Post-ICU Syndrome (PICS): Symptoms & Recovery

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What is PICS? The three faces of an invisible condition

PICS is the collective name for a cluster of complaints that can arise after an ICU admission. According to experts from, among others, the Amsterdam UMC it is caused by the enormous impact of the critical illness and intensive treatments. The symptoms can be roughly divided into three categories:

• The physical fight: Your muscle strength has disappeared, you feel heavy and constantly tired. Even simple actions require enormous effort. Chronic pain or shortness of breath are also common.
• The ‘brain fog’: Your memory is failing you, you have difficulty concentrating and you are easily overstimulated by light or sound. It feels like the world is moving too fast for your head.
• The mental blow: Anxiety, sadness and mood swings are very normal. Sometimes people even develop Post-Traumatic Stress Disorder (PTSD), with relives and nightmares about the ICU period.

The invisible patient: your loved ones are also hit

What is often forgotten is that an ICU admission does not only affect the patient. Partners, children and other loved ones can also become traumatized. The constant uncertainty and confrontational environment of the ICU can lead to similar complaints, which is called PICS-Family (PICS-F).

In the radio broadcast Villa VdB on NPO Radio 1, a former ICU patient said Fons van der Voort a heartbreaking detail about this. The only thing he said to his family on the phone was “sorry” because he felt like he had almost let them down. It illustrates the deep emotional impact on the entire family.

The road to recovery: Where do you start?

All these physical, cognitive and mental complaints can feel like an insurmountable mountain, both for the patient and for the family. You know you have to do ‘something’, but the energy and clarity are lacking. Where do you start? We asked a psychologist Marije Schoonbeekspecialized in the mental impact of serious illnesses.

Marije, what is, from your experience, the most important thing first step that can help a patient and his or her family cope with the mental chaos after an ICU admission?

“What you see is that it is often very difficult to recognize PICS properly and in a timely manner. Patients are often further along in their recovery process but remain stuck. This has sometimes caused a lot of frustration until PICS is considered. Good explanation is therefore essential to understand what happened in your brain during an ICU admission. I always advise patients and family members to talk a lot about what happened during that ICU admission so that the stories of everyone involved can ‘come together’. Making a (photo) diary of all events or a visit to the ICU and a conversation with a doctor or nurse who has done a lot with the patient, can help a lot in processing. If you are permanently stuck and also have many cognitive complaints, you should consider a rehabilitation program.”

Help and recognition: you are not alone

In addition to that important first mental step, practical support and contact with fellow sufferers are crucial. Good aftercare after an ICU admission is not yet self-evident everywhere in the Netherlands. That is why the national organization plays a role IC Connect a key role. They offer a listening ear, reliable information and put you in touch with people who understand exactly what you are going through. They develop tools such as the IC HerstelWijzer and work tirelessly to improve IC aftercare throughout the Netherlands.

Conclusion: be kind to yourself

The road back after an ICU admission is not a quick race to the finish; it is a gradual process that requires time and, above all, a lot of patience. The most important first step, as psychologist Marije emphasizes, is not just recognizing the complaints, but taking action putting the puzzle pieces together. The patient often has gaps in his memory, while the family has experienced everything. By talking, looking at a (photo) diary or visiting the ICU together, you create one complete, shared story. This provides clarity, recognition and is the starting point of the processing. Know that what you feel is ‘normal’ after such a traumatic event. And remember: you don’t have to do it alone.

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