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Review
. 2025 Oct;168(4):924-931.
doi: 10.1016/j.chest.2025.01.024. Epub 2025 Jan 31.

Communicating to Patients and Families About Post-Intensive Care Syndrome

Mark L Rolfsen  1 , M Elizabeth Wilcox  2 , Matthew F Mart  3 , James C Jackson  3 , Carla M Sevin  4 , E Wesley Ely  3
Affiliations
Review

Communicating to Patients and Families About Post-Intensive Care Syndrome

Mark L Rolfsen et al. Chest. 2025 Oct.

Abstract

Millions of people around the world survive critical illness each year only to realize that they and their loved ones are grappling with a new "normal" after hospital discharge for which their medical team may not have adequately prepared them. Up to one-half of all ICU survivors suffer from new or worsening impairments in physical, cognitive, and psychological domains of health that are often not realized until they attempt to re-enter their previous lives. These devastating long-term sequelae of critical illness, collectively described as post-intensive care syndrome (PICS), can carry enormous consequences for an ICU survivor's ability to care for their family, return to work, and regain their previous quality of life for months to years after their inciting illness. Despite mounting research on PICS and survivorship, a knowledge gap exists whereby ICU team members may not always be aware of PICS and may not counsel their patients on the challenges awaiting them after discharge. Understanding how best to communicate these challenges to patients and families is crucial in preparing for survivorship beyond the ICU. In this review, we summarize PICS and possible recovery trajectories of ICU survivors. We then discuss communication strategies, emphasizing the role of empathy. Finally, we provide a suggested framework to handle these crucial conversations. We aim to equip clinicians with the knowledge and framework to care for a patient who has survived critical illness but now faces the possibility of struggles inadequately addressed by our health care system.

Keywords: ABCDEF Bundle; ICU Liberation; PICS; brain injury; communication; critical care; delirium; dementia; disability; family engagement; functional impairment; long-term outcomes; mechanical ventilation; respiratory failure; sedation.

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Conflict of interest statement

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: M. L. R. is supported by the National Heart, Lung and Blood Institute (Grant No.T32HL087738). E. W. E. is supported by the National Institute on Aging (Grant No. R01AG058969) and the U.S. Department of Veteran Affairs (Grant No. I01RX002992). M. F. M. is supported by the U. S. Department of Veteran Affairs (Grant No. IK2RX004799). C. M. S. is supported by the National Institute of Aging (Grant No. R01AG077644), Patient-Centered Outcomes Research Institute (Grant No. BPS-2022C3-30021), and Department of Defense (Grant No. W81XWH-21-1-0051) None declared (J. C. J., M. E. W).

Figures

Figure 1
Figure 1
Major risk factors associated with development of PICS. PICS = post-intensive care syndrome.
Figure 2
Figure 2
Components of empathy in ICU communication.
Figure 3
Figure 3
Timeline of communication PICS to patients and families. A2F bundle = ABCDEF bundle; PICS = post-intensive care syndrome.
Figure 4
Figure 4
A2F bundle framework. A2F bundle = ABCDEF bundle; SAT = spontaneous awakening trial; SBT = spontaneous breathing trial.
See this image and copyright information in PMC

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Supplementary concepts