intensive care medicine is practiced and the profound effects it can have on those closest to the patient. Although our understanding of the subject has gained new insights in recent years, resources available to understand and interact with families in the ICU have been relatively limited and spread across journals, position statements, and guidelines, many of which are institution specific. In Families in the Intensive Care Unit, Dr Netzer has compiled a thoroughly comprehensive collection from international experts to fulfill the goal to “describe what families are going through, what mechanisms may be guiding their suffering, how we rise up to this great and noble challenge now, and how we may continue to rise up to meet it.” The overarching approach and style of this textbook are very clear and effective. It is divided into 28 chapters detailing specific aspects of a family member’s journey as their loved one is in intensive care. It begins with a personal vignette from a real-life experience to help illustrate intensive care from the point of view of a suffering individual. The next few chapters address the cognitive biases experienced by both intensivist and patient families when coming to a decision about a care plan. In these chapters and throughout the book, the authors define and characterize the physiological, psychological, practical, and emotional aspects of family ICU syndrome (FICUS) and its risk factors. Individual chapters address specific aspects of this complex syndrome and how to manage it from a multidisciplinary perspective. Subsequent chapters address post-ICU syndrome-family (PICS-F), highlighting that the suffering is far from over for the patient and family after discharge from ICU. This emerges as a fundamental concept to incorporate in critical care, as perhaps too often we tend to measure the impact of our decisions on the timescale of minutes, hours, or days, when in fact these can have an impact months and years down the line. A dedicated chapter addresses specifically the nuances of the pediatric critical care experience; however, most issues explored in this book can be generalized to both adult and pediatric critical care. The book then delves into the role of each member of the multidisciplinary health team and their role in supporting families in the ICU, including pharmacists, respiratory therapists, social workers, spiritual care providers, and ethicists. Finally, in such a novel, expanding, and evolving field of critical care medicine is a valuable chapter included suggesting research directions and approaches to gain further insight into FICUS. Families in the Intensive Care Unit can and should be read by health care professionals at any stage in their critical care career. This textbook is well written, and appropriately to the subject matter, each chapter strikes a perfect balance between being humanistic and technical. By raising awareness of cognitive biases and patterns, and the characteristics of FICUS and PICS-F, this textbook can help inform and effect intensivists’ decisions and behavior. Whether this leads to large- or small-scale change at either the individual or organizational level, it brings opportunities to have a significant and positive impact on the families of ICU patients. Alexander White, MDDepartment of AnesthesiaUniversity of TorontoToronto, Ontario, CanadaDepartment of Anesthesia and Pain ManagementToronto General HospitalToronto, Ontario, Canada Matteo Parotto, MD, PhDDepartment of AnesthesiaUniversity of TorontoToronto, Ontario, CanadaDepartment of Anesthesia and Pain ManagementToronto General HospitalToronto, Ontario, CanadaInterdepartmental Division of Critical Care MedicineUniversity of TorontoToronto, Ontario, Canada[email protected]