50th Anniversary ArticlesICU Survivorship—The Relationship of Delirium, Sedation, Dementia, and Acquired WeaknessMart, Matthew F. MD, MSCI1,2; Pun, Brenda T. DNP, RN, FCCM1,2; Pandharipande, Pratik MD, MSCI, FCCM2,3; Jackson, James C. PsyD1,2; Ely, E. Wesley MD, MPH, MCCM1,2,4–6Author Information 1 Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN. 2 Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN. 3 Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN. 4 The Institute for Medicine and Public Health, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN. 5 Veterans Affairs Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, TN. 6 The Institute for Medicine and Public Health, Vanderbilt Center for Quality Aging, Nashville, TN. Dr. Mart is currently receiving a grant (Arthur and Lisa Wheeler Critical Care Research Fund) from Vanderbilt University Medical Center as well as training support from National Institutes of Health (NIH) (National Heart, Lung, and Blood Institute [NHLBI] T32 HL087738). Dr. Mart’s institution received funding from the Arthur and Lisa Wheeler Critical Care Research Fund and the NHLBI; he received support for article research from the NIH. Dr. Pun is currently receiving grant funding from the NIH (NHLBI R01HL14678). Dr. Pun received funding from the Society of Critical Care Medicine and the NHLBI; she disclosed the off-label product use of Antipsychotics. Dr. Pandharipande is currently receiving a research grant from Pfizer, Inc. in collaboration with the NIH, and he has received grant support from the NIH (NHLBI R01 HL111111, National Institute on Aging (NIA) R01 AG058639, NIGMS R01 GM120484), the NIA, and the National Institute of General Medical Sciences (NIGMS). Dr. Jackson is currently receiving funding from the NIH, the NIA, the NHLBI (NIA R01 AG058639, NHLBI R01 HL111111), the Department of Defense, and the Department of Veterans Affairs Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC). Dr. Ely has received honoraria from Pfizer as lecturer of international continuing medical education meetings. He also acknowledges receiving funding from the NIH (NIA R01 AG058639, NIA K76 AG054864, NHLBI R01 HL111111, NIGMS R01 GM120484) and the Department of Veterans Affairs Tennessee Valley Health Care System GRECC and Orion. For information regarding this article, E-mail: [email protected] Critical Care Medicine: August 2021 - Volume 49 - Issue 8 - p 1227-1240 doi: 10.1097/CCM.0000000000005125 Buy Metrics Abstract The advent of modern critical care medicine has revolutionized care of the critically ill patient in the last 50 years. The Society of Critical Care Medicine (was formed in recognition of the challenges and need for specialized treatment for these fragile patients. As the specialty has grown, it has achieved impressive scientific advances that have reduced mortality and saved lives. With those advances, however, came growing recognition that the burden of critical illness did not end at the doorstep of the hospital. Delirium, once thought to be a mere by-product of critical illness, was found to be an independent predictor of mortality, prolonged mechanical ventilation, and long-lasting cognitive impairment. Similarly, deep sedation and immobility, so often used to keep patients “comfortable” and to facilitate mechanical ventilation and recovery, worsen mortality and lead to the development of ICU-acquired weakness. The realization that these outcomes are inextricably linked to one another and how we manage our patients has helped us recognize the need for culture change. We, as a specialty, now understand that although celebrating the successes of survival, we now also have a duty to focus on those who survive their diseases. Led by initiatives such as the ICU Liberation Campaign of the Society of Critical Care Medicine, the natural progression of the field is now focused on getting patients back to their homes and lives unencumbered by disability and impairment. Much work remains to be done, but the futures of our most critically ill patients will continue to benefit if we leverage and build on the history of our first 50 years. Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.