BEYOND PICS: a conceptual framework for post-ICU recovery stewardship

As survival from critical illness improves, the global burden of post-intensive care syndrome (PICS) and PICS-family continues to grow, reshaping the goals of modern intensive care. Despite growing awareness, prevention, follow-up and rehabilitation remain fragmented, and important gaps persist in the organisation of recovery-oriented care. We propose BEYOND PICS, a conceptual framework for ICU survivorship built around six complementary pillars: Begin before ICU discharge , Early follow-up and equitable access , Your journey , Ongoing multidomain assessment and rehabilitation , Networked care , and Driving improvement . Rather than describing clinical interventions to be implemented in practice, the framework promotes a coordinated recovery pathway integrating prevention, patient partnership, education, rehabilitation, multidisciplinary collaboration and continuous quality improvement across the peri-ICU continuum. BEYOND PICS is not a clinical bundle or guideline, it provides a mental model to guide the organization of care, integrating the key components of ICU survivorship into a coherent continuum of care while highlighting priorities for future research.