Effects of post-ICU follow-up interventions on symptoms of post-intensive care syndrome in sepsis survivors: a systematic review.

OBJECTIVES: This review synthesises the available evidence on the efficacy of post-intensive care unit (ICU) discharge follow-up interventions on the various domains of post-intensive care syndrome (PICS) in sepsis survivors. Sepsis survivors face a distinct recovery trajectory from general ICU survivors, characterized by higher post-discharge mortality, more severe and persistent cognitive and physical decline, and prolonged immune dysregulation. This burden, driven by infection-triggered inflammation, multi-organ dysfunction, and catabolism, warrants dedicated investigation. METHODS: Embase, CINAHL, Web of Science, and PubMed were searched from inception to 31 March 2026. Randomized controlled trials (RCTs) comparing post-ICU follow-up interventions with usual care in adult sepsis survivors were included. Risk of bias was evaluated using the Cochrane risk of bias tool 2.0. RESULTS: Six trials comprising 847 patients from the USA, Germany, the UK, and the Netherlands are included. All studies had some concerns regarding risk of bias, primarily due to non-blinded designs, attrition, and non-blinded outcome assessment. Interventions vary in content, duration, and follow-up. One trial finds that nurse-led case management improves patients' physical function and activities of daily living at 6 months and reduces symptoms of post-traumatic stress disorder (PTSD) at 24 months, while a feasibility trial finds that ICU-specific virtual reality (ICU-VR) reduces PTSD and depression up to 6 months following treatment. CONCLUSIONS: Post-ICU follow-up interventions may improve specific domains of PICS in sepsis survivors, particularly physical function and PTSD symptoms, though evidence is limited by the small number of studies, risk of bias, and lack of sustained effects. For cognitive impairment, no interventions have been adequately evaluated. High-quality clinical trials with standardised outcomes, adequate follow-up, and complete reporting are needed across all domains. IMPLICATIONS FOR CLINICAL PRACTICE: According to this study, no specific post-ICU follow-up intervention can yet be recommended for routine use in sepsis survivors, though nurse-led case management and ICU-VR have shown potential benefits for physical function and PTSD symptoms. Systematic screening for PICS symptoms remains essential.