Post-intensive care syndrome follow-up system after hospital discharge: a narrative review

Overview of Post-Intensive Care Syndrome (PICS)

As critical care medicine has advanced, survival rates for patients in intensive care units (ICUs) have improved significantly. However, many survivors experience long-term physical, cognitive, and mental health impairments, collectively known as Post-Intensive Care Syndrome (PICS). These issues can persist for years, severely impacting a patient's quality of life and ability to return to work. Because standard hospital-based interventions are often insufficient to prevent these long-term sequelae, structured follow-up systems are increasingly recognized as a critical component of post-ICU care.

The PICS Follow-up System

Follow-up systems aim to provide ongoing evaluation and treatment for survivors. These models vary widely, ranging from specialized outpatient PICS clinics to home visitations, telephone interviews, and internet-based telemedicine. While the first dedicated clinic was established in the U.K. in 1993, these systems remain relatively uncommon in many countries, including Japan.

Effective management requires a multidisciplinary team approach involving physicians, nurses, physical therapists, pharmacists, clinical psychologists, and dietitians. The authors emphasize that because PICS symptoms develop early, follow-up should ideally begin within one to three months after hospital discharge. Given the logistical challenges of face-to-face visits for severely ill patients, remote options like telemedicine are becoming vital for maintaining patient engagement and retention.

Assessment and Intervention

There is currently no global standardization for PICS assessment. Clinicians must choose from over 30 available instruments, balancing sensitivity and specificity. For example, simple screening tools like the PHQ-4 (mental health) or handgrip strength (physical) are useful for initial identification, while more comprehensive tools are reserved for deeper evaluation.

Treatment interventions focus on three pillars: medication management, rehabilitation, and nutrition therapy. Despite the intuitive benefits of these multidisciplinary interventions, randomized controlled trials have yet to provide definitive evidence that these clinics significantly improve long-term quality of life or reduce medical costs. The authors suggest that future research should focus on refining the target population—prioritizing high-risk patients such as those with prolonged ventilation or sepsis—to optimize resource allocation and improve clinical outcomes.