A novel ‘Timing it Right’-based intervention for post-intensive care syndrome in critically ill elderly patients: study protocol and preliminary implementation findings of a randomized controlled trial

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BACKGROUND: Critically ill elderly patients face elevated risks of post-intensive care syndrome (PICS) due to unique vulnerabilities, including rapid disease progression, multimorbidity, and multi-organ dysfunction. Current rehabilitation models often lack phase-integrated continuity, creating a significant gap in preventing long-term functional decline. This study aimed to test a novel, time-sequenced "Timing It Right" (TIR) framework spanning the entire post-ICU continuum-from ICU to community reintegration-to reduce the incidence and burden of PICS. METHODS: A prospective, randomized controlled trial (RCT; registered at ChiCTR2400083434) with blinded outcome assessment was conducted. The intervention group received TIR-based care, tailored to five specific recovery phases (ICU acute, ICU transition, discharge preparation, post-discharge adjustment, and acclimatization), in addition to usual care. The control group received usual care alone. Feasibility was assessed through strict protocol adherence monitoring and structured multidisciplinary team feedback. RESULTS: Preliminary implementation in 90 patients confirmed high protocol feasibility, with no major deviations and positive acceptability among the healthcare team. Full outcome analysis is ongoing and will be reported separately. DISCUSSION: The TIR framework directly addresses a critical gap in post-ICU care by providing integrated, stage-specific support. By dynamically aligning interventions with patients' evolving needs, this model holds promise for significantly improving functional outcomes and offers a scalable, efficient template for resource-limited settings. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400083434; registered 25/04/2024.

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