Post-intensive care syndrome: prevention, ICU diaries and follow-up for the patient and family

What it is

Post-intensive care syndrome (PICS) is a new or worse impairment of physical, cognitive or mental health that persists after an ICU stay. The family can be affected too (PICS-F). The most frequent physical problem is ICU-acquired weakness; delirium is the strongest predictor of later cognitive problems; and depression, anxiety and post-traumatic stress are common. Chronic pain, poor sleep and swallowing problems also occur. Prevention starts in the ICU with the ABCDEF bundle, early mobilisation, delirium prevention and family involvement, and continues after discharge with screening and follow-up. Evidence for diaries and follow-up clinics is mixed.

Key points

• In adult survivors, depression affects about 25–46 %, anxiety about 30 % and post-traumatic stress about 20 %.
• Physical restraints in the ICU may be linked to post-traumatic stress and delirium.
• Swallowing problems after extubation affect 36–44 % of patients; early bedside screening shortens the time to eating safely.
• ICU diaries: evidence is inconsistent; some studies show less anxiety or depression in survivors and fewer post-traumatic symptoms in relatives.
• Structured follow-up clinics have not consistently improved outcomes; the first one opened in the United Kingdom in 1993.

Components

• Physical domain: weakness, fatigue, low physical function, pain.
• Cognitive domain: memory, attention, language and executive function.
• Mental domain: depression, anxiety, post-traumatic stress, poor sleep.
• Family domain (PICS-F): depression, anxiety and caregiver burden.

What it is for

• Explains why survival is not the only outcome of intensive care.
• Gives a reason for ICU practices such as light sedation, delirium prevention and early mobilisation.
• Guides screening before discharge and in follow-up, with tools that record the baseline and later changes.
• Brings the family into the plan as people who also need care.

In nursing practice

• Mobilise early as the protocol allows and record the highest level of mobility reached each day.
• Screen for delirium every shift and apply the prevention measures; screening tools for cognition need the patient to be out of delirium.
• Screen swallowing after extubation before oral intake, according to the unit pathway.
• Avoid physical restraints when other options exist.
• Where diaries are used, staff and family write in plain language what happened day by day, and the diary is given to the patient after discharge.
• Before discharge, record the patient's physical and mental status so that later follow-up can measure the change.

Common mistakes

• Believing the patient «is fine» because they survived and went home.
• Leaving mobilisation until the patient is off the ventilator.
• Forgetting the relatives, who can develop anxiety and depression too.
• Testing memory or attention while the patient is still delirious.

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Elsewhere in DurgiPedia

• Stress: the general adaptation syndrome and allostatic load
• Coping and resilience

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Post-intensive care syndrome: a state-of-the-art review (Singapore Medical Journal, 2026); New developments in the provision of family-centered care in the intensive care unit (Intensive Care Medicine, 2017); Timing of exposure to ICU diaries and its impact on mental health, memories, and quality of life: a double-blind randomized control trial (Critical Care Explorations, 2022).

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