Post-intensive care unit syndrome: the silent legacy of intensive care unit survival. Narrative review and strategies for its approach in intermediate respiratory care units
Abstract
Advances in intensive care have increased survival rates among critically ill patients but revealed a new challenge: post-intensive care syndrome (PICS). This syndrome, affecting patients’ physical, cognitive, and psychological well-being, also impacts their quality of life (QoL). Recognized in the early 21st century, PICS is now a research and clinical priority, particularly in specialized units like intermediate respiratory care units (IRCUs). This review aims to examine the evolution, clinical impact, and management strategies of PICS. A narrative review approach was utilized. A systematic search was conducted in biomedical databases (PubMed, Scopus, and Google Scholar), identifying relevant studies on PICS, its manifestations, risk factors, and therapeutic strategies. The review included original articles and clinical guidelines published between 2010 and 2024. The findings are organized into emerging themes: clinical manifestations, risk factors, diagnostic tools, management strategies, and the role of IRCUs. Each theme was analyzed to identify recurring patterns and gaps in the current knowledge base. IRCUs offer an ideal setting to address PICS-related sequelae, improving patients’ QoL and facilitating their social reintegration. However, ongoing research is essential to optimize therapeutic strategies and develop more effective care models.
Keywords
Ethics Approval
Institutional review board approval was not required for this study as only de-identified compliant data were used in the analysis.
References
- Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med 2012;40:502-9. DOI: https://doi.org/10.1097/CCM.0b013e318232da75
- Tejero-Aranguren J, García del Moral R, Poyatos-Aguilera ME, et al. Family burden after critical illness: the forgotten caregivers. Med Intensiva Engl Ed 2024;48:69-76. DOI: https://doi.org/10.1016/j.medin.2023.08.011
- Renner C, Jeitziner MM, Albert M, et al. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Crit Care 2023;27:301. DOI: https://doi.org/10.1186/s13054-023-04569-5
- López-Padilla D, Corral Blanco M, Ferrer Espinosa S, et al. Unidades de cuidados respiratorios intermedios: preguntas y respuestas. Open Respir Arch 2022;4:100220. DOI: https://doi.org/10.1016/j.opresp.2022.100220
- Wong G, Greenhalgh T, Westhorp G, et al. RAMESES publication standards: realist syntheses. J Adv Nurs 2013;69:1005-22. DOI: https://doi.org/10.1111/jan.12095
- Geense WW, Zegers M, Peters MAA, et al. New physical, mental, and cognitive problems 1 year after icu admission: a prospective multicenter study. Am J Respir Crit Care Med 2021;203:1512-21. DOI: https://doi.org/10.1164/rccm.202009-3381OC
- Kawakami D, Fujitani S, Morimoto T, et al. Prevalence of post-intensive care syndrome among japanese intensive care unit patients: a prospective, multicenter, observational j-pics study. Crit Care 2021;25:69. DOI: https://doi.org/10.1186/s13054-021-03501-z
- Lee M, Kang J, Jeong YJ. Risk factors for post–intensive care syndrome: a systematic review and meta-analysis. Aust Crit Care 2020;33:287-94. DOI: https://doi.org/10.1016/j.aucc.2019.10.004
- Hiser SL, Fatima A, Ali M, et al. Post-intensive care syndrome (pics): recent updates. J Intensive Care 2023;11:23. DOI: https://doi.org/10.1186/s40560-023-00670-7
- Brown SM, Wilson EL, Presson AP, et al. Understanding patient outcomes after acute respiratory distress syndrome: identifying subtypes of physical, cognitive and mental health outcomes. Thorax 2017;72:1094-103. DOI: https://doi.org/10.1136/thoraxjnl-2017-210337
- Heesakkers H, Van der Hoeven JG, Corsten S, et al. Clinical outcomes among patients with 1-year survival following intensive care unit treatment for covid-19. JAMA 2022;327:559-65. DOI: https://doi.org/10.1001/jama.2022.0040
- Evans RA, Leavy OC, Richardson M, et al. Clinical characteristics with inflammation profiling of long covid and association with 1-year recovery following hospitalisation in the uk: a prospective observational study. Lancet Respir Med 2022;10:761-75. DOI: https://doi.org/10.1016/S2213-2600(22)00127-8
- Hermans G, Van den Berghe G. Clinical review: intensive care unit acquired weakness. Crit Care 2015;19:274. DOI: https://doi.org/10.1186/s13054-015-0993-7
- Fazzini B, Märkl T, Costas C, et al. The rate and assessment of muscle wasting during critical illness: a systematic review and meta-analysis. Crit Care 2023;27:2. DOI: https://doi.org/10.1186/s13054-022-04253-0
- Zuercher P, Moret CS, Dziewas R, et al. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care 2019;23:103. DOI: https://doi.org/10.1186/s13054-019-2400-2
- Schefold JC, Berger D, Zürcher P, et al. Dysphagia in mechanically ventilated icu patients (dynamics): a prospective observational trial. Crit Care Med 2017;45:2061-9. DOI: https://doi.org/10.1097/CCM.0000000000002765
- Nakanishi N, Liu K, Kawauchi A, et al. Instruments to assess post-intensive care syndrome assessment: a scoping review and modified delphi method study. Crit Care 2023;27:430. DOI: https://doi.org/10.1186/s13054-023-04681-6
- Turan Z, Topaloglu M, Ozyemisci Taskiran O. Medical research council-sumscore: a tool for evaluating muscle weakness in patients with post-intensive care syndrome. Crit Care 2020;24:562. DOI: https://doi.org/10.1186/s13054-020-03282-x
- Zhang Q, Wang X, Liu M, et al. Assessing the diagnostic efficacy of handgrip dynamometry and diaphragmatic ultrasound in intensive care unit-acquired weakness. J Multidiscip Healthc 2024;17:2359-70. DOI: https://doi.org/10.2147/JMDH.S462297
- Ohtake PJ, Lee AC, Scott JC, et al. Physical impairments associated with post-intensive care syndrome: systematic review based on the world health organization’s international classification of functioning, disability and health framework. Phys Ther 2018;98:631-45. DOI: https://doi.org/10.1093/ptj/pzy059
- Herridge MS, Cheung AM, Tansey CM, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 2003;348:683-93. DOI: https://doi.org/10.1056/NEJMoa022450
- Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med 2011;39:371-9. DOI: https://doi.org/10.1097/CCM.0b013e3181fd66e5
- Smith JM, Lee AC, Zeleznik H, et al. Home and community-based physical therapist management of adults with post-intensive care syndrome. Phys Ther 2020;100:1062-73. DOI: https://doi.org/10.1093/ptj/pzaa059
- Mikkelsen ME, Still M, Anderson BJ, 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;48:1670-9. DOI: https://doi.org/10.1097/CCM.0000000000004586
- Rose L, Blackwood B, Needham DM, et al. Measures for the core outcome set for research evaluating interventions to prevent and/or treat delirium in critically ill adults: an international consensus study (del-cors). Crit Care Explor 2023;5:e0884. DOI: https://doi.org/10.1097/CCE.0000000000000884
- Lin JS, O’connor E, Rossom RC, et al. Screening for cognitive impairment in older adults: a systematic review for the U.S. preventive services task force. JAMA 2020;323:764-85. DOI: https://doi.org/10.1001/jama.2019.22258
- Fernández-Gonzalo S, Navarra-Ventura G, Bacardit N, et al. Cognitive phenotypes 1 month after icu discharge in mechanically ventilated patients: a prospective observational cohort study. Crit Care 2020;24:618. DOI: https://doi.org/10.1186/s13054-020-03334-2
- Inoue S, Nakanishi N, Amaya F, et al. Post‐intensive care syndrome: recent advances and future directions. Acute Med Surg 2024;11:e929. DOI: https://doi.org/10.1002/ams2.929
- Wolters AE, Peelen LM, Welling MC, et al. Long-term mental health problems after delirium in the ICU. Crit Care Med 2016;44:1808-13. DOI: https://doi.org/10.1097/CCM.0000000000001861
- Hatch R, Young D, Barber V, et al. Anxiety, depression and post-traumatic stress disorder after critical illness: a UK-wide prospective cohort study. Crit Care 2018;22:310. DOI: https://doi.org/10.1186/s13054-018-2223-6
- Needham DM, Sepulveda KA, Dinglas VD, et al. Core outcome measures for clinical research in acute respiratory failure survivors an international modified delphi consensus study. Am J Respir Crit Care Med 2017;196:1122-30. DOI: https://doi.org/10.1164/rccm.201702-0372OC
- Jutte JE, Needham DM, Pfoh ER, et al. Psychometric evaluation of the hospital anxiety and depression scale 3 months after acute lung injury. J Crit Care 2015;30:793-8. DOI: https://doi.org/10.1016/j.jcrc.2015.04.006
- Iribarren-Diarasarri S, Bermúdez-Ampudia C, Barreira-Mendez R, et al. Post-intensive care syndrome one month after discharge in surviving critically ill covid-19 patients. Med Intensiva Engl Ed 2023;47:493-500. DOI: https://doi.org/10.1016/j.medine.2022.10.012
- Spies CD, Krampe H, Paul N, et al. Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings – results of an expert consensus and feasibility field test. J Intensive Care Soc 2021;22:159-74. DOI: https://doi.org/10.1177/1751143720923597
- Arias-Rivera S, Raurell-Torredà M, Thuissard-Vasallo IJ, et al. Adaptation and validation of the ICU mobility scale in Spain. Enferm Intensiva 2020;31:131-46. DOI: https://doi.org/10.1016/j.enfie.2019.03.005
- Da Silveira LTY, Da Silva JM, Pavan Soler JM, et al. Assessing functional status after intensive care unit stay: the barthel index and the katz index. Int J Qual Health Care 2018;30:265-70. DOI: https://doi.org/10.1093/intqhc/mzx203
- He X, Song Y, Cao Y, et al. Post-intensive care syndrome: a review of clinical symptoms, evaluation, intervention. Heliyon 2024;10:e31278. DOI: https://doi.org/10.1016/j.heliyon.2024.e31278
- Torres A, Ferrer M, Blanquer JB, et al. Unidades de cuidados respiratorios intermedios. Definición y características. Arch Bronconeumol 2005;41:505-12. [Article in Spanish]. DOI: https://doi.org/10.1157/13078653
- Jara Chinarro B, Pazos Rodriguez L, Cuchí Alfaro M, et al. Innovations and challenges in intermediate respiratory care units: toward effective integration into the hospital system. Open Respir Arch 2024;6:100396. DOI: https://doi.org/10.1016/j.opresp.2024.100396
- Clarissa C, Salisbury L, Rodgers S, et al. Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities. J Intensive Care 2019;7:3. DOI: https://doi.org/10.1186/s40560-018-0355-z
- Vranceanu AM, Bannon S, Mace R, et al. Feasibility and efficacy of a resiliency intervention for the prevention of chronic emotional distress among survivor-caregiver dyads admitted to the neuroscience intensive care unit: a randomized clinical trial. JAMA Netw Open 2020;3:e2020807. DOI: https://doi.org/10.1001/jamanetworkopen.2020.20807
- Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018;46:E825-73.
Metrics
Citations and online attention from Dimensions, Altmetric and PlumX.
License
Copyright (c) 2025 The Author(s)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.