Using ehealth to understand and monitor early post-ICU PICS symptom development

: exploring feasibility, patient experience, and early recovery trajectories

Abstract

Patients discharged from the Intensive Care Unit (ICU) frequently experience Post-Intensive Care Syndrome (PICS), characterised by persistent and substantial impairment to 3 domains: physical, psychological and cognitive. Though the first three months following ICU discharge are the most vulnerable for patients, this phase remains the least explored. Despite growing recognition of heterogenous recovery trajectories, the lack of knowledge regarding the early post-discharge phase suggests that some patients may be at risk of developing PICS earlier than the routine 3-month review in the post-ICU clinic. Existing monitoring systems do not monitor all three domains concurrently. This thesis aimed to evaluate the feasibility and acceptability of a remote patient monitoring (RPM) system developed to capture multidomain recovery processes in the early post-discharge phase.

The thesis first focused on developing the RPM system by conducting a systematic review and analysing predictors of assessment non-adherence in intensive longitudinal designs. The developed RPM system’s feasibility was then evaluated in a post-ICU patient population. Feasibility was established through moderate recruitment outcomes, assessment adherence, and a high retention rate. Participants generally found the RPM system easy to use and acceptable. However, perceived usefulness of the system was mixed. To increase system usefulness, qualitative findings emphasised the importance of perceived purpose, flexibility and clinician feedback.

Finally, data collected were analysed to chart early recovery trajectories. Distinct patterns of Health-Related Quality of Life (HRQoL) were identified indicating that recovery heterogeneity develops earlier than typically assessed. Physical fatigue and sleep variability emerged as potential clinical markers of recovery. HRQoL was also found to be associated more with psychological symptoms, highlighting the need for more holistic post-ICU recovery profiles.

Overall, the findings of the thesis support earlier monitoring and the integration of RPM systems into post-ICU care pathways, not only provide earlier identification of high-risk patients but to improve continuity of care.

Date of Award	2025
Original language	English
Awarding Institution	Canterbury Christ Church University