Non-pharmacological post-intensive care interventions to improve patient outcome following critical illness: a scoping review

Patients discharged from intensive care units (ICU) commonly experience multiple problems in care during the acute hospital period. These can negatively impact their recovery and contribute to poor outcomes such as ICU readmission or in-hospital mortality. Many studies have aimed to address this through non-pharmacological interventions. However there has been no comprehensive synthesis of this literature. To improve care during the post-ICU in-hospital period, it is important to understand existing interventions and highlight priorities to guide future research. We therefore aimed to assess the extent of current literature relating to non-pharmacological interventions delivered to critical care survivors in hospital. We systematically searched five electronic databases (MEDLINE, EMBASE, CINAHL, AMED and CENTRAL) and grey literature to 4th February 2025. Search results were independently screened for eligibility by two reviewers at title, abstract and full text. Reports relating to non-pharmacological interventions delivered to adult patients in hospital following discharge from critical care were included. Study characteristics, intervention delivery and development, and outcomes were extracted using a formal data charting process. Searches yielded 41,242 reports, from which 202 met the inclusion criteria. The most common interventions were critical care outreach/follow-up (CCOT/FU) (n = 93, 46%), physical rehabilitation (n = 77, 38.1%), and nutrition (n = 36, 17.8%). A small proportion of reports described randomised controlled trials (RCTs) (n = 31, 15.3%), of which few evaluated either CCOT/FU (n = 5, 16.1%) or multicomponent interventions (n = 6, 19.4%). Positive primary outcomes were reported by 51.6% (n = 16) of the RCTs (five of which were feasibility outcomes). Details of intervention implementation/training was included in only 17.6% (n = 18/102) of original studies. Interventions delivered by CCOT/FU included onward referrals, ordering investigations, family and patient support, and education provision. This review provides a comprehensive summary of the current knowledge of non-pharmacological interventions delivered following discharge from critical care, to improve outcomes. Although this is a large body of literature, it is limited by a lack of RCTs, and uncommon reporting of intervention development, implementation or training. Multicomponent interventions and CCOT/FU showed promising initial results but were infrequently evaluated in clinical trials, which should be considered for future investigation.