Review article
Post–intensive care syndrome
From diagnosis to treatment
Dtsch Arztebl Int 2026; 123: 1-7. DOI: 10.3238/arztebl.m2025.0145
; ; ; ; ;
For technical reasons, the English full text will be published approximately two weeks after the German print edition has been published.
* Die beiden Autorinnen teilen sich die Erstautorenschaft.
Klinik für Anästhesiologie und Intensivmedizin (CCM/CVK), PICS-Ambulanz, Charité Universitätsmedizin Berlin: Dr. rer. nat. Claudia Denke, Dr. med. Karin Steinecke, PD Dr. Dipl.-Psych. Henning Krampe, Dr. med. Désirée J. Boehnke, Prof. Dr. med. Björn Weiß, Prof. Dr. med. Claudia Spies
Klinik für Anästhesiologie und Intensivmedizin (CCM/CVK), PICS-Ambulanz, Charité Universitätsmedizin Berlin: Dr. rer. nat. Claudia Denke, Dr. med. Karin Steinecke, PD Dr. Dipl.-Psych. Henning Krampe, Dr. med. Désirée J. Boehnke, Prof. Dr. med. Björn Weiß, Prof. Dr. med. Claudia Spies
| 1. | Paul N, Weiss B: Post-intensive care syndrome after critical illness: An imperative for effective prevention. J Clin Med 2022; 11: 6203 CrossRef MEDLINE PubMed Central |
| 2. | 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 CrossRef MEDLINE |
| 3. | Marra A, Pandharipande PP, Girard TD, et al.: Co-occurrence of post-intensive care syndrome problems among 406 survivors of critical illness. Crit Care Med 2018; 46: 1393–401 CrossRef MEDLINE PubMed Central |
| 4. | Herridge MS, Azoulay É: Outcomes after critical illness. N Engl J Med 2023; 388: 913–24 CrossRef MEDLINE |
| 5. | Gupta L, Subair MN, Munjal J, et al.: Beyond survival: Understanding post-intensive care syndrome. Acute Crit Care 2024; 39: 226–33 CrossRef MEDLINE PubMed Central |
| 6. | Senger D, Erbguth F.: [Critical illness myopathy and polyneuropathy]. Med Klin Intensivmed Notfmed 2017]; 112: 589–96 CrossRef MEDLINE PubMed Central |
| 7. | Meyer-Frießem CH, Malewicz NM, Rath S, et al.: Incidence, time course and influence on quality of life of Intensive care unit-acquired weakness symptoms in long-term intensive care survivors. J Intensive Care Med 2021; 36: 1313–22 CrossRef MEDLINE |
| 8. | 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 CrossRef CrossRef MEDLINE PubMed Central |
| 9. | Mikkelsen ME, Christie JD, Lanken PN, et al.: The adult respiratory distress syndrome cognitive outcomes study: Long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med 2012; 185: 1307–15 CrossRef CrossRef MEDLINE PubMed Central |
| 10. | Inoue S, Hatakeyama J, Kondo Y, et al.: Post-intensive care syndrome: Its pathophysiology, prevention, and future directions. Acute Med Surg 2019; 6: 233–46 CrossRef MEDLINE PubMed Central |
| 11. | Emsden C, Steinecke K: Post-intensive-care-syndrom: Risikofaktoren, Prävention und Nachsorge. Journal Club AINS 2023; 12: 206–15 CrossRef |
| 12. | 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 CrossRef MEDLINE |
| 13. | 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 CrossRef MEDLINE PubMed Central |
| 14. | Kapfhammer HP: [Depressive, anxiety and posttraumatic stress disorders as long-term sequelae of intensive care treatment]. Nervenarzt 2016; 87: 253–63 CrossRef MEDLINE |
| 15. | Sasannejad C, Ely EW, Lahiri S: Long-term cognitive impairment after acute respiratory distress syndrome: A review of clinical impact and pathophysiological mechanisms. Crit Care 2019; 23: 352 CrossRef MEDLINE PubMed Central |
| 16. | Inoue S, Nakanishi N, Amaya F, et al.: Post-intensive care syndrome: Recent advances and future directions. Acute Med Surg 2024; 11(1): e929 CrossRef MEDLINE PubMed Central |
| 17. | Hashem MD, Hopkins RO, 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 CrossRef MEDLINE PubMed Central |
| 18. | Renner C, Jeitziner MM, Albert M, et al.: Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Crit Care 2023; 27: 301 CrossRef MEDLINE PubMed Central |
| 19. | Barr J, Fraser GL, Puntillo K, et al.: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41: 263–306 CrossRef MEDLINE |
| 20. | Pun BT, Balas MC, Barnes-Daly MA, et al.: Caring for critically Ill patients with the ABCDEF bundle: Results of the ICU liberation collaborative in over 15,000 adults. Crit Care Med 2019; 47: 3–14 CrossRef MEDLINE PubMed Central |
| 21. | 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: 1377–88 CrossRef MEDLINE |
| 22. | Meraner V, Sperner-Unterweger B: [Patients, physicians and nursing personnel in intensive care units: Psychological and psychotherapeutic interventions]. Nervenarzt 2016; 87: 264–8 CrossRef MEDLINE |
| 23. | Schaller S, Paul N, Grunow J, Weiss B, Spies C: The post-ICU patient—management of long-term impairments after critical illness. 2020; 20: 275–82. |
| 24. | Schofield-Robinson OJ, Lewis SR, Smith AF, McPeake J, Alderson P: Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. Cochrane Database Syst Rev 2018; 11: Cd012701 CrossRef MEDLINE |
| 25. | Griffiths JA, Barber VS, Cuthbertson BH, Young JD: A national survey of intensive care follow-up clinics. Anaesthesia 2006; 61: 950–5 CrossRef MEDLINE |
| 26. | Connolly B, Milton-Cole R, Adams C, et al.: Recovery, rehabilitation and follow-up services following critical illness: An updated UK national cross-sectional survey and progress report. BMJ Open 2021; 11: e052214 CrossRef MEDLINE PubMed Central |
| 27. | Farley KJ, Eastwood GM, Bellomo R: A feasibility study of functional status and follow-up clinic preferences of patients at high risk of post intensive care syndrome. Anaesth Intensive Care 2016; 44: 413–9 CrossRef MEDLINE |
| 28. | Jensen JF, Thomsen T, Overgaard D, Bestle MH, 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: 763–75 CrossRef MEDLINE |
| 29. | Peris A, Bonizzoli M, Iozzelli D, et al.: Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients. Crit Care 2011; 15: R41 CrossRef MEDLINE PubMed Central |
| 30. | Drewitz KP, Hasenpusch C, Bernardi C, et al.: Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): Feasibility of a pragmatic randomised controlled trial. BMC Anesthesiol 2023; 23: 344 CrossRef MEDLINE PubMed Central |
| 31. | Schmidt K, Worrack S, Von 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: 2703–11 CrossRef MEDLINE PubMed Central |
| 32. | Bloom SL, Stollings JL, Kirkpatrick O, et al.: Randomized clinical trial of an ICU recovery pilot program for survivors of critical illness. Crit Care Med 2019; 47: 1337–45 CrossRef CrossRef MEDLINE |
| 33. | 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: b3723 CrossRef MEDLINE PubMed Central |
| 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: R142 CrossRef MEDLINE PubMed Central |
| 35. | Jones C, Eddleston J, McCairn A, et al.: Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: A randomized controlled trial. J Crit Care 2015; 30: 901–7 CrossRef CrossRef |
| 36. | Haines KJ, Beesley SJ, Hopkins RO, et al.: Peer support in critical care: A systematic review. Crit Care Med 2018; 46: 1522–31 CrossRef MEDLINE |
| 37. | McPeake J, Iwashyna TJ, Boehm LM, et al.: Benefits of peer support for intensive care unit survivors: Sharing experiences, care debriefing, and altruism. Am J Crit Care 2021; 30: 145–9 CrossRef MEDLINE PubMed Central |
| 38. | Haines KJ, Hibbert E, Leggett N, et al.: Transitions of care after critical illness-challenges to recovery and adaptive problem solving. Crit Care Med 2021; 49: 1923–31 CrossRef MEDLINE PubMed Central |
| 39. | Spies CD, Paul N, Adrion C, et al.: Effectiveness of an intensive care telehealth programme to improve process quality (ERIC): A multicentre stepped wedge cluster randomised controlled trial. Intensive Care Med 2023; 49: 191–204 CrossRef MEDLINE PubMed Central |
| 40. | Ali Abdelhamid Y, Phillips LK, White MG, Presneill J, Horowitz M, Deane AM: Survivors of intensive care with type 2 diabetes and the effect of shared-care follow-up clinics: The SWEET-AS randomized controlled pilot study. Chest 2021; 159: 174–85 CrossRef | MEDLINE
| e1. | Society of Critical Care: Critical care statistics. 2022. https://sccm.org/communications/critical-care-statistics (last accessed on 30 May 2025). |
| e2. | Fan E, Dowdy DW, Colantuoni E, et al.: Physical complications in acute lung injury survivors: A two-year longitudinal prospective study. Crit Care Med 2014; 42: 849–59 CrossRef MEDLINE PubMed Central |
| e3. | Kemp HI, Laycock H, Costello A, Brett SJ: Chronic pain in critical care survivors: A narrative review. Br J Anaesth 2019; 123: e372–e84 CrossRef MEDLINE PubMed Central |
| e4. | Zielske J, Bohne S, Axer H, Brunkhorst FM, Guntinas-Lichius O: [Dysphagia management of acute and long-term critically ill intensive care patients]. Med Klin Intensivmed Notfmed 2014; 109: 516–25 CrossRef MEDLINE |
| e5. | Pandharipande PP, Girard TD, Jackson JC, et al.: Long-term cognitive impairment after critical illness. N Engl J Med 2013; 369: 1306–16 CrossRef MEDLINE PubMed Central |
| e6. | Rawal G, Yadav S, Kumar R: Post-intensive care syndrome: An overview. J Transl Int Med 2017; 5: 90–2 CrossRef MEDLINE PubMed Central |
| e7. | Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson LV: Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 1999; 160: 50–6 CrossRef MEDLINE |
| e8. | Nikayin S, Rabiee A, Hashem MD, et al.: Anxiety symptoms in survivors of critical illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2016; 43: 23–9 CrossRef MEDLINE PubMed Central |
| e9. | Hatch R, Young D, Barber V, Griffiths J, Harrison DA, Watkinson P: Anxiety, depression and post traumatic stress disorder after critical illness: a UK-wide prospective cohort study. Crit Care 2018; 22: 310 CrossRef MEDLINE PubMed Central |
| e10. | Jackson JC, Pandharipande PP, Girard TD, et al.: Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: A longitudinal cohort study. Lancet Respir Med 2014; 2: 369–79 CrossRef MEDLINE |
| e11. | Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM: Posttraumatic stress disorder in critical illness survivors: A metaanalysis. Crit Care Med 2015; 43: 1121–9 CrossRef MEDLINE |
| e12. | Wade D, Hardy R, Howell D, Mythen M: Identifying clinical and acute psychological risk factors for PTSD after critical care: A systematic review. Minerva Anestesiol 2013; 79: 944–63. |
| e13. | Girard TD, Thompson JL, Pandharipande PP, et al.: Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: A prospective cohort study. Lancet Respir Med 2018; 6: 213–22 CrossRef MEDLINE |
| e14. | Wilcox ME, Brummel NE, Archer K, Ely EW, Jackson JC, Hopkins RO: Cognitive dysfunction in ICU patients: Risk factors, predictors, and rehabilitation interventions. Crit Care Med 2013; 41(9 Suppl 1):S81–98 CrossRef MEDLINE |
| e15. | Duning T, van den Heuvel I, Dickmann A, et al.: Hypoglycemia aggravates critical illness-induced neurocognitive dysfunction. Diabetes Care 2010; 33: 639–44 CrossRef MEDLINE PubMed Central |
| e16. | Girard TD, Jackson JC, Pandharipande PP, et al.: Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010; 38: 1513–20 CrossRef MEDLINE PubMed Central |
| e17. | 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: 699–706 CrossRef MEDLINE PubMed Central |
| e18. | Hiser SL, Fatima A, Ali M, Needham DM: Post-intensive care syndrome (PICS): Recent updates. J Intensive Care 2023; 11: 23 CrossRef MEDLINE PubMed Central |
| e19. | Marra A, Ely EW, Pandharipande PP, Patel MB: The ABCDEF bundle in critical care. Crit Care Clin 2017; 33: 225–43 CrossRef MEDLINE PubMed Central |
| e20. | Schweickert WD, Pohlman MC, Pohlman AS, et al.: Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. Lancet 2009; 373: 1874–82 CrossRef MEDLINE |
| e21. | Deffner T, Rosendahl J, Niecke A: [Psychotraumatological aspects in intensive care medicine]. Med Klin Intensivmed Notfmed 2020; 115: 511–8 CrossRef MEDLINE |
| e22. | Garrouste-Orgeas M, Coquet I, Périer A, et al.: Impact of an intensive care unit diary on psychological distress in patients and relatives. Crit Care Med 2012; 40: 2033–40 CrossRef MEDLINE |
| e23. | Brown SM, Bose S, Banner-Goodspeed V, et al.: Approaches to addressing post-intensive care syndrome among intensive care unit survivors. A narrative review. Ann Am Thorac Soc 2019; 16: 947–56 CrossRef MEDLINE |
| e24. | Svenningsen H, Langhorn L, Ågård AS, Dreyer P: Post-ICU symptoms, consequences, and follow-up: An integrative review. Nurs Crit Care 2017; 22: 212–20 CrossRef MEDLINE |
| e25. | Lee CM, Herridge MS, Matte A, Cameron JI: Education and support needs during recovery in acute respiratory distress syndrome survivors. Crit Care 2009; 13: R153 CrossRef MEDLINE PubMed Central |
| e26. | Prinjha S, Field K, Rowan K: What patients think about ICU follow-up services: A qualitative study. Crit Care 2009; 13: R46 CrossRef MEDLINE PubMed Central |
| e27. | Sevin CM, Bloom SL, Jackson JC, Wang L, Ely EW, Stollings JL: Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center. J Crit Care 2018; 46: 141–8 CrossRef MEDLINE PubMed Central |
| e28. | Zatzick D, Jurkovich G, Rivara FP, et al.: A randomized stepped care intervention trial targeting posttraumatic stress disorder for surgically hospitalized injury survivors. Annals of Surgery 2013; 257: 390–9 CrossRef MEDLINE PubMed Central |
| e29. | Henderson P, Quasim T, Asher A, et al.: Post-intensive care syndrome following cardiothoracic critical care: Feasibility of a complex intervention. J Rehabil Med 2021; 53: jrm00206 CrossRef MEDLINE PubMed Central |
| e30. | Sayde GE, Stefanescu A, Hammer R: Interdisciplinary treatment for survivors of critical illness due to COVID-19: Expanding the post-intensive care recovery model and impact on psychiatric outcomes. J Acad Consult Liaison Psychiatry 2023; 64: 226–35 CrossRef MEDLINE PubMed Central |
| e31. | Khan BA, Lasiter S, Boustani MA: CE: critical care recovery center: An innovative collaborative care model for ICU survivors. Am J Nurs 2015; 115: 24–31; quiz 4, 46 CrossRef MEDLINE PubMed Central |
| e32. | McWilliams DJ, Atkinson D, Carter A, Foëx BA, Benington S, Conway DH: Feasibility and impact of a structured, exercise-based rehabilitation programme for intensive care survivors. Physiother Theory Pract 2009; 25: 566–71 CrossRef MEDLINE |
| e33. | Major ME, Dettling-Ihnenfeldt D, Ramaekers SPJ, Engelbert RHH, van der Schaaf M: Feasibility of a home-based interdisciplinary rehabilitation program for patients with post-intensive care syndrome: The REACH study. Crit Care 2021; 25: 279 CrossRef MEDLINE PubMed Central |
| e34. | Boehm LM, Drumright K, Gervasio R, Hill C, Reed N: Implementation of a patient and family-centered intensive care unit peer support program at a veterans affairs hospital. Crit Care Nurs Clin North Am 2020; 32: 203–10 CrossRef MEDLINE PubMed Central |
| e35. | McPeake J, Shaw M, Iwashyna TJ, Daniel M, et al.: Intensive care syndrome: Promoting independence and return to employment (InS:PIRE). Early evaluation of a complex intervention. PLoS One 2017; 12: e0188028 CrossRef MEDLINE PubMed Central |
| e36. | Henderson P, Quasim T, Shaw M, et al.: Evaluation of a health and social care programme to improve outcomes following critical illness: A multicentre study. Thorax 2023; 78(2): 160–8 CrossRef MEDLINE PubMed Central |