A Lived Experience of Intensive Care Unit Survivors Regarding Post‐Intensive Care Syndrome After Liver Transplantation: A Phenomenological Study, Response to Hu

We are pleased to have the opportunity to engage in an academic dialogue with the readers of your esteemed journal through reflective exchanges. We would like to thank Dr. Hu for his interest in our study and for his comments on the lived experience of intensive care unit (ICU) survivors following liver transplantation (Gravante, Trotta, et al. 2025; Hu 2026). We appreciate the opportunity to clarify and further explore several points raised. Post-intensive care syndrome (PICS) is increasingly used to describe the interaction of various physical, psychological and other deficits that emerge after ICU discharge, affecting both individuals and their families (Yuan et al. 2021). The description of lived experience is based on the narration of personal experiences, drawing from reserves such as memory. ICU survivors' recollections ranged from complete memory loss to vivid memories of specific events, thus filtering the narrative of their lived experience. In the general population, there is a tendency to perceive memories as more pleasant than unpleasant, with negative memories fading more quickly than positive ones. There is also a tendency to diminish the emotional impact of negative events compared to positive events (Adamson et al. 2004). We acknowledge that the clinical condition following liver transplantation may predispose participants to hepatic encephalopathy. However, this condition does not necessarily preclude their ability to narrate their lived experience after ICU discharge. PICS is strongly influenced by the compromised clinical state, which encompasses all the sequelae of the underlying disease, thus integrating them into the experience itself (Gravante, Iovino, et al. 2025). Moreover, a full understanding of the sequelae that comprise PICS, particularly those affecting the cognitive dimensions and related strategies of post-ICU lived experience, remains an area for further research (Kang and Jeong 2018). The timing of the interviews plays a crucial role in recognising the long-term sequelae of PICS. Yuan et al. (2021) define the concept of PICS in ICU survivors, addressing it through three dimensions—cognitive, psychological and physical—and introducing the concept of social reintegration. Furthermore, the variability of sequelae associated with PICS depends on the timing of their assessment. In fact, the physical and cognitive dimensions tend to manifest more rapidly, in contrast to the psychological and social dimensions, with the latter being more evident after hospital discharge. This varies according to the discharge context. The social dimension is characterised by difficulties in social relationships with family and reintegration into work, which manifest differently from the initial discharge phase from the ICU. The multidimensional symptoms that persist after ICU and hospital discharge range from 1 month to 9 years, with PICS typically appearing within this time frame and manifesting its long-term outcomes (Yuan et al. 2021). Although PICS remains a priority for researchers, a full understanding of the three main dimensions—cognitive, psychological and physical—along with the social dimension and their timing and severity of sequelae is yet to be determined. We agree with Dr. Hu that longitudinal trajectories would help shed light on the long-term outcomes in ICU survivors. However, future research should adopt more diverse approaches, such as mixed-methods studies, to further explore the cognitive dimension of ICU survivors. Furthermore, dyadic approaches (patient–family member) could offer a new perspective on the definition of the cognitive dimension by involving the family member who participates in the care of the survivor during their ICU stay. We hope that these reflections contribute to a deeper understanding of the lived experiences of ICU survivors post-liver transplantation and offer insights for future research. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.