Background:  Post-intensive care syndrome (PICS) refers to a constellation of new or worsening physical, cognitive, or psychiatric deficits following a critical illness that persists beyond the index hospitalization. PICS is reported in over half of intensive care unit (ICU) survivors (1). Despite increased interest, studies of PICS prevalence and risk factors remain limited by the highly comorbid and heterogeneous population. Data regarding therapeutic interventions are lacking. Nonetheless, understanding this concept is important for clinicians taking care of ICU survivors.

Diagnosis: PICS has no specific diagnostic criteria and is not considered a billable clinical syndrome. The term is used in the published literature to describe the co-occurrence of common symptoms and findings in survivors of critical illness.  It is not limited to older patients or those with baseline comorbidities (2). Clinicians should have high suspicion for PICS in any patient with a prolonged ICU stay (e.g., > 1-2 weeks), especially those with long durations of ICU delirium, hypoxemia, mechanical ventilation, sedation, or neuromuscular blockade. Weakness, fatigue, pain are common elements of PICS as is neurocognitive impairment.  In fact, up to 25% of ICU survivors without baseline cognitive impairment demonstrate similar cognitive testing scores to patients with mild dementia 3 months after their ICU stay (2). Post-traumatic stress disorder (PTSD) is newly diagnosed in 5-10% of ICU survivors; anxiety and depression likely in 10 and 20%, respectively (1). Use of screening tools is not necessary for diagnosis of PICS, but experts recommend the use of 6-minute walk test, Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS), and Revised Impact of Event Scale (IES-R) at post-ICU follow up visits to screen for physical deficits, cognitive deficits, anxiety/depression, and PTSD (3).

Management: Due to limited research, PICS management strategies are largely non-specific and extrapolated from treatments for each individual symptom in patients without ICU exposure. Interprofessional team members such as social workers, mental health specialists, pharmacists, geriatricians, physical and occupational therapists, and neuropsychologists are recommended in accordance with established treatment guidelines for physical deconditioning, anxiety, depression, cognitive impairment, and post-traumatic stress (4-7).

Prognosis: Symptoms of PICS typically show incomplete improvement over time, with the domain of cognitive impairment carrying the worst prognosis. Of patients with significant cognitive impairment at three months after ICU discharge, 85% had persistence of their cognitive impairment at one year (2). Physical symptoms tend to fare better with roughly half of patients with new weakness after acute lung injury showing significant improvement at one year (8). Functional status and patient-reported health-related quality of life often remain below ICU-admission levels one year after the ICU stay (8).

Follow-up care in PICS:  Both primary and specialist palliative care are important components of caring for ICU survivors (9). Most patients who survive > 1 year after a critical illness report an acceptable quality of life, though survivorship bias likely limits the generalizability of this finding to patients in the acute care setting (10). For many ICU survivors, especially those with recurrent or chronic critical illness, treatment preferences evolve following ICU exposure and/or changes in functional status or prognosis. It is important for clinicians to provide clear and honest communication in terms of likelihood of recovery of specific abilities such as walking, communicating, and carrying out activities of daily living (ADLs). Ascertaining patients’ and their families’ illness understanding and exploring what is most important should guide these conversations and clinicians should be willing to engage in these discussions iteratively, over time. These conversations commonly uncover complexities or uncertainty in treatment goals, and involvement of specialty palliative care for discussions of values and advance care planning may be indicated.  The role of specialized post-ICU follow-up clinics is expanding and can be helpful following hospital discharge to address lingering physical, cognitive, and mental health issues from the ICU stay. These clinics are typically multidisciplinary, often staffed by intensivists, rehabilitation specialists, physical therapists, nurses, social workers, and psychologists (11). 

Post-Intensive Care Syndrome – Family (PICS-F): PICS-F refers to psychological distress in a family member of a patient with a prolonged critical illness. PTSD has been shown in as many as 14% of family members of patients who die in the ICU (12). PTSD appears to be more prevalent when families who prefer to be involved in medical decision making are not included and when families who preferred to leave decision-making to the clinicians were pressured to partake in it. This highlights the importance of nuanced, family-centered communication in the ICU. Involvement of interprofessional support (e.g., social workers, chaplains, nurses, child-life specialists) as well as specialized palliative care teams during the ICU stay can help family caregivers.  

References 

1. Geense WW, Zegers M, Peters MAA, et al. New Physical, Mental, and Cognitive Problems 1 Year after ICU Admission: A Prospective Multicenter Study.Am J Respir Crit Care Med2021;203(12):1512-1521. doi:10.1164/rccm.202009-3381OC.
2. Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness.NEngl J Med 2013;369(14):1306-16. doi:10.1056/NEJMoa1301372.
3. Mikkelsen ME, Still M, Anderson BJ, et al. Society of Critical Care Medicine’s International Consensus Conference on Prediction and Identification of Long-Term Impairments After Critical Illness.Crit Care Med2020;48(11):1670-1679. doi:10.1097/CCM.0000000000004586.
4. Connolly B, Salisbury L, O’Neill B, et al. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness.Cochrane Database SystRev. Jun 22 2015;2015(6):CD008632. doi:10.1002/14651858.CD008632.pub2.
5. American Psychological Association. Clinical practiceguidelinefor the treatment of depression across three age cohorts. 2019.  
6. Szuhany KL, Simon NM. Anxiety Disorders: A Review.JAMA. Dec 272022;328(24):2431-2445. doi:10.1001/jama.2022.22744.
7. American Psychological Association. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) inAdults. 2025.
8. Fan E, Dowdy DW, Colantuoni E, et al. Physical complications in acute lung injury survivors: a two-year longitudinal prospective study.Crit Care Med. Apr 2014;42(4):849-59. doi:10.1097/CCM.0000000000000040.
9. Mehta A, Bullock K, Gustin JL, et al. Top Ten Tips Palliative Care Clinicians Should Know About Intensive Care Unit Consultation.J Palliat Med. Mar 112026:10966218251366072. doi:10.1177/10966218251366072.
10. Kerckhoffs MC,KosasiFFL, Soliman IW, van Delden JJM, Cremer OL, de Lange DW, et al. Determinants of self-reported unacceptable outcome of intensive care treatment 1 year after discharge. Intensive Care Med. 2019;45(6):806-14. 
11. Mehlhorn J, Freytag A, Schmidt K, et al. Rehabilitation interventions forpostintensivecare syndrome: a systematic review. Crit Care Med. May 2014;42(5):1263-71. doi:10.1097/CCM.0000000000000148.
12. Gries CJ, Engelberg RA, Kross EK, et al. Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU.Chest. Feb 2010;137(2):280-7. doi:10.1378/chest.09-1291.

Author Affiliations: Icahn School of Medicine at Mount Sinai, New York, NY.
Version History: First electronically published in July 2026, originally edited by Sean Marks MD.
Authors attestation: The authors attest that they authored the Fast Fact and verified all references.  No conflicts of interest were disclosed.