Surviving the ICU alone does not equate to recovery. As advancements in critical care continue to improve ICU survival, attention has shifted toward lingering impairments among survivors, described as post-intensive care syndrome (PICS)—a spectrum of physical, cognitive, and psychological impairments that can persist for months to years following ICU discharge.1
The burden of PICS is significant, affecting an estimated 50% to 80% of ICU survivors with at least one domain of impairment.2 Physical impairments often include ICU-acquired weakness and reduced mobility, largely due to prolonged immobility, systemic inflammation, and medication side effects. Cognitive symptoms include memory loss, issues with attention, and executive dysfunction. Psychiatric conditions such as depression, anxiety, and post-traumatic stress disorder are frequently reported.3 PICS may affect families as well, contributing to caregiver burden, anxiety, and depression—a phenomenon termed PICS-Family, or PICS-F.
A key challenge is that these impairments often go unrecognized and diagnosis remains challenging, as these symptoms often emerge after hospital discharge and may be misattributed to age-related decline or preexisting medical conditions. Significant risk factors include sepsis, prolonged mechanical ventilation, sedation, and delirium.3 Also, a patient’s condition pre-ICU admission can greatly influence both their hospital course and post-ICU recovery, with frailty often predicting comparable or worse outcomes.4
Preventative measures during ICU care remain critical. The ABCDEF bundle—addressing pain, spontaneous awakening and breathing trials, sedation choice, delirium management, early mobility, and family engagement—has become standard in improving short- and long-term outcomes.2 Sedation minimization, especially benzodiazepines, reduces the risk of delirium and long-term cognitive deficits. Early mobility protocols within the ICU are essential for preserving muscle function and reducing hospital length of stay.1
Post-discharge care models are beginning to address these gaps. Multidisciplinary post-ICU recovery clinics have shown promise in helping patients regain function and receive follow-up care, often involving intensivists, physical therapists, mental health professionals, and primary care providers. However, access remains limited and inconsistent across health systems.3
Evidence continues to grow supporting targeted, nonpharmacologic interventions. A systematic review and meta-analysis of 36 studies involving 5,165 patients categorized interventions into early mobilization/physical rehabilitation (56%), post-ICU follow-up (14%), psychosocial programs (8%), ICU diaries (8%), and education (6%). Although many interventions showed trends toward benefit, statistically significant improvements were primarily found in two areas: ICU diaries and structured exercise. ICU diaries significantly reduced depression (SMD 0.68; 95% CI, 0.14–1.21) and anxiety (SMD 0.44; 95% CI, 0.01–0.87). Exercise-based interventions led to improvements in mental health scores (SMD 2.62; 95% CI, 0.92–4.32).5
Education and expectation-setting also play an essential role in recovery. Patients and families should be informed early that recovery may be prolonged and nonlinear. Simple interventions such as journaling, peer support groups, and early mental health referrals can make a meaningful difference.4
As we shift from a survival-focused paradigm to one that embraces recovery and restoration, addressing PICS must become a routine component of ICU care. Early recognition, proactive prevention, and continued post-discharge multidisciplinary clinic care are crucial to supporting the long-term well-being of ICU survivors and their families.
References
1. Smith S, Rahman O. Postintensive care syndrome. StatPearls. StatPearls Publishing; 2025.
2. Schwitzer E, Jensen KS, Brinkman L, et al. Survival ≠ recovery: a narrative review of post-intensive care syndrome. CHEST Critical Care. 2023;1(1):100003. doi:10.1016/j.chstcc.2023.100003
3. Hiser SL, Fatima A, Ali M, Needham DM. Post-intensive care syndrome (PICS): recent updates. J Intensive Care. 2023;11(1):23. doi:10.1186/s40560-023-00670-7
4. Mikkelsen M, Still M, Anderson B, et al. Society of Critical Care Medicine’s International Consensus Conference on Prediction and Identification of Long-Term Impairments After Critical Illness. Crit Care Med. 2020;48(11):1670-1679. doi:10.1097/CCM.0000000000004586
5. Geense WW, van den Boogaard M, van der Hoeven JG, Vermeulen H, Hannink G, Zegers M. Nonpharmacologic interventions to prevent or mitigate adverse long-term outcomes among ICU survivors: a systematic review and meta-analysis. Crit Care Med. 2019;47(11):1607-1618. doi:10.1097/CCM.0000000000003974
