Parenting after critical illness: a biopsychosocial review of post-intensive care syndrome, family systems, and child outcomes

Parenting is a multi-domain capacity integrating emotional availability, executive functioning, physical caregiving, and a coherent self-narrative. When a parent survives critical illness and develops post-intensive care syndrome (PICS), these foundations may be disturbed concurrently, yet parenting has not been studied as an outcome of adult ICU survivorship. This biopsychosocial review treats parenting as the central phenomenon, drawing on family systems, attachment, ecological, and trauma transmission frameworks. We conducted a narrative review with a structured search and a hierarchical synthesis ranking sources by proximity to the target phenomenon. No identified study measured parenting outcomes after adult ICU admission, and no adult ICU, PICS, or cardiac arrest survivorship study in our retrieved body of literature recorded whether patients had dependent children. Available evidence suggests parenting capacity may be constrained: survivors carry impairment across the domains that scaffold parenting; well co-parents experience burden that reshapes co-parental functioning; and children show vulnerabilities consistent with secondary traumatic stress and disrupted attachment in analogous contexts. Children's involvement in family recovery is not uniformly harmful, varying along a continuum of caregiving load, with risk concentrated where sustained load coincides with role reversal, obligation, concealment, and absent adult alternatives. We propose, as a preliminary organising framework rather than a validated syndrome, that children of PICS survivors be recognised as a distinct affected population (a PICS-F-Children construct), that parenting become a measured outcome in PICS research, and that family-systems-informed screening be integrated into ICU follow-up.