Post–intensive care syndrome is defined as a new physical, cognitive, psychologic, or thromboinflammatory impairment that develops and persists following intensive care unit admission and hospital discharge, according to a consensus guideline.
The guideline provides recommendations for recognizing, evaluating, and managing post–intensive care syndrome (PICS) in patients who have undergone surgery or major trauma requiring intensive care unit (ICU) admission.
Methods
A working group conducted targeted literature searches of the PubMed and Embase databases, which focused on patients aged 16 years and older admitted to surgical ICUs. They prioritized randomized controlled trials, large observational studies, and societal guidelines. Recommendations were developed through structured discussion, with consensus defined as at least 80% agreement among the committee members. The document reflects expert consensus rather than a formal systematic review.
Findings
The guideline expands PICS to include persistent thromboinflammatory dysregulation and sustained organ dysfunction alongside physical, cognitive, and psychologic impairments.
In a 2021 study, 96% of patients with ICU stays longer than 72 hours met at least one PICS criterion at follow-up up to 24 weeks. Cognitive impairment was reported in approximately 30% to 50% of survivors.
Long-term outcomes included functional decline and mortality. In a 2009 study involving patients with ICU stays of at least 10 days, 49% returned to work or school at a median of 3.3 years, while 25% of them experienced long-term disability. Mortality associated with chronic critical illness and thromboinflammatory dysfunction approached 25% to 30% at 1 year follow-up.
The guideline recommends domain-specific evaluation of PICS. Cognitive impairment should be assessed in person using the Montreal Cognitive Assessment, with telephone-based tools when in-person testing is not feasible. Physical impairment should be evaluated using strength, function, and mobility measures such as sit-to-stand and walk tests, with the selection individualized to baseline function and injury.
Laboratory and genomic markers may support identification of thromboinflammatory dysregulation and organ failure but aren't diagnostic. Among the biomarkers are C-reactive protein, total lymphocyte count, serum albumin, serum prealbumin, creatinine height index, weight loss, body mass index during hospital admission, retinol-binding protein, lymphocyte subsets, anemia, thrombocytopenia, neutrophil-to-lymphocyte ratio, and inflammatory cytokines.
Patients with ICU stays longer than 48 hours or those at high risk should be considered for referral to multidisciplinary PICS clinics. Follow-up is recommended within two to four weeks following discharge, with additional evaluations at 3, 6, and 12 months.
Limitations
The recommendations are based on expert consensus and heterogeneous evidence, with many cited studies derived from mixed-population critical care environments rather than exclusively surgical cohorts. The guideline authors also noted the limited validation of diagnostic tools and insufficient evidence on the effectiveness of structured follow-up programs.
Conclusion
“It is important to recognize PICS because a patient’s recovery and quality of life can be significantly impacted after discharge from the ICU,” wrote lead guideline author Jeffrey Anderson, MD, of the Medical College of Wisconsin, and colleagues.
Full disclosures of the study authors can be found in the study.
Source: Trauma Surgery & Acute Care Open