The tests do not end: what awaits those who were seriously ill with COVID-19, after being discharged from the hospital

For recovered patients with coronavirus who were on mechanical ventilation machines (IVL), the tests do not end with a discharge, writes Science.

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In addition to complications of the disease itself, there are consequences of a prolonged stay in intensive care. Doctors are developing rehabilitation programs, but they are still far from widespread use.

Among those hospitalized with severe COVID-19, there are those who are lucky. These are people who were connected to mechanical ventilators to make it easier to breathe, who recovered and were discharged from the hospital. Today, patients are returning home, and doctors are turning their attention to the potential consequences of the virus and to intensive care, which helped patients survive.

“In the coming months, all of us will first of all face the question of how to help these people recover and recover completely,” says Lauren Ferrante, a pulmonologist and resuscitator from Yale University School of Medicine.

COVID-19 affects not only the lungs, but also the kidneys, blood vessels, heart, brain and other organs. Doctors do not yet know what long-term health problems the virus causes, but you can guess this by examining the severe cases of pneumonia, during which, like during COVID-19, pneumonia of the alveoli begins. Such an infection can lead to acute respiratory distress syndrome when these alveolar sacs are filled with fluid. Most patients regain lung function over time, but sometimes acute respiratory distress syndrome leads to pulmonary fibrosis, which can lead to prolonged breathing problems, Ferrante says.

After severe pneumonia, a combination of chronic illnesses and prolonged inflammation increases the risk of other diseases, including heart attack, stroke, and kidney failure, says epidemiologist and resuscitator Sachin Yende, who works at the University of Pittsburgh Medical Center. According to him, COVID-19 may cause a serious increase in such risks.

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Patients who have spent some time in intensive care, regardless of their illness after discharge, may encounter a whole range of physical, cognitive and mental disorders. Patients in the intensive care unit who have been treated with coronavirus are especially exposed to these risks, partly due to the fact that in the case of severe lung injuries, many patients are on a ventilator for a long time under the influence of sedatives, says resuscitator Dale Needham, a medical practitioner Department of Johns Hopkins University.

Those few patients who survive for a long time lying on mechanical ventilation often have muscle weakness and atrophy. If you force a seriously ill patient to move, helping him raise his arms and legs, and eventually sit down, get up and walk, then this will reduce weakness and make it possible to quickly disconnect him from ventilation. But in some hospitals, due to a lack of protective clothing, physiotherapists try to stay away from patients with COVID-19.

Another danger is blurred consciousness, as the state of confused thinking is called, which can cause long-term intellectual disorder, such as impaired memory. "With COVID, delirium occurs very often," says pulmonologist and resuscitator E. Wesley Ely, who works at Vanderbilt University.

One reason is the virus itself, which can infect the brain. However, sedatives, which are given in order to suppress a painful cough and relieve the patient of the discomfort of the respiratory tube, increase the risk of a delusional state. And when the stores of widely used sedative drugs in hospitals run out, doctors resort to other drugs that can cause an “intense and prolonged delusional state,” says Eli.

Eli and his colleagues have been developing recommendations for the care of patients in intensive care units for many years, and among other things, there is an instruction to interrupt the supply of narcotic and sedative drugs daily, checking whether the patient can recover, breathe and tolerate the ventilator without medication. “But this requires constant monitoring, which is not possible in crowded resuscitation,” says Eli. - Everyone there is trying their best .... But do not give up what we have learned over the past 20 years. ”

The danger of getting infected also prevents doctors from communicating with patients, although this calms them and sometimes makes it possible to abandon drugs that cause a delusional state. “We invented a system that is completely unsuitable for older people ... relatives are not allowed to visit them, doctors go in masks, dressed in protective suits. It’s very scary, ”says geriatrician Sharon Inouye, who works at the Harvard University School of Medicine at Hebrew SeniorLife’s healthcare system.

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Some resuscitators are beginning to doubt the need to use mechanical ventilation at an early stage of the disease. “If we put more people on a ventilator than needed, then it will definitely affect their condition after recovery,” said C. Terri Hough, resuscitator at the University of Washington in Seattle.

Some hospitals have already experienced an initial increase in the number of diseases, and scientists are starting to look into the future. Eli's team is testing a rehabilitation program for people suffering from intellectual disability after hospitalization in serious condition. The Yende team is implementing a project for the care of discharged patients after pneumonia and sepsis, which includes remote monitoring, treatment and home visits to prevent re-hospitalization.

And someone is preparing for a surge of mental illness among survivors, such as anxiety disorder, depression, and post-traumatic syndrome. Hawk and colleagues are testing a mobile application that improves alertness and stress tolerance for those discharged from the hospital. According to her, such a collective approach to overcoming the consequences gives survivors of the disease in a severe form hope that they did not have before.

Text translation prepared edition Inosmi.ru.

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