Rehabilitation and the post-intensive care syndrome across the recovery continuum: a narrative review
Abstract
Purpose Improved survival from critical illness has produced a growing population of intensive care unit (ICU) survivors with new or worsened physical, cognitive, and mental-health impairment, defined as post-intensive care syndrome (PICS), and frequent distress among families/caregivers (PICS-family, PICS-F). This narrative review synthesises the evidence in adults treated in high-resource settings. Methods Rather than a formal guideline process, we used a structured descriptive approach: for each recommendation, we identified the predominant study design, assessed the consistency of findings, summarised uncertainties, and assigned an evidence-strength label (high, moderate, low, or insufficient). Results We summarise the definition of PICS and its overlap with related constructs (post-sepsis morbidity, chronic critical illness, post-COVID conditions, and frailty); the mechanisms linking acute injury to persistent disability, including skeletal-muscle pathobiology, neuroinflammation, mitochondrial and neuroendocrine dysfunction, and epigenetic change; and the instruments assessing the three PICS core domains (recommending a two-step assessment approach), as well as quality of life, across the care continuum. We describe preventive and rehabilitative interventions from the ICU (e.g., the ABCDEF bundle that includes light/no sedation, delirium prevention, early mobilisation and family participation) through the ward to the post-hospital phase, the heterogeneous organisation of post-ICU recovery services, PICS-F, the educational and cultural change needed, and the health-system and policy context. PICS-F affects 20-60% of relatives; nurse-led family interventions seem promising. Conclusion The evidence base remains limited and heterogeneous, preventing firm recommendations. Research priorities include harmonised outcome measurement, phenotyping of recovery trajectories, the optimal dose and timing of rehabilitation, and rigorous comparison of follow-up models. Visual abstract
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Authors: Stefan J. Schaller, Teresa Cardoso, Sabrina Eggmann, Martina Hermann, Cheryl Hickmann, Rahel Naef, Margo van Mol, Simone Piva, Emilio Rodríguez‐Ruiz, Mahan Sadjadi, Akos Tiboldi, Greet Van den Berghe, Marion Wiegele, David McWilliams, Björn Weiß, on behalf of the ESICM PICS&Rehab Section
Institutions: Universidade do Porto, KU Leuven, University Hospital Münster, Monash University, University of Brescia, UCLouvain, Humboldt-Universität zu Berlin, Erasmus MC, University Hospital Zurich, University Hospital of Bern, Decision Sciences (United States), Medical University of Vienna, Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Ludwig Boltzmann Institute for Digital Health and Prevention, University of Mons, Instituto de Investigación Sanitaria de Santiago, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Universidade de Santiago de Compostela, Coventry University, Servicio Gallego de Salud, University Hospitals Coventry and Warwickshire NHS Trust, University Children's Hospital Zurich, Haute École Provinciale de Hainaut Condorcet, Hospital Padre Américo, The Geneva Association