title: Understanding, recognizing, and managing chronic critical illness syndrome.
abstract: OBJECTIVE
  No evidence-based guidelines exist for the care of patients with chronic critical illness syndrome (CCIS), a growing population of patients being cared for by nurse practitioners (NPs). The purpose of this article is to provide NPs with a beginning physiological framework, allostasis, to guide their understanding and management of patients with CCIS.
  
  
  METHODS
  Scientific publications, related clinical guidelines.
  
  
  CONCLUSIONS
  Patients with CCIS are a distinct group of critically ill patients whose care needs are different from those of patients who are acutely critically ill. These patients demonstrate widespread tissue and organ damage. The widespread tissue and organ damage results in a syndrome of interrelated elements, which include neuroendocrine problems, severe malnutrition, wounds, infections, bone loss, polyneuropathy and myopathy, delirium and depression, and suffering.
  
  
  CONCLUSIONS
  In caring for patients with CCIS, NPs need to focus on treating the elements of the syndrome as a cohort of interrelated elements and on re-establishing normalcy for the patient.
authors.affiliation: College of Health Professions, University of Detroit Mercy, Detroit, Michigan, USA. bellaran@udmercy.edu
authors.forename: Ann
authors.initials: A
authors.lastname: Bellar
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kunkler
authors.forename: Mary
authors.initials: M
authors.lastname: Burkett
mesh_terms: D000210:Acute-Phase Reaction / Q000175:diagnosis* / Q000451:nursing; D000222:Adaptation, Physiological; D052636:Allostasis; D002908:Chronic Disease; D016638:Critical Illness; D006801:Humans; D044342:Malnutrition; D008660:Metabolism; D013312:Stress, Physiological; D013577:Syndrome