The interconnectedness of the post-intensive care syndrome domains: A qualitative study

Each year, more than 30 million people worldwide are admitted to intensive care units (ICUs) with life-threatening illness or injury. While advances in intensive care have improved survival, many continue to face long-term consequences after discharge. Post-intensive care syndrome (PICS), encompassing physical, cognitive, psychological, and social impairments, profoundly affects everyday life, family dynamics, and the ability to return to previous activity levels. Prevalence estimates vary, but more than half of individuals surviving an ICU admission remain affected 1 year after discharge. Although research has often focused on isolated symptoms, less is known about how these domains interact and shape recovery. Exploring this interconnectedness from the perspectives of individuals with a previous ICU admission and their relatives is essential for guiding person-centred rehabilitation strategies.

This study explored how individuals with a previous ICU admission and their relatives experience the interconnections between physical, cognitive, psychological, and social domains of PICS in the months following discharge.

We conducted a secondary qualitative content analysis of data originally collected in a phenomenological-hermeneutic study. Semistructured single and dyadic interviews were carried out with 18 individuals with a previous ICU admission and 14 relatives (partners, parents, or children) at 3 and 6 months after ICU discharge. Participants were recruited from two Danish hospitals. Data analysis followed Elo and Kyngäs' approach, combining deductive and inductive phases: the PICS framework guided the deductive coding, while inductive analysis allowed new themes to emerge. The study adhered to the Consolidated Criteria for Reporting Qualitative Research.

Participants described persistent challenges across all four PICS domains. These were rarely experienced in isolation but overlapped, shaping everyday struggles such as managing energy, coping with memory difficulties, and maintaining social connections. Relatives provided perspectives that both complemented and extended the accounts of individuals with a prior ICU admission, highlighting how the interplay between domains influenced recovery trajectories.

Recovery after critical illness is shaped by the interconnected nature of physical, cognitive, psychological, and social challenges, with fatigue emerging as a central factor affecting all domains. The findings underscore the need for integrated, multidimensional rehabilitation strategies that actively include both individuals with a previous ICU admission and their relatives.