Co-occurring Subjective Post-Intensive Care Unit Syndrome (PICS) Symptoms: A Scoping Review

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Abstract Rationale: A growing number of intensive care unit (ICU) survivors experience distressing physical, cognitive, or mental symptoms or impairments post-ICU discharge, collectively known as post-intensive care syndrome (PICS). The surge in ICU admissions during the COVID-19 pandemic has brought greater attention to PICS, with changes in critical care practices—such as increased flexibility in resource utilization and new treatments—suggesting a potentially different ICU and post-ICU experience. Increasing evidence suggests that multiple PICS symptoms co-occur, with these co-occurring symptoms recognized as important correlates for patient prognosis and health outcomes across various populations. However, there is limited collation of literature on this topic. This scoping review aimed to map the current literature on co-occurring subjective PICS symptoms in ICU survivors, including the measures used and recall periods for assessing symptom co-occurrence. Methods: We searched PubMed, CINAHL, PsycINFO, and SCOPUS for articles published in English between January 2020 and December 2023. We included studies conducted in the United States that described co-occurring (multiple and concurrent) subjective, self-reported symptoms within one year of ICU discharge in adult (18 years) ICU survivors. Studies of families, caregivers, or pediatric patients were excluded unless the adult survivors’ symptoms were reported separately. This review followed the Joanna Briggs Institute (JBI) guidelines, with reporting based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) checklist. Results: Of 1,278 articles screened, eight studies met the inclusion criteria. Acute Respiratory Distress Syndrome (ARDS) and sepsis were the most common reasons for ICU admission. Measures included the Hospital Anxiety and Depression Scale (anxiety and depression), Patient Health Questionnaire-9 (depression), EuroQol 5-Dimension 5-Level (pain), and the Patient-Reported Outcome Measurement Information System Fatigue Item Bank (fatigue), with recall periods varying from “right now” to “two weeks”. One study directly reported co-occurring symptoms of fear, anxiety, frustrations, and breathing discomfort. Seven studies suggested possible symptom co-occurrence by documenting symptoms and impairments associated with PICS across multiple domains, reporting correlations between symptoms, or indicating possible symptom co-occurrence based on prior research. Conclusions: Literature on co-occurring symptoms in PICS remains limited, with symptom measures often focusing on a single PICS domain and showing wide variability in recall periods. Future research should focus on conceptually defining co-occurring symptoms, particularly concerning recall periods, and developing valid tools to establish consistent measurement of co-occurring symptoms from a patient-centered perspective. This would inform effective post-discharge symptom management interventions for ICU survivors.

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