Sepsis is a life-threatening condition marked by a dysregulated immune response, causing inflammation, tissue damage, and organ failure. It contributes to around 20% of global deaths and often leads to long-term impairments in survivors, known as post-sepsis syndrome (PSS), which can include physical, cognitive, and psychological symptoms such as fatigue, memory deficits, and depression. These effects persist for years and are more common among ICU-treated patients.
The burden impacts not only individuals and caregivers but also the broader healthcare system. Recognising this, the 2021 Surviving Sepsis Campaign introduced recommendations for post-sepsis care, emphasising the need for screening and support. However, there remains a lack of effective, symptom-guided interventions, and follow-up care strategies are still underdeveloped.
To address this gap, a systematic review was conducted to evaluate existing post-sepsis follow-up interventions and their effects on survivor outcomes. A systematic search of PubMed, Web of Science, and ClinicalTrials.gov was conducted for studies published between January 2013 and August 2024. Included studies assessed the impact of targeted post-acute interventions and follow-up services compared to usual care.
Fourteen studies from high-income countries, involving 383,680 patients, were included. Interventions varied widely in type, timing, and targeted outcomes. Rehabilitation programmes were linked to improved long-term survival (up to 10 years) in three observational studies, and one randomised trial showed that an 8-week exercise programme enhanced anaerobic threshold. Seven studies on care coordination and follow-up bundles reported reduced rehospitalisation and mortality within 12 months, along with improved physical function and PTSD symptoms. An ICU-specific virtual reality intervention showed potential for reducing PTSD and depression up to six months post-intervention.
This review found that post-sepsis interventions such as mental health support, physical rehabilitation, care coordination, and pharmacist-led programmes can improve long-term outcomes for survivors. Rehabilitation and coordinated follow-up care were particularly effective, showing benefits in physical function, mental health, survival, and reduced hospital readmissions. While technology-based psychological interventions showed potential, evidence was limited and mixed. Most studies had moderate risk of bias or some concerns, highlighting the need for more robust research to validate and generalise these findings.
Post-acute interventions like care coordination, bundled approaches, and rehabilitation can enhance outcomes for sepsis survivors. However, the evidence base remains limited, with existing studies subject to bias and gaps in interventions for certain post-sepsis impairments, especially cognitive deficits. High-quality prospective studies are needed to strengthen the evidence and address all domains of post-sepsis care.
Source: Critical Care
Image Credit: iStock
