9 GENERAL INTRODUCTION 1 THE POST-INTENSIVE CARE SYNDROME Being critically ill can have a long-term impact on a patient’s health and wellbeing. The consequences of critical illness and prolonged treatment in an Intensive Care Unit (ICU) are nowadays characterised as the post-intensive care syndrome (-family), or PICS(-F).1,2 A variety of physical and mental health problems result in a reduced health-related quality of life (HRQoL) in some patients, but not all.3–5 Long-lasting immobility in ICU, mechanical ventilation and the use of neuromuscular blockers, among others, often result in ICU- acquired weakness (ICU-AW) and impaired physical functioning.6 Common mental health problems post-ICU are depression, anxiety, trauma, fatigue, and cognitive dysfunction.7–10 Additionally, an ICU-admission can have a large impact on loved-ones and informal caregivers of the patient, often resulting in symptoms of trauma and increased caregiver burden.11 However, it is still unclear which patients are most at risk for long-term health deficits. Impaired recovery in ICU-survivors and their informal caregivers can have widespread consequences. It has been previously described that PICS and long-termhealth problems can result inmore hospital and ICU-readmissions.12 In addition, survivors have three to five times higher healthcare costs than healthy controls in their age-group.13 Furthermore, long-term lack of recovery reflects in an inability to return to work in 30-50% of ICU-survivors.14–16 Nevertheless, the full scope of long-term consequences of critical illness is yet to be explored. To facilitate this, it is essential to perform in-depth research on group and individual recovery trajectories and develop aftercare services or transmural care chains that are tailored towards the individual needs of the patients. However, to provide adequate aftercare properly aligned with both individual needs and the current state of research, a shift in focus in research and clinical practice is essential. Box 1 Meaningful Recovery A newly introduced term for integrated recovery based on the Positive Health framework by Machteld Huber (2011), where the emphasis is not on illness, but on the people themselves; on their resilience and on what it is that makes their lives meaningful.19 In this case; to regain physical, mental and cognitive wellbeing resulting in the capability of ICU-survivors and their informal caregivers to be able to participate in society in a way that is meaningful to them.
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