Greater recovery after critical illness (GRACE): a call to action to create a new roadmap for critical illness research

For decades, most critical care patients have survived hospitalisation, supporting increased attention on the long-term critical illness recovery. The term 'Post-Intensive Care Syndrome' was coined in 2012 to raise awareness of long-term impairment in physical, cognitive and/or mental health after critical illness. However, the incidence of these impairments has persisted over the past decade, reaching as high as 60% and remains a major public health problem. Aiming to set a research agenda to address evidence gaps in critical illness recovery over the next 10 years, we invited key international opinion leaders from diverse clinical and methodological backgrounds to a roundtable meeting in June 2024 to assess the progress of post-critical illness recovery research and outline a future research agenda to address the unmet needs of critical illness survivors over the next decade. An early outcome from the meeting was to conduct a thematic analysis of critical care recovery literature, which highlighted the need for effective expectation management, ongoing patient support and education throughout recovery, integration between inpatient and community care, caregiver support and opportunities to reconnect with the intensive care unit. Participants identified conceptual challenges concerning current terminology and scope, population heterogeneity and phenotyping, and outcome definitions. Methodological challenges were identified around study design, with a call to shift to contemporary trial designs, incorporating qualitative methods. Translation into clinical practice will require interdisciplinary engagement. The roundtable concluded that a roadmap should be developed to guide clinical and research efforts over the coming decade, with the aim of developing a precision recovery approach.