Challenges for ICU Survivors and Their Caregivers.

Advances in technology and therapeutics continue to improve survival of critically ill patients. However, with improved survival has come the recognition that many ICU survivors face a complex recovery trajectory following discharge from the ICU.1,2 Numerous studies document that critical illness can impact ICU survivors’ physical, psychological, and cognitive function.3 Recovery can be prolonged and unpredictable.2,4 Many ICU survivors require substantial assistance from informal caregivers, mostly family members. From one of the largest longitudinal cohort studies that recruited 817 ICU subjects who required mechanical ventilation for 48 h, Chelluri et al5 reported that the majority (75%) required caregiver assistance 2 months after the onset of mechanical ventilation, and over half (57%) who survived to 12 months continued to require caregiver assistance. Family caregivers are vital care partners in providing this assistance but may, themselves, experience depressive symptoms,6-9 caregiver burden,8,10 post-traumatic stress,11-13 and poor physical health.14-16 Knowledge of these consequences following critical illness has prompted growing interest in ICU survivorship, with the goal of improving patient and caregiver outcomes. We have learned that the complex sequelae of critical illness affect both ICU survivors and family caregivers. The terms post-ICU syndrome (PISC) and post-ICU syndrome family (PICS-F) have been proposed to describe this outcome.17,18 PICS is defined as new or worsening impairment in physical, cognitive, or mental health status arising and persisting after hospitalization for critical illness.17,18 To better understand ICU survivorship and provide targeted support to this population, it is important to investigate the experience of ICU survivors and their family caregivers as dyads, because challenges faced by survivors impact caregivers and vice versa. However, relatively few studies have included both ICU survivors and family caregivers when describing outcomes following critical illness. From a longitudinal descriptive study, Choi et al10 reported the experience of 69 family caregivers of ICU survivors. Caregivers reported greater lifestyle restrictions and psychological distress when ICU survivors required prolonged institutionalization and experienced difficulty regaining functional independence. In a second longitudinal study, Choi et al19 described physical symptoms in ICU