What happens after a patient leaves the ICU?


ESSEN, GERMANY - OCTOBER 21: A room with a ventilator is seen in the Covid-19 intensive care unit of Universitaetsklinikum Essen university hospital during the second wave of the coronavirus pandemic on October 21, 2020 in Essen, Germany.  Nationwide, the number of Covid patients being treated in the ICU rose steadily in October, to 879 as of yesterday, with about half of those patients on respiratory.  Germany last week recorded a new daily high of more than 7,000 new confirmed cases of coronavirus infections.  (Photo by Thomas Lohnes / Getty Images)
A room with a ventilator was observed in the Covid-19 intensive care unit of the University Hospital Universitaetsklinikum Essen during the second wave of the coronavirus pandemic on October 21, 2020 in Essen, Germany. (Photo by Thomas Lohnes / Getty Images)

For COVID-19 patients who have been treated in the intensive care unit (ICU) and survived the virus, the road to full recovery is not an easy one. While the long-term effects of the virus are still unclear, there is also much more to learn about what life after COVID-19 will be like for those experiencing the worst.

Researchers at the University of British Columbia are looking into the type of long-term support needed for patients who have been sent to the ICU.

Dr. Fuchsia Howard, assistant professor at UBC’s School of Nursing, focuses her research on survival from critical illness. Examine patients who have spent time in intensive care for a range of conditions, including COVID-19, and track how they do once released.

Although the unknowns around COVID-19 are still vast, there is a good knowledge base on survivors of critical illness. And Howard says that in many ways there are similarities between the two.

“The burden is huge,” Howard says Yahoo Canada.

Survivors of COVID-19 who have been in intensive care are at risk of developing post-intensive care syndrome (PICS), which is a constellation of physical, mental and cognitive impairments that last long after patients are discharged. About half of the patients who have been in the ICU suffer from PICS.

Many survivors develop what is called ICU acquired weakness. This is when it becomes difficult to move and function in daily life. A patient who is bedridden and on a ventilator loses about 2-5% of muscle function and mass each day.

“There’s a tremendous loss of functionality,” Howard says. “And especially with COVID-19 patients, there is a lot of impaired lung function, with ongoing shortness of breath.”

Some COVID-19 patients that Howard’s colleagues have followed since they were discharged from the ICU have experienced significant shortness of breath and as a result were unable to function in their daily lives.

Up to 80 percent of people who have been in intensive care for various conditions continue to suffer from cognitive impairment, Howard says. This includes problems with memory, attention span and mental processing speed.

“If someone has a cognitive impairment, it’s hard for them to understand everything they’ve been through and then try to get functional again,” he says. “For this reason they have a very poor quality of life.”

Finally, mental health impairment is a real concern for patients who have been in intensive care. Many experience delusions, hallucinations, and nightmares while there. When they leave, they are likely to develop significant levels of anxiety, depression, and post-traumatic stress symptoms.

“Post-traumatic stress levels rival those of veterans returning home from war,” Howard says.

For COVID-19 patients, social isolation, in addition to the stigma of having had the virus, exacerbates that mental burden.

Seeking support for post-intensive care patients

Many places around the world have intensive care recovery programs and follow-up clinics. While Canada has some of the latter, Howard says the country needs a comprehensive process connecting people from the ICU to the hospital at home.

“All of those parts of PICS need to be addressed in rehab,” he says. “And that should include peer support.”

The term PICS has only been recognized in the last 10 years or so. Howards says the COVID-19 pandemic is a perfect opportunity to develop programs that address the problems that arise from time spent in the ICU and create systems that help a seamless transition from disease to health.

Although there are a handful of follow-up clinics across the country, they are mostly found in the larger cities. There is no system for all people who have passed ICU to follow a trajectory once they are gone.

Howard says the medical community needs to raise awareness and make it a priority. There is also a need for funding.

“There are no big funding blocks or a clear path to do it,” he says.

Howards points out that there must be a comprehensive and informed research program, because there is still so much that is not known about how to best treat PICS and support critically ill survivors in their recovery.

“It really needs to be integrated into research, or we won’t know what works and how to develop different models of care and different ways of providing support,” he says.

While 80% of people who go to ICU make it out alive, Howard says we let people down when it comes to living a meaningful, quality life once they get home.

“How can we go from saving a life to actually surviving and having a meaningful life?” she asks.

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