Swedish Consensus Recommendation for Follow-Up After ICU Stay

A substantial proportion of intensive care unit (ICU) survivors experience long-term physical, psychological and cognitive impairments after critical illness. However, methods for identifying patients in need of post-ICU support vary widely. As a result, many patients are left without access to established rehabilitation pathways. This consensus recommendation provides a framework for the organisation and content of follow-up for adult ICU survivors in Sweden, informed by available evidence, stakeholder perspectives and expert consensus.

The National System for Knowledge-Driven Healthcare Management (NPO) in Sweden commissioned the development of a practice recommendation for the follow-up of critically ill adults. Multidisciplinary experts in ICU survivorship formed a task force group. A systematic literature search in four databases was conducted in 2024 to identify pre-existing systematic reviews on the topic. The literature was reviewed, assessed for quality and recommendations were developed based on the literature evidence. The draft was discussed among multiprofessional groups involved in follow-up, in workshops with critical care nurses (n = 30) and professionals responsible for follow-up clinics (n = 74) and among patient representatives (n = 4). The final draft underwent external peer review by representatives from relevant professional organisations, the national registry for intensive care and governmental agencies in Sweden.

The consensus recommendation suggests that all adult patients with an ICU length of stay ≥ 48 h are recommended for follow-up, with an initial contact within 1 week of ICU discharge to assess clinical status, identify early problems and ensure continuity of care. Patients and their families are recommended to be offered an outpatient follow-up visit at 2-3 months after discharge, led by ICU clinicians and, when possible, delivered by a multidisciplinary team. Validated screening tools and objective tests are recommended to assess relevant outcomes, including post-traumatic stress, anxiety, depression, cognitive impairment, physical function and Health-Related Quality of Life (HRQoL) as appropriate. Patients with identified problems should be referred to appropriate healthcare providers or specialist services for further management.

This consensus recommendation provides a framework for patient selection, timing and assessment to support a more structured and equitable management of post-intensive care syndrome.

Systematic follow up of ICU survivors after hospital discharge is needed in order to assess long-term patient-centred outcomes. This is a consensus set of recommendations and not a GRADE-based clinical practice guideline for doing this, which can be considered by relevant ICUs.