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Objective-To assess the feasibility and efficacy of implementing "Family Care Rituals" as a means of engaging family members in the care of patients admitted to the ICU with a high risk of ICU mortality on outcomes including stress related symptoms in family members. Design-Prospective, before-and-after intervention evaluationSetting-2 United States academic medical ICU's, and 1 Italian academic medical/surgical ICU Participants-Family members of patients who had an attending predicted ICU mortality of greater than 30% within the first 24 hours of admission.

Failure to respond within the first few days of empirical treatment may be due to antibiotic resistance or inadequate doses. Therefore the same rigor should be applied to achieving adequate antibiotic concentrations as is applied to inotropes, which are titrated to achieve predetermined physiological targets.