Skip to main content

Post-intensive care syndrome (PICS): recent updates


An increasing number of patients are surviving critical illness, but some experience new or worsening long-lasting impairments in physical, cognitive and/or mental health, commonly known as post-intensive care syndrome (PICS). The need to better understand and improve PICS has resulted in a growing body of literature exploring its various facets. This narrative review will focus on recent studies evaluating various aspects of PICS, including co-occurrence of specific impairments, subtypes/phenotypes, risk factors/mechanisms, and interventions. In addition, we highlight new aspects of PICS, including long-term fatigue, pain, and unemployment.


Intensive care units (ICUs) were established in the mid-1900s [1, 2]. With advances in life-saving interventions, survival improved over the past decades, positively impacting a large number of patients [1, 3, 4]. However, ICU survivors often report long-lasting impairments in physical, cognitive and/or mental health after hospital discharge [4]. In 2010, the Society of Critical Care Medicine (SCCM) convened an international multi-stakeholder group that created the term “Post-Intensive Care Syndrome” (PICS). PICS was created with multiple objectives, including: (1) to raise awareness among clinicians, patients/families and the general public, (2) to increase screening for specific impairments occurring after critical illness, (3) to facilitate further research into specific morbidities [4]. More specifically, PICS was defined “as new onset or worsening of impairment(s) in physical, cognitive, and/or mental health that arose after the ICU and persisted beyond hospital discharge” [4]. Furthermore, the PICS term can be applied to experiences of a family member (PICS-F) of a survivor of critical illness [4]. It is important to note that PICS is not a medical diagnosis, but a concept for improving education and awareness of post-ICU impairments [4].

Some recent publications highlighted in this narrative review evaluated data from the ARDSNet Long Term Outcomes Study (ALTOS). ALTOS is a multi-center study (including 41 hospitals in the USA) that prospectively examined physical, cognitive and mental health status at 6 and 12 months after Acute Respiratory Distress Syndrome (ARDS). This large study has recently expanded our understanding of PICS with data evaluating ICU survivors’ fatigue, pain, and delayed return to work [5]. In addition to highlighting these new data, this review is to present findings from additional recent PICS-related studies that focus on co-occurrence of specific morbidities, subtypes/phenotypes, risk factors, and interventions.

General updates

Incidence of post-ICU impairments

Determining the incidence of new or worsening impairments after critical illness is challenging due to a lack of data on pre-ICU baseline status [6]. As a result, most studies evaluate the prevalence of post-ICU impairments. However, a recent study of 2,345 ICU survivors in the Netherlands, collected baseline health status via questionnaires completed by patients or their proxies [6]. Among patients urgently admitted to the ICU, patients/proxies rated baseline health status retrospectively, while for those admitted for elective surgery, baseline questionnaires were disseminated at patients’ pre-operative visit and completed a few days before ICU admission [6]. Among those admitted to the ICU for medical (N = 649, 28%), urgent surgery (284, 12%), and elective surgery (1412, 60%), 58%, 64%, 43%, respectively, experienced new physical, cognitive and/or mental problems (Table 1) [6]. Notably, physical problems were measured using a non-validated questionnaire. The incidence of frailty, fatigue, muscle weakness, anxiety, depression, and cognitive impairment at 1 year post-ICU was more common among urgent surgical patients compared to elective surgery [6]. Patients undergoing elective surgery tended to have a shorter ICU length of stay than urgent surgery or medical patients [6]. Additionally, elective surgery patients were more likely to demonstrate improvements in physical and mental functioning at 1 year follow-up; however, baseline fatigue and anxiety were more common in elective surgery patients [6]. Overall, this landmark study provided new insights regarding the incidence of new impairments.

Table 1 Percentage of patients with new impairments at 1 year, by reason for admission

An earlier smaller-sized study (N = 293) conducted in the United Kingdom (UK) found that ICU survivors experience more mobility issues, self-care issues, pain, and anxiety/depression after the ICU compared to their pre-ICU status based on the EQ-5D subscales [7]. However, this study is limited by potential for recall bias regarding baseline status and by use of only simple one-item assessments in the five subscales within the EQ-5D. Another earlier study (N = 36) conducted in the UK evaluated anxiety and depression symptoms among ICU survivors, excluding patients with pre-existing psychological symptoms; thus attempting to identify new symptoms after critical illness [8]. At 1 month after discharge, they found 16 (44%) and 17 (47%) of participants fell into the “disorder likely” category for anxiety and depression, respectively, based on scores from the Hospital Anxiety and Depression Scale (HADS) [8].

To better understand what long-term impairments are attributed to patients’ critical illness, we need further validation of methods of estimating baseline status [9, 10]. Additionally, future research should focus on evaluating the severity of impairments using continuous measures and via using validated and recommended measurement instruments [11], which would help have greater comparability in research findings and assist in understanding the magnitude of worsening of pre-existing impairments.

Subtypes of physical, cognitive and mental health outcomes

To better understand PICS, researchers have conducted analyses to identify subtypes. From the ALTOS study with 698 ARDS survivors evaluated at 6- and 12-month follow-up, four subtypes were identified via weighted network analysis and recursive partitioning [12]: (1) mildly impaired physical and mental health status (22%), (2) moderately impaired physical and mental health status (39%), (3) severely impaired physical and moderately impaired mental health status (15%), and (4) severely impaired physical and mental health status (24%) [12]. As illustrated by these subtypes, physical and mental impairment, and severity of impairment, demonstrated close associations that were distinct from the presence and severity of cognitive impairment [12]. ICU-related variables and severity of illness were not associated with these subtypes of patient outcomes [12]. Notably, when considering retrospectively-assessed baseline status, patients in all four subtypes demonstrated declines from their baseline status.

Another recent study evaluating clustering of impairments among COVID-19 survivors reported that physical and mental impairments were closely related, but did not co-occur with cognitive impairments [13]. Notably, this study included both ICU and non-ICU patients. Another COVID-19 study evaluating outcomes at 1-year follow-up of ICU survivors reported that cognitive and mental impairments always occurred together [14].

Given common co-occurrence of physical and mental health impairments, future interventions should consider jointly targeting these impairments, such as considered with a novel behavioral activation-rehabilitation (the BEHAB trial) being evaluated via a pilot randomized trial [15]. Furthermore, distinct interventions targeting cognitive impairments are needed.

Risk factors: patient/ICU specific

A multitude of risk factors for PICS-related impairments have been identified along with possible mechanisms for these impairments. A systematic review of 89 publications identified 60 risk factors, with approximately half categorized as patient-related and half as ICU-related [16]. Advanced age, female sex, a history of mental illness, severity of illness, poor ICU patient experience (including negative memories of the ICU), and delirium were significantly associated with physical, mental and/or cognitive impairments [16]. More specifically, a negative ICU patient experience and delirium have a strong impact on anxiety, Post-Traumatic Stress Disorder (PTSD), and cognitive function [16]. Although patient-related variables cannot be altered, they are helpful in identifying patients at highest risk for aspects of PICS. Interventions should target modifiable ICU-related risk factors; for instance, a negative ICU patient experience may be modified by implementing strategies to reduce delirium, increase early mobilization, optimize pain management, and reduce and/or modify the use of restraints [16]. The implementation of these strategies may facilitate alignment with patient-centeredness and improve patients’ ICU experiences; thus, addressing relevant risk factor for post-ICU impairments [17].

Potential mechanisms: inflammatory subphenotypes

Recent research, using data from the ALTOS study, has explored the relationship between ICU-based hyper- vs. hypo-inflammatory subphenotypes with physical, cognitive and mental health impairments over 12-month follow-up [18]. The hyper-inflammatory phenotype was associated with decreased survival within 90 days [18]. However, survival did not differ beyond 90 days based on inflammatory phenotype [18]. Additionally, physical, cognitive, and mental outcomes at 6- and 12-month follow-up were similar across the two inflammatory subphenotypes [18].

Recent research also has demonstrated that acute systemic inflammation and coagulation markers measured early in critical illness are not associated with cognitive function at 3 and 12-month follow-up. Moreover, only 2 markers were associated with disability in activities of daily living over follow-up [19].

Hence, based on these two studies, inflammation during critical illness may not an appropriate mechanistic target for future intervention. However, evaluating associations of prolonged inflammation after hospital discharge with PICS-related impairments merits more investigation [20].


A recent systematic review of 36 studies with 5,165 patients, evaluated the effectiveness of non-pharmacological interventions for improving long-term outcomes after critical illness [21]. The study classified interventions into early mobilization and physical rehabilitation (56%), post-ICU follow-up (14%), psychosocial programs (8%), ICU diaries (8%), and educational activities (6%) [21]. Results from each of these 36 studies are summarized in Table 2 [8, 21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56]. Only 31% of these studies included interventions after hospital discharge. Given the prolonged impairments experienced by patients, further studies evaluating the impact of interventions post-discharge are needed [21]. Notably, existing studies have risk of bias from incomplete reporting and loss to follow-up, along with lack of standardization in instruments used to measure outcomes [21]. Hence, further improvement in study design is needed. Overall, the design and evaluation of non-pharmacological interventions targeting aspects of PICS is at an early stage and needs further investigation to improve our understanding of potential efficacy.

Table 2 Evaluations of non-pharmacological interventions for improving long-term outcomes after critical illness

Recent data on additional aspects of PICS


Survivors of acute respiratory failure commonly experience fatigue with growing empirical evaluation of this symptom. An analysis of data from the ALTOS study (n = 732) evaluated fatigue symptoms using the validated Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) [5], with 70% and 66% reporting fatigue at 6 and 12 months respectively [5]. At 12-month versus 6-month follow-up, 28% of participants reported their symptoms were worse, 31% reported no change, and 41% reported improved symptoms. Increased fatigue was associated with female sex and unemployment prior to hospital admission [5]. At 6 and 12 months, patients with fatigue symptoms had worse physical functioning and higher psychological impairments [5]. Thus, health care providers should screen for both physical and psychological impairments among ICU survivors reporting fatigue. Importantly, in this cohort of ARDS survivors, there was no association between fatigue and ICU length of stay or severity of illness [5]. Additionally, a prospective study among a broader population of ICU survivors, rather than exclusively ARDS survivors, reported a high prevalence of fatigue at 12 month follow-up among medical, urgent surgery, and elective surgery ICU survivors as follows: 36%, 45%, and 24%, respectively [6].


In the ALTOS study, nearly 50% of ARDS survivors reported clinically significant pain during the first year after ARDS [57]. Unemployment and the use of opioids in the ICU were associated with greater pain at 6- and 12-month follow-up [57]. Among those with pain, 78% also reported anxiety and/or depressive symptoms and 78% reported cognitive and/or physical function impairment. This prevalence in the ALTOS study was similar to another study that reported 31% and 35% of medical and surgical ICU survivors having moderate to severe pain at 3 and 12 months, respectively [58]. In contrast, the prevalence of pain in the community is substantially lower, with only 20% of the US population reporting chronic pain [15]. A prior study using the brief pain inventory (BPI) measurement instrument in 295 patients from medical and surgical ICUs examined pain intensity and its effect on patients after hospital discharge [58]. Cumulative ICU opioid exposure was not associated with increased pain intensity or increased pain interference of daily life after the intensive care unit [58]. The authors suggest that patients with underlying chronic pain may report higher pain after hospital discharge due to opioid tolerance, hyperalgesia, or predisposition to developing a pain syndrome [58].

Delayed return to work and joblessness

Previously-employed survivors of critical illness experience challenges in returning to work after hospital discharge (Fig. 1) [59]. Some issues commonly encountered are delayed return to work, loss of job after return to work, and the need to change occupations [59, 60]. These problems frequently lead to a financial burden for patients and their families [59]. A meta-analysis, including 52 studies evaluating 10,015 previously-employed ICU survivors, assessed return to work [60]. Approximately 36%, 64%, 60% of patients reported return to work at 1 to 3, 6, and 12- month follow-up, respectively [60]. Furthermore, results from the ALTOS study, including 326 previously-employed ARDS survivors, found that 48% and 43% were jobless at 6- and 12-month follow-up [61]. Patients with pain or fatigue were less likely to return to work [61]. At 6 and 12 months, the imbalance between occupational workload requirements and ARDS survivors’ functional ability occurred in 90% of ALTOS participants [62]. Furthermore, having imbalance in both physical and psychosocial areas at 6 months was significantly associated with joblessness at 6 and 12 months [62]. The findings from these studies highlight the need to improve patient’s functional abilities, and to decrease work load via workplace accommodations for ICU survivors [62, 63].

Fig. 1
figure 1

Barriers to return to work after critical illness


Post-intensive care syndrome is experienced by many ICU survivors who have new or worsening physical, cognitive, and/or mental health impairments. These impairments often co-occur and may include pain and fatigue. Together these impairments and symptoms create substantial challenges in returning to work for previously-employed ICU survivors. Evaluation of ARDS survivor subtypes/phenotypes demonstrate that physical and mental health impairments are closely associated, without association with cognitive outcomes. The biological mechanisms underlying many of these long-standing impairments are uncertain despite exploration into inflammatory biomarkers in the ICU setting. Increased understanding of risk factors, especially across different types of ICU patients has improved our ability to potentially identify high-risk patients for screening and intervention. However, in terms of interventions, evaluation of non-pharmacological interventions, including early mobilization and physical rehabilitation in the ICU, ICU diaries, psychological interventions, multi-disciplinary post-ICU follow-up clinics and interventions, and educational activities, are still in an early stage. Future well-designed studies are needed to better understand mechanisms and potential interventions to improve post-intensive care syndrome.

Availability of data and materials

Not applicable.



ARDSNet Long Term Outcomes Study


Acute Respiratory Distress Syndrome


Brief pain intensity


Coronavirus disease 2019


Functional assessment of chronic illness therapy fatigue scale


Hospital Anxiety and Depression Scale


Intensive Care Unit


Post-intensive care syndrome


Post-traumatic stress disorder


Society of Critical Care Medicine


United Kingdom


  1. Calvin JE, Habet K, Parrillo JE. Critical care in the United States who are we and how did we get here? Crit Care Clin. 1997;13(2):363–76.

    Article  CAS  PubMed  Google Scholar 

  2. Efu ME, Ojo B, Eke BA, Anefu GO, Ozoagu MA. Characterization of the intensive care unit (ICU) admission in the Benue State University teaching hospital. Med Surg Sci. 2019;6(4):126–8.

    Article  Google Scholar 

  3. Kaukonen K, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311(13):1308–16.

    Article  CAS  PubMed  Google Scholar 

  4. Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit. Crit Care Med. 2012;40(2):502–9.

    Article  PubMed  Google Scholar 

  5. Neufeld KJ, Leoutsakos JS, Yan H, et al. Fatigue symptoms during the first year following ARDS. Chest. 2020;158(3):999–1007.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Geense WW, Zegers M, Peters MAA, et al. New physical, mental, and cognitive problems 1 year after ICU admission. Am J Respir Crit Care Med. 2021;203(12):1512–21.

    Article  PubMed  Google Scholar 

  7. Griffiths J, Hatch RA, Bishop J, et al. An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors : a 12-month follow-up study. Crit Care. 2013;17(3):R100.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Knowles RE, Tarrier N. Evaluation of the effect of prospective patient diaries on emotional well-being in intensive care unit survivors: a randomized controlled trial. Crit Care Med. 2009;37(1):184–91.

    Article  PubMed  Google Scholar 

  9. Azoulay E, Vincent J, Angus DC, et al. Recovery after critical illness: putting the puzzle together—a consensus of 29. Crit Care. 2017;21(1):296.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Spragg RG, Bernard GR, Checkley W, et al. Beyond mortality: future clinical research in acute lung injury. Am J Respir Crit Care Med. 2010;181(10):1121–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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. Crit Care Med. 2017;196(9):1122–30.

    Article  Google Scholar 

  12. 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(12):1094–103.

    Article  PubMed  Google Scholar 

  13. The PHOSP-COVID Collaborative Group. 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;2600(22):1–15.

    Article  Google Scholar 

  14. Heesakkers H, van der Hoeven J, Corsten S, et al. Clinical outcomes among patients with 1-year survival following intensive care unit treatment for COVID-19. JAMA. 2022;327(6):559–65.

    Article  CAS  PubMed  Google Scholar 

  15. Parker A. Behavioral activation-rehabilitation to improve depressive symptoms and physical function after acute respiratory failure (BEHAB). 2022:1-9.

  16. Lee M, Kang J, Jeong Y. Risk factors for post-intensive care syndrome: a systematic review and meta-analysis. Aust Crit Care. 2020;33(3):287–94.

    Article  PubMed  Google Scholar 

  17. Cabrini L, Landoni G, Antonelli M, et al. Critical care in the near future: patient-centered, beyond space and time boundaries. Ninerva Anestesiol. 2016;82(5):599–604.

    Google Scholar 

  18. Hashem M, Hopkins R, Colantuoni E, et al. Six-month and 12-month patient outcomes based on inflammatory subphenotypes in sepsis-associated ARDS: secondary analysis of SAILS-ALTOS trial. Thorax. 2022;77:22–30.

    Article  PubMed  Google Scholar 

  19. Brummel NE, Hughes CG, Thompson JL, et al. Inflammation and coagulation during critical illness and long-term cognitive impairment and disability. Am J Respir Crit Care Med. 2021;203(6):699–706.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Parker A, Sinha P, Needham D. Biological mechanisms of cognitive and physical impairments after critical care rethinking the inflammatory model? Am J Respir Crit Care Med. 2021;203(6):665–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Geense W, van den Boogaard M, van der Hoeven J, Vermuelen 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):1607–18.

    Article  CAS  PubMed  Google Scholar 

  22. Chen S, Su CL, Wu YT, et al. Physical training is beneficial to functional status and survival in patients with prolonged mechanical ventilation. J Formos Med Assoc. 2011;110(9):572–9.

    Article  PubMed  Google Scholar 

  23. Vitacca M, Barbano L, Vanoglio F, et al. Does 6-month home caregiver-supervised physiotherapy improve post-critical care outcomes? Am J Phys Med Rehabil. 2016;95(8):571–9.

    Article  PubMed  Google Scholar 

  24. Brummel NE, Girard TD, Ely EW, et al. Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the activity and cognitive therapy in ICU (ACT-ICU) trial. Intensive Care Med. 2014;40(3):370–9.

    Article  CAS  PubMed  Google Scholar 

  25. Jones C, Skirrow P, Griffiths RD, et al. Rehabilitation after critical illness: a randomized, controlled trial. Crit Care Med. 2003;31(10):2456–61.

    Article  PubMed  Google Scholar 

  26. Battle C, James K, Temblett P, Hutchings H. Supervised exercise rehabilitation in survivors of critical illness: a randomised controlled trial. J Intensive Care Soc. 2019;20(1):18–26.

    Article  PubMed  Google Scholar 

  27. Shelly A, Prabhu N, Jirange P, Kamath A, Vaishali K. Quality of life improves with individualized home-based exercises in critical care survivors. Indian J Crit Care Med. 2017;21(2):89–93.

    Article  PubMed  PubMed Central  Google Scholar 

  28. McDowell K, O’Neill B, Blackwood B, et al. Effectiveness of an exercise programme on physical function in patients discharged from hospital following critical illness: a randomised controlled trial (the REVIVE trial). Thorax. 2016;72(7):600–9.

    Article  Google Scholar 

  29. McWilliams DJ, Benington S, Atkinson D. Outpatient-based physical rehabilitation for survivors of prolonged critical illness: a randomized controlled trial. Physiother Theory Pract. 2016;32(3):179–90.

    Article  PubMed  Google Scholar 

  30. Connolly B, Thompson A, Douiri A, Moxham J, Hart N. Exercise-based rehabilitation after hospital discharge for survivors of critical illness with intensive care unit-acquired weakness: a pilot feasibility trial. J Crit Care. 2015;30(3):589–98.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Batterham AM, Bonner S, Wright J, Howell SJ, Hugill K, Danjoux G. Effect of supervised aerobic exercise rehabilitation on physical fitness and quality-of-life in survivors of critical illness: an exploratory minimized controlled trial (PIX study). Br J Anaesth. 2014;113(1):130–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Arthur HM, Daniels C, McKelvie R, Hirsh J, Rush B. Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery: a randomized, controlled trial. Ann Intern Med. 2000;133(4):253–62.

    Article  CAS  PubMed  Google Scholar 

  33. Jackson J, Ely W, Morey M, et al. Cognitive and physical rehabilitation of ICU survivors: results of the RETURN randomized, controlled pilot investigation. Crit Care Med. 2012;40(4):1088–97.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Elliott D, McKinley S, Alison J, et al. Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program. Crit Care. 2011;15(3):R142.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Jónasdóttir RJ, Jónsdóttir H, Gudmundsdottir B, Sigurdsson GH. Psychological recovery after intensive care: outcomes of a long-term quasi-experimental study of structured nurse-led follow-up. Intensive Crit Care Nurs. 2018;44:59–66.

    Article  PubMed  Google Scholar 

  36. Jensen JF, Egerod I, Bestle MH, et al. A recovery program to improve quality of life, sense of coherence and psychological health in ICU survivors: a multicenter randomized controlled trial, the RAPIT study. Intensive Care Med. 2016;42(11):1733–43.

    Article  PubMed  Google Scholar 

  37. Schmidt K, Worrack S, Korff M, et al. Effect of a primary care management intervention on mental-health-related quality of life among survivors of sepsis: a randomized clinical trial. JAMA. 2016;315(24):2703–11.

    Article  CAS  PubMed  Google Scholar 

  38. Cuthbertson BH, Rattray J, Campbell MK, et al. The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. BMJ. 2009;339(7728):1016.

    Article  Google Scholar 

  39. Douglas S, Daly B, Kelley C, O’Toole E, Montenegro H. Chronically critically ill patients: health-related quality of life and resource use after a disease management intervention. Am J Crit Care. 2007;16(5):447–57.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Cox CE, Hough CL, Jones DM, et al. Effects of mindfulness training programmes delivered by a self-directed mobile app and by telephone compared with an education programme for survivors of critical illness: a pilot randomised clinical trial. Thorax. 2019;74(1):33–42.

    Article  PubMed  Google Scholar 

  41. Cox CE, Hough CL, Carson SS, et al. Effects of a telephone- and web-based coping skills training program compared with an education program for survivors of critical illness and their family members a randomized clinical trial. Am J Respor Crit Care Med. 2018;197(1):66–78.

    Article  Google Scholar 

  42. Ågren S, Berg S, Svedjeholm R, Strömberg A. Psychoeducational support to post cardiac surgery heart failure patients and their partners—a randomised pilot study. Intensive Crit Care Nurs. 2015;31(1):10–8.

    Article  PubMed  Google Scholar 

  43. Wright SE, Thomas K, Watson G, et al. Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC): a multicentre, parallel-group, randomised controlled trial. Thorax. 2018;73(3):213–21.

    Article  PubMed  Google Scholar 

  44. Garrouste-Orgeas M, Coquet I, Perier A, et al. Impact of an intensive care unit diary on psychological distress in patients and relatives. Crit Care Med. 2012;40:2033–40.

    Article  PubMed  Google Scholar 

  45. Jones C, Bäckman C, Capuzzo M, et al. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care. 2010;14(5):R168.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Demircelik MB, Cakmak M, Nazli Y, et al. Effects of multimedia nursing education on disease-related depression and anxiety in patients staying in a coronary intensive care unit. Appl Nurs Res. 2016;29:5–8.

    Article  PubMed  Google Scholar 

  47. Fleischer S, Berg A, Behrens J, et al. Does an additional structured information program during the intensive care unit stay reduce anxiety in ICU patients ?: a multicenter randomized controlled trial. BMC Anesthesiol. 2014;14(1):1–11.

    Article  Google Scholar 

  48. Sosnowski K, Mitchell ML, White H, et al. A feasibility study of a randomised controlled trial to examine the impact of the ABCDE bundle on quality of life in ICU survivors. Pilot Feasibility Stud. 2018;4(1):1–12.

    Article  Google Scholar 

  49. Demoule A, Carreira S, Lavault S, et al. Impact of earplugs and eye mask on sleep in critically ill patients : a prospective randomized study. Crit Care. 2017;21:284.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Giraud K, Pontin M, Sharples LD, et al. Use of a structured mirrors intervention does not reduce delirium incidence but may improve factual memory encoding in cardiac surgical ICU patients aged over 70 years : a pilot time-cluster randomized controlled trial. Front Aging Neurosci. 2016;8:228.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Morris PE, Berry MJ, Files DC, et al. Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure a randomized clinical trial. JAMA. 2016;315(24):2694–702.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Hodgson CL, Bailey M, Bellomo R, et al. A binational multicenter pilot feasibility randomized controlled trial of early goal-directed mobilization in the ICU. Crit Care Med. 2016;44(6):1145–52.

    Article  PubMed  Google Scholar 

  53. Schaller SJ, Anstey M, Blobner M, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet. 2016;388(10052):1377–88.

    Article  PubMed  Google Scholar 

  54. Kayambu G, Boots R, Paratz J. Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial. Intensive Care Med. 2015;41(5):865–74.

    Article  PubMed  Google Scholar 

  55. Moss M, Nordon-Craft A, Malone D, et al. A randomized trial of an intensive physical therapy program for patients with acute respiratory failure. Am J Respir Crit Care Med. 2016;193(10):1101–10.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Denehy L, Skinner EH, Edbrooke L, et al. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up. Crit Care. 2013;17(4):1–12.

    Article  Google Scholar 

  57. Probert JM, Lin S, Yan H, et al. Bodily pain in survivors of acute respiratory distress syndrome : a 1-year longitudinal follow-up study. J Psychosom Res. 2021;144:110418.

    Article  PubMed  Google Scholar 

  58. Hayhurst CJ, Jackson JC, Archer KR, Thompson JL, Chandrasekhar R, Hughes CG. Pain and its long-term interference of daily life after critical illness. Anesth Analg. 2018;127(3):690–7.

    Article  PubMed  Google Scholar 

  59. 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(8):683–93.

    Article  PubMed  Google Scholar 

  60. Kamdar BB, Suri R, Suchyta MR, et al. Return to work after critical illness : a systematic review and meta-analysis. Thorax. 2020;75(1):17–27.

    Article  PubMed  Google Scholar 

  61. Su H, Thompson HJ, May S, et al. Association of job characteristics and functional impairments on return to work after ARDS. Chest. 2021;160(2):509–18.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Su H, Hopkins RO, Kamdar BB, et al. Association of imbalance between job workload and functional ability with return to work in ARDS survivors. Thorax. 2022;77(2):123–8.

    Article  PubMed  Google Scholar 

  63. Su H, Thompson HJ, Pike K, et al. Interrelationships among workload, illness severity, and function on return to work following acute respiratory distress syndrome. Aust Crit Care. 2023;36(2):247–53.

    Article  PubMed  Google Scholar 

Download references


Not applicable.


No specific funding supported this work.

Author information

Authors and Affiliations



SLH, AF, and MA performed literature review and primary first draft. DMN performed critical revisions. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stephanie L. Hiser.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hiser, S.L., Fatima, A., Ali, M. et al. Post-intensive care syndrome (PICS): recent updates. j intensive care 11, 23 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Critical illness
  • Intensive care
  • Long-term outcomes