Comment on: ‘A Lived Experience of Intensive Care Unit Survivors Regarding Post‐Intensive Care Syndrome After Liver Transplantation: A Phenomenological Study’

I read with great interest the article by Gravante et al. (2025) titled ‘A Lived Experience of Intensive Care Unit Survivors Regarding Post-Intensive Care Syndrome After Liver Transplantation: A Phenomenological Study’. The study vividly illuminates the ‘profound life reorientation’ and ‘physical impairment’ experienced by this population through interpretative phenomenological analysis (IPA), offering valuable perspectives on the subjective world of survivors and highlighting the critical role of human-centered nursing care in the recovery process. However, to more accurately contextualise these findings within the clinical landscape, I believe there are two methodological considerations regarding participant selection and interview timing that warrant further discussion. First, there appears to be an intrinsic contradiction between the study's exclusion criteria and the clinical definition of PICS. While I acknowledge the necessity of selecting participants capable of ‘articulating their lived experience’ to generate rich interview data, this requirement inadvertently acts as a filter against the most severe phenotypes of PICS. Specifically, given that a core characteristic of PICS is new or worsening cognitive impairment, strict communication requirements may unintentionally exclude the very population the study aims to investigate. Furthermore, since liver transplant candidates are inherently prone to hepatic encephalopathy, excluding patients whose cognitive status precludes participation in video interviews effectively ‘sanitises’ the sample. Consequently, the reported themes likely reflect the experiences of ‘high-functioning’ survivors, while the voices of those suffering from devastating cognitive sequelae—arguably the core of PICS pathology—remain silent. This raises a significant concern regarding the construct validity of the ‘PICS experience’ as described in the study (Voiriot et al. 2022). Second, the timing of the interviews—1 month post-discharge—introduces a potential ‘honeymoon period’ confounder that may mask the true psychological trajectory of PICS. In the immediate post-transplant phase, patients are often immersed in a surge of euphoria and ‘gratitude for survival’ associated with the success of the procedure. This state is clearly reflected in the theme of ‘Profound life reorientation’, where transient gratitude may amplify positive psychological experiences and favourable perceptions of care. However, the chronic psychological sequelae of PICS, such as severe depression, post-traumatic stress disorder (PTSD) and frustration with social reintegration, often fully manifest only after this ‘honeymoon’ phase subsides (Hatch et al. 2018). Once the realities of long-term chronic illness management set in—typically 3 to 6 months later—the psychological landscape often shifts drastically. Therefore, the current findings might conflate transient post-operative relief with the typical experience of PICS, potentially underestimating its long-term psychological burden. Despite these limitations, I highly commend the authors for their efforts in shedding light on the lived experiences of this complex patient population. This study provides an important benchmark for understanding early post-transplant recovery. To achieve a more comprehensive picture, I suggest that future research employ longitudinal designs extending beyond the acute recovery phase and consider including caregivers as proxy respondents to capture the authentic experiences of survivors who are unable to speak due to severe cognitive or physical impairments. This would facilitate a more holistic understanding of the full spectrum of PICS following liver transplantation, thereby guiding more precise interventions. The author has nothing to report. The author declares no conflicts of interest. The author has nothing to report.