Post-intensive Care Syndrome: Its Pathophysiology, Prevention, and Future Directions

Overview

Journal Acute Med Surg

Specialty Critical Care

Date 2019 Jul 16

PMID 31304024

Citations 174

Authors

Shigeaki Inoue

Junji Hatakeyama

Yutaka Kondo

Toru Hifumi

Hideaki Sakuramoto

Tatsuya Kawasaki

Shunsuke Taito

Kensuke Nakamura

Takeshi Unoki

Yusuke Kawai

Yuji Kenmotsu

Masafumi Saito

Kazuma Yamakawa

Osamu Nishida

Affiliations

Soon will be listed here.

Abstract

Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long-term prognoses. Post-intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long-term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS-p) and the mental status of their family (PICS-F). Intensive care unit-acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow-up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.

Citing Articles

Patient and family experiences of early cognitive rehabilitation in critical illness: A qualitative study protocol.

Collet M, Svendsen L, Nielsen A, Laerkner E, Egerod I Nurs Crit Care. 2025; 30(2):e13254.

PMID: 40040364 PMC: 11880795. DOI: 10.1111/nicc.13254.

Mobile Applications for Longitudinal Data Collection: Web-based Survey Study of Former Intensive Care Patients.

Molinnus D, Mainz A, Kurth A, Lowitsch V, Nuchter M, Bloos F J Med Syst. 2025; 49(1):18.

PMID: 39888468 PMC: 11785681. DOI: 10.1007/s10916-025-02151-w.

Identification of unmet information needs among families of critically ill patients and their association with post-intensive care syndrome-family: protocol for a single-center cross-sectional study.

Ito Y, Hamaguchi T, Suzuki M, Otaka Y, Asai M, Sakaguchi Y BMC Palliat Care. 2025; 24(1):29.

PMID: 39881294 PMC: 11776254. DOI: 10.1186/s12904-024-01599-w.

Patient perspectives on stress after ICU and a short primary care based psychological intervention - results from a qualitative sub‑study of the PICTURE trial.

Beutel A, Sanftenberg L, Friemel C, Kosilek R, Schauer M, Elbert T BMC Prim Care. 2025; 26(1):12.

PMID: 39815198 PMC: 11734548. DOI: 10.1186/s12875-024-02698-6.

Factors associated with ABCDEF bundle implementation for critically ill patients: An international cross-sectional survey in 54 countries.

Haruna J, Unoki T, Liu K, Nakamura K, Inoue S, Nishida O SAGE Open Med. 2025; 13():20503121241312944.

PMID: 39790294 PMC: 11713948. DOI: 10.1177/20503121241312944.

References

Wolfe R . The 2017 Sir David P Cuthbertson lecture. Amino acids and muscle protein metabolism in critical care. Clin Nutr. 2018; 37(4):1093-1100. DOI: 10.1016/j.clnu.2017.12.010. View

Taito S, Shime N, Ota K, Yasuda H . Early mobilization of mechanically ventilated patients in the intensive care unit. J Intensive Care. 2016; 4:50. PMC: 4966815. DOI: 10.1186/s40560-016-0179-7. View

Petrinec A, Mazanec P, Burant C, Hoffer A, Daly B . Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers. Crit Care Med. 2015; 43(6):1205-12. PMC: 4818005. DOI: 10.1097/CCM.0000000000000934. View

Nelson L, Gold J . Posttraumatic stress disorder in children and their parents following admission to the pediatric intensive care unit: a review. Pediatr Crit Care Med. 2011; 13(3):338-47. DOI: 10.1097/PCC.0b013e3182196a8f. View

Singer P, Reintam Blaser A, Berger M, Alhazzani W, Calder P, Casaer M . ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2018; 38(1):48-79. DOI: 10.1016/j.clnu.2018.08.037. View

Routsi C, Gerovasili V, Vasileiadis I, Karatzanos E, Pitsolis T, Tripodaki E . Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial. Crit Care. 2010; 14(2):R74. PMC: 2887197. DOI: 10.1186/cc8987. View

Stanojcic M, Finnerty C, Jeschke M . Anabolic and anticatabolic agents in critical care. Curr Opin Crit Care. 2016; 22(4):325-31. PMC: 7859865. DOI: 10.1097/MCC.0000000000000330. View

Davidson J, Jones C, Bienvenu O . Family response to critical illness: postintensive care syndrome-family. Crit Care Med. 2011; 40(2):618-24. DOI: 10.1097/CCM.0b013e318236ebf9. View

Wesley Ely E . The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families. Crit Care Med. 2017; 45(2):321-330. PMC: 5830123. DOI: 10.1097/CCM.0000000000002175. View

10.

Netzer G, Sullivan D . Recognizing, naming, and measuring a family intensive care unit syndrome. Ann Am Thorac Soc. 2014; 11(3):435-41. PMC: 4028736. DOI: 10.1513/AnnalsATS.201309-308OT. View

11.

Phua J, Joynt G, Nishimura M, Deng Y, Myatra S, Chan Y . Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Intern Med. 2015; 175(3):363-71. DOI: 10.1001/jamainternmed.2014.7386. View

12.

Ginguay A, De Bandt J, Cynober L . Indications and contraindications for infusing specific amino acids (leucine, glutamine, arginine, citrulline, and taurine) in critical illness. Curr Opin Clin Nutr Metab Care. 2016; 19(2):161-9. DOI: 10.1097/MCO.0000000000000255. View

13.

Fan E, Dowdy D, Colantuoni E, Mendez-Tellez P, Sevransky J, Shanholtz C . Physical complications in acute lung injury survivors: a two-year longitudinal prospective study. Crit Care Med. 2013; 42(4):849-59. PMC: 3959239. DOI: 10.1097/CCM.0000000000000040. View

14.

Jensen J, Thomsen T, Overgaard D, Bestle M, Christensen D, Egerod I . Impact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis. Intensive Care Med. 2015; 41(5):763-75. DOI: 10.1007/s00134-015-3689-1. View

15.

Jones C, Skirrow P, Griffiths R, Humphris G, Ingleby S, Eddleston J . Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med. 2004; 30(3):456-60. DOI: 10.1007/s00134-003-2149-5. View

16.

Koch S, Wollersheim T, Bierbrauer J, Haas K, Morgeli R, Deja M . Long-term recovery In critical illness myopathy is complete, contrary to polyneuropathy. Muscle Nerve. 2014; 50(3):431-6. DOI: 10.1002/mus.24175. View

17.

Allingstrup M, Kondrup J, Wiis J, Claudius C, Pedersen U, Hein-Rasmussen R . Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Med. 2017; 43(11):1637-1647. DOI: 10.1007/s00134-017-4880-3. View

18.

Jackson J, Gordon S, Wesley Ely E, Burger C, Hopkins R . Research issues in the evaluation of cognitive impairment in intensive care unit survivors. Intensive Care Med. 2004; 30(11):2009-16. DOI: 10.1007/s00134-004-2422-2. View

19.

Phillips S . A brief review of critical processes in exercise-induced muscular hypertrophy. Sports Med. 2014; 44 Suppl 1:S71-7. PMC: 4008813. DOI: 10.1007/s40279-014-0152-3. View

20.

Kress J, Hall J . ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014; 370(17):1626-35. DOI: 10.1056/NEJMra1209390. View