Critical illness can be lethal and devastating to survivors.
Improvements in acute care have increased the number of intensive
care unit (ICU) survivors. These survivors confront a range of
new or worsened health states that collectively are commonly
denominated post–intensive care syndrome (PICS). These problems
include physical, cognitive, psychological, and existential aspects,
among others. Burgeoning interest in improving long-term
outcomes for ICU survivors has driven an array of potential
interventions to improve outcomes associated with PICS. To date,
the most promising interventions appear to relate to very early
physical rehabilitation. Late interventions within aftercare and recovery clinics have yielded mixed results, although experience in heart failure programs suggests the possibility that very early case management interventions may help improve intermediate-term outcomes, including mortality and hospital readmission. Predictive models have tended to underperform, complicating study design
and clinical referral. The complexity of the health states associated
with PICS suggests that careful and rigorous evaluation of
multidisciplinary, multimodality interventions—tied to the specific
conditions of interest—will be required to address these important
problems.