title: Resilience in Survivors of Critical Illness in the Context of the Survivors' Experience and Recovery.
abstract: Post-intensive care syndrome (PICS), defined as new or worsening impairment in cognition, mental health, or physical function after critical illness, is an important development in survivors. Although studies to date have focused on the frequency of these impairments, fundamental questions remain unanswered regarding the survivor experience and the impact of the critical illness event on survivor resilience and recovery.
  
  
  
  To examine the association between resilience and neuropsychological and physical function and to contextualize these findings within the survivors' recovery experience.
  
  
  
  We conducted a mixed-methods pilot investigation of resilience among 43 survivors from two medical intensive care units (ICUs) within an academic health-care system. We interviewed survivors to identify barriers to and facilitators of recovery in the ICU, on the medical ward, and at home, using qualitative methods. We used a telephone battery of standardized tests to examine resilience, neuropsychological and physical function, and quality of life. We examined PICS in two ways. First, we identified how frequently survivors were impaired in one or more domains 6-12 months postdischarge. Second, we identified how frequently survivors reported that neuropsychological or physical function was worse.
  
  
  
  Resilience was low in 28% of survivors, normal in 63% of survivors, and high in 9% of survivors. Resilience was inversely correlated with self-reported executive dysfunction, symptoms of anxiety, depression, and post-traumatic stress disorder, difficulty with self-care, and pain (P < 0.05). PICS was present in 36 survivors (83.7%; 95% confidence interval, 69.3-93.2%), whereas 23 survivors (53.5%; 95% confidence interval, 37.6-68.8%) reported worsening of neuropsychological or physical function after critical illness. We identified challenges along the recovery path of ICU survivors, finding that physical limitations and functional dependence were the most frequent challenges experienced in the ICU, medical ward, and on return to home. Spiritual and family support facilitated recovery.
  
  
  
  Resilience was inversely correlated with neuropsychological impairment, pain, and difficulty with self-care. PICS was present in most survivors of critical illness, and 54% reported neuropsychological or physical function to be worse, yet resilience was normal or high in most survivors. Survivors experienced many challenges during recovery, while spiritual and family support facilitated recovery.
authors.affiliation: 1 Department of Medicine.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Maley
authors.affiliation: 2 School of Nursing, University of Pennsylvania, and.
authors.forename: Isabel
authors.initials: I
authors.lastname: Brewster
authors.affiliation: 2 School of Nursing, University of Pennsylvania, and.
authors.forename: Iris
authors.initials: I
authors.lastname: Mayoral
authors.affiliation: 2 School of Nursing, University of Pennsylvania, and.
authors.forename: Renata
authors.initials: R
authors.lastname: Siruckova
authors.affiliation: 2 School of Nursing, University of Pennsylvania, and.
authors.forename: Sarah
authors.initials: S
authors.lastname: Adams
authors.affiliation: 3 Medical Intensive Care Unit, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors.forename: Kelley A
authors.initials: KA
authors.lastname: McGraw
authors.affiliation: 3 Medical Intensive Care Unit, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors.forename: Angela A
authors.initials: AA
authors.lastname: Piech
authors.affiliation: 4 Interdivisional Department of Critical Care, University of Toronto, and.|5 Division of Respirology, Department of Medicine, Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Detsky
authors.affiliation: 1 Department of Medicine.|6 Pulmonary, Allergy, and Critical Care Division, Department of Medicine; and.|7 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
mesh_terms: D000328:Adult; D000368:Aged; D060825:Cognitive Dysfunction / Q000453:epidemiology*; D016638:Critical Illness / Q000523:psychology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015143:Philadelphia; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D055500:Resilience, Psychological; D057566:Self Report; D017741:Survivors / Q000523:psychology*; D013577:Syndrome
keywords: cognitive impairment; critical care; quality of life; resilience; survivorship