Critical Illness Recovery, Mechanical Ventilation, Post-Intensive Care Syndrome (PICS)
Conditions
Keywords
Ventilator liberation, High-dependency unit, Post-ICU rehabilitation
Brief summary
Post-intensive care syndrome (PICS) is characterized by persistent physical, cognitive, and psychological impairments among survivors of critical illness. Although advances in intensive care medicine have reduced mortality, a large proportion of ICU survivors experience long-term functional impairments after discharge. High-dependency units (HDUs) serve as transitional care settings between intensive care units and general wards. Many critically ill survivors who cannot directly return home are transferred to HDU for continued treatment and rehabilitation. However, evidence regarding systematic multidisciplinary rehabilitation interventions in HDU settings remains limited. This prospective single-center interventional study aims to evaluate the effects of an integrated multidisciplinary rehabilitation model implemented in the HDU on physical, cognitive, and psychological outcomes among patients with post-intensive care syndrome. All enrolled patients will receive standardized integrated medical, nursing, and rehabilitation interventions. Multidimensional functional assessments will be conducted at baseline, during hospitalization, and before discharge from the HDU.
Detailed description
Post-intensive care syndrome (PICS) includes physical weakness, cognitive impairment, and psychological disorders that occur after critical illness. Previous studies have shown that 50-70% of ICU survivors develop at least one PICS-related impairment within 6-12 months after discharge. Current interventions mainly focus on ICU-based strategies such as the ABCDEF bundle, which can improve short-term outcomes but may not adequately address long-term functional recovery. Many patients remain severely debilitated after ICU discharge and require transitional care. The high-dependency unit (HDU) represents a potential critical window for early rehabilitation intervention. Patients in this stage often have multiple functional impairments but remain medically stable enough to participate in rehabilitation programs. This study will enroll patients transferred from ICU to HDU who meet diagnostic criteria for PICS. Participants will receive an integrated multidisciplinary intervention including medical management, respiratory rehabilitation, physical rehabilitation, nursing care, and cognitive-psychological support. Functional assessments will be conducted at baseline, every two weeks during hospitalization, and prior to HDU discharge. The study will evaluate changes in physical, cognitive, and psychological outcomes associated with this intervention.
Interventions
BEHAVIORALIntegrated Multidisciplinary Rehabilitation
Participants will receive a standardized multidisciplinary rehabilitation program implemented in the HDU, including: Medical management Continuous treatment of primary diseases, medication optimization, complication prevention, and gradual removal of medical devices. Respiratory rehabilitation Respiratory muscle training, airway clearance techniques, and breathing pattern training. Physical rehabilitation Progressive mobilization according to patient tolerance, including passive exercises, active bed exercises, sitting training, standing training, and walking training. Sessions are conducted 1-2 times per day, lasting 20-40 minutes each. Rehabilitation nursing Position management, pressure injury prevention, device safety management, and sleep management. Cognitive and psychological interventions Orientation training, cognitive stimulation activities, psychological support, and family participation.
Sponsors
Hongying Jiang, MD
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years * Diagnosed with post-intensive care syndrome * Transferred from ICU to HDU * Available paired admission and discharge data
Exclusion criteria
* Death within 24 hours after HDU admission * Missing primary outcome data
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Physical Function (CPAx Score) | Baseline (within 48 hours after HDU admission) and at HDU discharge，assessed up to 2 days | Change in Chelsea Critical Care Physical Assessment Tool (CPAx) score from baseline to HDU discharge. The CPAx score ranges from 0 to 50, with higher scores indicating better physical function. |
Countries
China
Contacts
CONTACTJingyi Ge
STUDY_CHAIRHongying Jiang, MD
Beijing Rehabilitation Hospital of Capital Medical University
Outcome results
None listed