Survivors of critical illness are at risk for PICS development, and in particular those who experience shock and respiratory failure requiring mechanical ventilation. Risk factors associated with long-term physical and/or neuropsychological impairment include sepsis, acute respiratory distress syndrome (ARDS), multi-system organ failure, prolonged ICU length of stay, duration of delirium, glucose dysregulation, and the use of corticosteroids [2, 5–9].

Physical and neuropsychological impairment should be screened for at the time of hospital discharge to guide the procurement of post-acute care services (Table 32.2). Physical impairment is common following critical illness, can be measured using a standardized scale, and frequently contributes to the need for skilled care or acute rehabilitation facility placement. Several validated options exist to examine functional status, and specific areas of functional abilities, clinically. Cognitive impairment is an under-recognized consequence of critical illness. In a prospective study of survivors of shock and respiratory failure, Pandharipande et al. revealed that 40 % of survivors performed at a level consistent with moderate traumatic brain injury at 3 months, 26 % performed at a level consistent with mild Alzheimer’s disease, and these impairments frequently persisted [8]. Given its prevalence, providers should screen for cognitive impairment in ICU survivors with suspected PICS. A number of validated screening tools exist to identify cognitive impairment, including the Mini Mental Status Exam, the Mini-Cog, and the Montreal Cognitive Assessment (MoCA). As a simple, highly sensitive, and validated test, the MoCA is arguably the best screening tool to detect mild cognitive impairment in ICU survivors [10]. Psychiatric illness seen in PICS manifests as symptoms of anxiety, depression, or post-traumatic stress disorder (PTSD) [14].

A growing body of literature supports the use of the “ABCDEF” bundle as a potential means to mitigate the risk of PICS [15]. The components of the ABCDE bundle include the coordination of sedation minimization and standardized ventilator weaning [16], delirium monitoring, prevention, and management, and early occupational and physical therapy [17]. When coupled with family engagement and empowerment, the bundle is transformed to the ABCDEF bundle. The benefits of an ABCDE bundle include reduced duration of delirium, reduced incidence of ventilator-associated events, increased ventilator-free days, and improved functional outcomes at discharge with increased likelihood of return to functional independence [16–20].