Post-intensive care syndrome: Recent advances and future directions

doi:10.1002/ams2.929

Review

. 2024 Feb 20;11(1):e929.

doi: 10.1002/ams2.929. eCollection 2024 Jan-Dec.

Post-intensive care syndrome: Recent advances and future directions

Shigeaki Inoue¹, Nobuto Nakanishi², Fumimasa Amaya³, Yoshihisa Fujinami⁴, Junji Hatakeyama⁵, Toru Hifumi⁶, Yuki Iida⁷, Daisuke Kawakami⁸, Yusuke Kawai⁹, Yutaka Kondo¹⁰, Keibun Liu^{11

12

13}, Kensuke Nakamura¹⁴, Takeshi Nishida¹⁵, Hidenori Sumita¹⁶, Shunsuke Taito¹⁷, Shunsuke Takaki¹⁴, Norihiko Tsuboi¹⁸, Takeshi Unoki^{19

20}, Yasuyo Yoshino²¹, Osamu Nishida²²

Affiliations

¹ Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan.
² Division of Disaster and Emergency Medicine, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan.
³ Department of Pain Management and Palliative Care Medicine Kyoto Prefectural University of Medicine Kyoto Japan.
⁴ Department of Emergency Medicine Kakogawa Central City Hospital Kakogawa Japan.
⁵ Department of Emergency and Critical Care Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan.
⁶ Department of Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan.
⁷ Faculty of Physical Therapy, School of Health Sciences Toyohashi Sozo University Toyohashi Japan.
⁸ Department of Intensive Care Medicine Aso Iizuka Hospital Fukuoka Japan.
⁹ Department of Nursing Fujita Health University Hospital Toyoake Japan.
¹⁰ Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Japan.
¹¹ Critical Care Research Group The Prince Charles Hospital Chermside Queensland Australia.
¹² Faculty of Medicine The University of Queensland, Mayne Medical School Herston Queensland Australia.
¹³ Non-Profit Organization ICU Collaboration Network (ICON) Tokyo Japan.
¹⁴ Department of Critical Care Medicine Yokohama City University School of Medicine Yokohama Japan.
¹⁵ Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan.
¹⁶ Clinic Sumita Toyokawa Japan.
¹⁷ Division of Rehabilitation, Department of Clinical Practice and Support Hiroshima University Hospital Hiroshima Japan.
¹⁸ Division of Critical Care Medicine, Department of Critical Care and Anesthesia National Center for Child Health and Development Setagaya Japan.
¹⁹ Department of Acute and Critical Care Nursing, School of Nursing Sapporo City University Sapporo Japan.
²⁰ Teine Keijinkai Hospital Sapporo Japan.
²¹ Department of Nursing, Faculty of Nursing Komazawa Women's University Tokyo Japan.
²² Department of Anesthesiology and Critical Care Medicine Fujita Health University School of Medicine Toyoake Japan.

PMID: 38385144
PMCID: PMC10879727
DOI: 10.1002/ams2.929

Review

Post-intensive care syndrome: Recent advances and future directions

Shigeaki Inoue et al. Acute Med Surg. 2024.

. 2024 Feb 20;11(1):e929.

doi: 10.1002/ams2.929. eCollection 2024 Jan-Dec.

Authors

Affiliations

¹ Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan.
² Division of Disaster and Emergency Medicine, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan.
³ Department of Pain Management and Palliative Care Medicine Kyoto Prefectural University of Medicine Kyoto Japan.
⁴ Department of Emergency Medicine Kakogawa Central City Hospital Kakogawa Japan.
⁵ Department of Emergency and Critical Care Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan.
⁶ Department of Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan.
⁷ Faculty of Physical Therapy, School of Health Sciences Toyohashi Sozo University Toyohashi Japan.
⁸ Department of Intensive Care Medicine Aso Iizuka Hospital Fukuoka Japan.
⁹ Department of Nursing Fujita Health University Hospital Toyoake Japan.
¹⁰ Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Japan.
¹¹ Critical Care Research Group The Prince Charles Hospital Chermside Queensland Australia.
¹² Faculty of Medicine The University of Queensland, Mayne Medical School Herston Queensland Australia.
¹³ Non-Profit Organization ICU Collaboration Network (ICON) Tokyo Japan.
¹⁴ Department of Critical Care Medicine Yokohama City University School of Medicine Yokohama Japan.
¹⁵ Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan.
¹⁶ Clinic Sumita Toyokawa Japan.
¹⁷ Division of Rehabilitation, Department of Clinical Practice and Support Hiroshima University Hospital Hiroshima Japan.
¹⁸ Division of Critical Care Medicine, Department of Critical Care and Anesthesia National Center for Child Health and Development Setagaya Japan.
¹⁹ Department of Acute and Critical Care Nursing, School of Nursing Sapporo City University Sapporo Japan.
²⁰ Teine Keijinkai Hospital Sapporo Japan.
²¹ Department of Nursing, Faculty of Nursing Komazawa Women's University Tokyo Japan.
²² Department of Anesthesiology and Critical Care Medicine Fujita Health University School of Medicine Toyoake Japan.

PMID: 38385144
PMCID: PMC10879727
DOI: 10.1002/ams2.929

Abstract

Post-intensive care syndrome comprises physical, cognitive, and mental impairments in patients treated in an intensive care unit (ICU). It occurs either during the ICU stay or following ICU discharge and is related to the patients' long-term prognosis. The same concept also applies to pediatric patients, and it can greatly affect the mental status of family members. In the 10 years since post-intensive care syndrome was first proposed, research has greatly expanded. Here, we summarize the recent evidence on post-intensive care syndrome regarding its pathophysiology, epidemiology, assessment, risk factors, prevention, and treatments. We highlight new topics, future directions, and strategies to overcome post-intensive care syndrome among people treated in an ICU. Clinical and basic research are still needed to elucidate the mechanistic insights and to discover therapeutic targets and new interventions for post-intensive care syndrome.

Keywords: cognitive impairment; mental impairment; physical impairment; post‐intensive care syndrome.

PubMed Disclaimer

Conflict of interest statement

Dr. Yutaka Kondo is an Editorial Board member of AMS Journal and a co‐author of this article. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication. The other authors declare no conflicts of interest in relation to this review article.

Figures

**FIGURE 1**
Number of published PICS‐related papers per year. (Post‐intensive care syndrome [Title]) OR (Post intensive care syndrome [Title]) was searched in PubMed (https://pubmed.ncbi.nlm.nih.gov/) on June 29th 6:00 am. Articles were divided into three groups: clinical study, experimental study, and review articles.

**FIGURE 2**
Relationship between PICS and ICU‐acquired chronic pain. (A) Current concept: ICU‐acquired chronic pain is independent of PICS although partly overlapping. (B) Authors' hypothesis: ICU‐acquired chronic pain is included in PICS and related to each PICS domain.

**FIGURE 3**
Concept of persistent inflammation, immunosuppression, and catabolism syndrome (PIICS). In ICU patients, the first hit (e.g., sepsis, trauma, and burn) causes persistent inflammation, immunosuppression, and hyper‐catabolism, thereby leading to the likelihood of a second hit caused by the infection.

**FIGURE 4**
Risk factors for PICS. Letters (P, I, C, and S) include each component shown in the figure.

**FIGURE 5**
ABCDEF bundle for PICS prevention. The ABCDEF bundle includes A–F components shown in the figure.

See this image and copyright information in PMC

Cited by

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients.
Ekong M, Monga TS, Daher JC, Sashank M, Soltani SR, Nwangene NL, Mohammed C, Halfeld FF, AlShelh L, Fukuya FA, Rai M. Ekong M, et al. Cureus. 2024 May 31;16(5):e61443. doi: 10.7759/cureus.61443. eCollection 2024 May. Cureus. 2024. PMID: 38953087 Free PMC article. Review.
Gut-Brain Axis-Based Polygala Tenuifolia and Magnolia Officinalis Improve D-gal-Induced Cognitive Impairment in Mice Through cAMP and NF-κB Signaling Pathways.
Yang D, Li W, Chen Q, Liu S, Peng C, Deng F, Meng Y, Yang Y, Yan P, Ao H, Huang L. Yang D, et al. Drug Des Devel Ther. 2025 Mar 13;19:1869-1894. doi: 10.2147/DDDT.S506545. eCollection 2025. Drug Des Devel Ther. 2025. PMID: 40098911 Free PMC article.
Prevalence and Management of Oral Intake Restrictions in Critically Ill Patients: Insights from a Multicenter Point Prevalence Study.
Hongo T, Yumoto T, Liu K, Nakamura K, Kawauchi A, Tsunemitsu T, Nakanishi N, Nakao A, Naito H; Oral Intake in I. C. U. study group. Hongo T, et al. Dysphagia. 2025 Aug;40(4):747-758. doi: 10.1007/s00455-024-10772-5. Epub 2024 Oct 21. Dysphagia. 2025. PMID: 39433566 Free PMC article.
Consensus-Based Recommendations for Assessing Post-Intensive Care Syndrome: A Systematic Review.
Bornemann-Cimenti H, Lang J, Hammer S, Lang-Illievich K, Labenbacher S, Neuwersch-Sommeregger S, Klivinyi C. Bornemann-Cimenti H, et al. J Clin Med. 2025 May 21;14(10):3595. doi: 10.3390/jcm14103595. J Clin Med. 2025. PMID: 40429591 Free PMC article. Review.
Two-year trajectory of functional recovery and quality of life in post-intensive care syndrome: a multicenter prospective observational study on mechanically ventilated patients with coronavirus disease-19.
Hatakeyama J, Nakamura K, Inoue S, Liu K, Yamakawa K, Nishida T, Ohshimo S, Hashimoto S, Kanda N, Aso S, Suganuma S, Maruyama S, Ogata Y, Takasu A, Kawakami D, Shimizu H, Hayakawa K, Yoshida T, Oshima T, Fuchigami T, Yawata H, Oe K, Kawauchi A, Yamagata H, Harada M, Sato Y, Nakamura T, Sugiki K, Hakozaki T, Beppu S, Anraku M, Kato N, Iwashita T, Kamijo H, Kitagawa Y, Nagashima M, Nishimaki H, Tokuda K, Nishida O. Hatakeyama J, et al. J Intensive Care. 2025 Feb 6;13(1):7. doi: 10.1186/s40560-025-00777-z. J Intensive Care. 2025. PMID: 39915821 Free PMC article.

See all "Cited by" articles

References

1. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–1247. - PMC - PubMed
1. Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, et al. The Japanese clinical practice guidelines for management of sepsis and septic shock 2020 (J‐SSCG 2020). Acute Med Surg. 2021;8(1):e659. - PMC - PubMed
1. Kadri SS, Rhee C, Strich JR, Morales MK, Hohmann S, Menchaca J, et al. Estimating ten‐year trends in septic shock incidence and mortality in United States academic medical centers using clinical data. Chest. 2017;151(2):278–285. - PMC - PubMed
1. Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009–2014. JAMA. 2017;318(13):1241–1249. - PMC - PubMed
1. Imaeda T, Nakada TA, Takahashi N, Yamao Y, Nakagawa S, Ogura H, et al. Trends in the incidence and outcome of sepsis using data from a Japanese nationwide medical claims database‐the Japan Sepsis Alliance (JaSA) study group. Crit Care. 2021;25(1):338. - PMC - PubMed

Publication types

Actions

LinkOut - more resources

Full Text Sources

[1] Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–1247. - PMC - PubMed

[2] Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–1247. - PMC - PubMed

[3] Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, et al. The Japanese clinical practice guidelines for management of sepsis and septic shock 2020 (J‐SSCG 2020). Acute Med Surg. 2021;8(1):e659. - PMC - PubMed

[4] Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, et al. The Japanese clinical practice guidelines for management of sepsis and septic shock 2020 (J‐SSCG 2020). Acute Med Surg. 2021;8(1):e659. - PMC - PubMed

[5] Kadri SS, Rhee C, Strich JR, Morales MK, Hohmann S, Menchaca J, et al. Estimating ten‐year trends in septic shock incidence and mortality in United States academic medical centers using clinical data. Chest. 2017;151(2):278–285. - PMC - PubMed

[6] Kadri SS, Rhee C, Strich JR, Morales MK, Hohmann S, Menchaca J, et al. Estimating ten‐year trends in septic shock incidence and mortality in United States academic medical centers using clinical data. Chest. 2017;151(2):278–285. - PMC - PubMed

[7] Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009–2014. JAMA. 2017;318(13):1241–1249. - PMC - PubMed

[8] Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009–2014. JAMA. 2017;318(13):1241–1249. - PMC - PubMed

[9] Imaeda T, Nakada TA, Takahashi N, Yamao Y, Nakagawa S, Ogura H, et al. Trends in the incidence and outcome of sepsis using data from a Japanese nationwide medical claims database‐the Japan Sepsis Alliance (JaSA) study group. Crit Care. 2021;25(1):338. - PMC - PubMed

[10] Imaeda T, Nakada TA, Takahashi N, Yamao Y, Nakagawa S, Ogura H, et al. Trends in the incidence and outcome of sepsis using data from a Japanese nationwide medical claims database‐the Japan Sepsis Alliance (JaSA) study group. Crit Care. 2021;25(1):338. - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Post-intensive care syndrome: Recent advances and future directions

Affiliations

Post-intensive care syndrome: Recent advances and future directions

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

LinkOut - more resources

Full Text Sources

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

Related information

LinkOut - more resources

Full Text Sources