Resilience in Survivors of Critical Illness in the Context of the Survivors' Experience and Recovery
Resilience in Survivors of Critical Illness in the Context of the Survivors' Experience and Recovery
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DOI：
10.1513/annalsats.201511-782oc
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发表时间：
2016-08-01
影响因子：
8.3
通讯作者：
Mikkelsen, Mark E.
中科院分区：
文献类型：
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作者：
Maley, Jason H.;Brewster, Isabel;Mikkelsen, Mark E.
基本原理：重症监护后综合征（Post-intensive care syndrome，PICS）是指危重病患者发生认知功能、心理健康或身体功能的新的或恶化的损害。尽管迄今为止的研究主要集中在这些损伤的频率上，但关于幸存者的经历以及重大疾病事件对幸存者复原力和恢复的影响的基本问题仍然没有得到回答。目的：研究复原力与神经心理和身体功能之间的关系，并将这些发现与幸存者的恢复经历联系起来。我们进行了一项混合方法的试点调查的韧性之间的43名幸存者从两个医疗重症监护病房（ICU）内的学术卫生保健系统。我们采访了幸存者，以确定在ICU，内科病房和家中恢复的障碍和促进因素，使用定性方法。我们使用了一系列标准化测试来检查弹性，神经心理和身体功能以及生活质量。我们以两种方式检查了PICS。首先，我们确定了幸存者在出院后6-12个月在一个或多个领域受损的频率。其次，我们确定了幸存者报告神经心理或身体功能变差的频率。测量和主要结果：28%的幸存者的复原力较低，63%的幸存者正常，9%的幸存者较高。复原力与自我报告的执行功能障碍、焦虑、抑郁和创伤后应激障碍症状、自我护理困难和疼痛呈负相关（P，0.05）。36名幸存者（83.7%; 95%置信区间，69.3-93.2%）存在PICS，而23名幸存者（53.5%; 95%置信区间，37.6-68.8%）报告了危重病后神经心理或身体功能恶化。我们确定了ICU幸存者康复过程中的沿着挑战，发现身体限制和功能依赖是ICU、内科病房和返回家中时最常见的挑战。精神和家庭的支持促进了recovery.Conclusions：复原力与神经心理障碍，疼痛和自我照顾困难呈负相关。PICS存在于大多数危重病幸存者中，54%的人报告神经心理或身体功能更差，但大多数幸存者的弹性正常或较高。幸存者在恢复期间经历了许多挑战，而精神和家庭支持有助于恢复。
Rationale: 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.Objectives: To examine the association between resilience and neuropsychological and physical function and to contextualize these findings within the survivors' recovery experience.Methods: 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.Measurements and Main Results: 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.Conclusions: 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.