Effectiveness of targeted post-acute interventions and follow-up services for sepsis survivors: a systematic review

Abstract

Background: The majority of sepsis survivors suffer from significant long-term consequences, including cognitive, psychological, and physical impairments. Despite growing recognition of these challenges, there is a lack of robust evidence regarding effective post-acute interventions to improve long-term outcomes. This systematic review aims to compile the present evidence on the effectiveness of post-acute interventions and follow-up services on patient-relevant long-term outcomes of sepsis survivors.

Methods: PubMed, Web of Science and ClinicalTrials.gov were searched for relevant publications from 01/2013 until 08/2024. Studies evaluating the effect of targeted post-acute interventions and follow-up services compared to usual care were included. Risk of bias was assessed using the RoB2- and ROBINS-I tool.

Results: Fourteen studies including 383,680 patients from high-income-countries were identified. All included studies showed either a moderate risk of bias (non-randomized studies) or some concerns (randomized trials), primarily due to residual confounding, suboptimal blinding and outcome assessment. Interventions varied substantially in terms of measures, implementation time and outcomes addressed. Rehabilitation interventions were associated with long-term survival benefits until 10 years after sepsis according to three observational studies. Additionally, one randomized controlled trial with minimization found that an 8-week exercise-based intervention improved the anaerobic threshold in sepsis survivors. Interventions (n = 7) targeting care coordination and follow-up bundles led to reductions in rehospitalization rates and mortality until 12 months post-discharge and were associated with improvements in long-term physical function and PTSD symptoms. An ICU-specific virtual reality-based intervention may reduce symptoms of PTSD and depression up to six months after exposure.

Conclusion: Post-acute interventions, such as care coordination, bundle approaches, and rehabilitation can improve patient-relevant outcomes in sepsis survivors. However, the overall number of existing studies is small, all studies may be affected by certain forms of bias and for some domains of post-sepsis impairment no specific interventions have yet been identified. Therefore, further high-quality prospective follow-up studies are needed to strengthen the evidence regarding the effectiveness and acceptability of interventions across all domains of post-sepsis impairments, particularly cognitive impairments.

Keywords: Long-term outcomes of sepsis; Post-acute care; Post-sepsis syndrome; Sepsis; Sepsis sequelae.

Fig. 1

Flow of study inclusion (created in https://BioRender.com)

Fig. 2

Implementation Period of the Interventions. Interventions focused on mental health are marked in blue; those including rehabilitation and physical exercise are marked in green; and studies using post-sepsis care coordination or bundle approaches as well as pharmacist-led interventions are marked in violet. (created in https://BioRender.com)