'Learning to breathe again': what happens to patients with COVID-19 after resuscitation

“Psychosis, hopelessness and sticky horror”: British doctors said Air forcewhat new reality patients have to face after a long stay in the intensive care unit.

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There is no proven cure for the new coronavirus yet, so the basis of any treatment is to provide the body with oxygen while the immune system fights the virus.

However, experts say defeating the virus is only the beginning of a long recovery process.

The path that a patient who has been discharged from intensive care has to go is complicated, it can take years of life. All this can leave deep scars on the psyche.

“It costs a lot, even if you recover later.”

After a long stay in the intensive care unit, patients often need physiotherapy to re-learn how to walk, and sometimes breathe.

A patient discharged from resuscitation may very well develop psychosis; he may for a long time experience the effects of post-traumatic stress disorder (PTSD).

And the longer the patient was in intensive care, the more time he needs to become himself again.

“When a person ends up in intensive care, this is an event that changes his entire life. It's costly, even if you recover later,” says Dr David Hepburn, consultant intensive care physician at the Royal Gwent Hospital in Wales.

“When our patients come to, they are so weak that they are often unable to sit up on their own. Many, due to weakness, cannot even lift their hands from the bed,” he says.

If intubation or feeding through the tube was required during treatment, then patients may experience problems with speech and swallowing.

Screenshot: Images from the intensive care unit of a London hospital. BBC News / YouTube

“Many people have problems with their appearance, post-traumatic stress disorder and difficulties with mental functioning,” says Dr. Hepburn.

“They get better over time, but the process can take a year, and it takes an army of physiotherapists, speech coaches, psychologists and nurses to speed it up,” says the doctor.

According to him, the time spent in intensive care can only be the tip of the iceberg of all health problems that will require attention in the long run.

“Several weeks on a ventilator are just a small touch in the overall picture of the process,” explains the doctor.

Postresuscitation psychosis

Psychosis or delirium after resuscitation is common. According to some estimates, it affects between a quarter and a third of all patients who pass through the intensive care unit.

British journalist David Aaronovich told the BBC how he woke up in intensive care after anesthesia when he was treated for pneumonia in 2011.

“To put it simply, I was getting more and more crazy every day. I experienced auditory hallucinations. It seemed like I could hear snatches of conversations that I, of course, couldn’t hear,” he recalls.

“It seemed to me that things were happening to me that weren’t really happening. I gradually came to the conclusion that the hospital staff had turned me into a zombie. And then - that they decided to eat me.”

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“So I spent three or four days in the most hopeless horror I had ever experienced,” adds David.

He later learned that many people in his position experience similar emotions. This phenomenon was noted in intensive care patients and was described by doctors in the 1960s.

Researchers have many versions of why this happens - the consequences of the disease itself, lack of oxygen in the brain, side effects from anesthesia and sedatives, sleep disturbances after stopping sedatives.

Aaronovich notes that there is still very little talk about “resuscitation psychosis”: patients are afraid that if they talk about their feelings, they will be considered crazy.

Homecoming

Regardless of how qualified and experienced the staff of the intensive care unit is, it is always a place full of stress.

“If you imagine all the types of torture that are used in torture, you will find a lot of it in the intensive care unit,” comments Hugh Montgomery, professor of critical care medicine at University College London, in an interview with the Guardian newspaper.

For example, he says, patients are often stripped naked and left to lie in plain sight.

They constantly hear disturbing sounds, and this always happens unexpectedly, their sleep is interrupted by medical procedures and injections in the middle of the night, they are disoriented, they are uncomfortable and scared.

Unsurprisingly, on returning home, patients and even their family members often suffer from PTSD.

They may have trouble sleeping, they may even forget that they were in intensive care at all. The British Health Service recommends that patients' relatives begin to keep a diary of their stay in intensive care, so that when they get better, it will be easier to gradually understand what happened to them.

At the physiological level, after the machines have been performing the basic functions of the body for a long time, the body has to re-learn these skills after waking up, the muscles weaken and atrophy.

According to Johns Hopkins University of America, every day, while in the intensive care unit, the patient loses from 3% to 11% of muscle strength, and this effect lasts at least two years after discharge.

Screenshot: British doctors applaud the patient who defeated the coronavirus. TheGuardian / YouTube

Long recovery

Many patients with COVID-19 are connected to a ventilator.

The ventilator, colloquially known as a “ventilator,” pumps oxygen into the lungs of patients and pumps carbon dioxide out of them when they are unable to breathe on their own.

Patients under deep anesthesia receive oxygen through a tube connected to a mask that is placed over the mouth and nose. In some cases, intubation is required - a tube is inserted into the trachea, making an incision in the throat area. This method subsequently leads to additional complications.

As a rule, patients in intensive care in England, Wales and Northern Ireland spend an average of four to five days there.

However, according to statistics as of April 4, out of 2249 patients, only 15% were discharged after this period. About the same number died, and the rest (about 1600 people) remained in intensive care.

But statistics should be treated with caution, because treatment rates in different countries are very different.

It was recently revealed that in Britain, 67% of patients infected with COVID-19 who were connected to a ventilator died. In China, a local study found that only 14% of those connected to a “ventilator” survive.

Step by step

61-year-old Hilton Murray-Philipson was connected to a ventilator at the peak of the disease. Symptoms of COVID-19 were severe.

Due to tube feeding, he lost 15% of his weight. After leaving the hospital, Hilton learned to walk again.

He jokes that it was a lengthy process that had to go through tiny steps.

Screenshot: Hilton Murray-Philipson, a patient who suffered a serious illness and is now learning to live anew. GoodMorningBritain / YouTube

“Sitting in a chair for three hours for the first time instead of lying supine and basically begging for mercy was a fantastic feeling!” - he shared in an interview with the BBC.

Murray Phillipson was a patient at a hospital in Leicester. After he was discharged, hospital staff escorted him with applause.

He says that he is grateful to the doctors for giving him a second life. Now he has learned to value things that he previously attached little importance to.

“Birds chirping, yellow daffodils, blue sky. While I was in hospital, I dreamed of toast and jam and other things we take for granted,” he says.

“Over time they started giving me liquid food, and - oh God! - hospital potato soup! I thought I could live on it alone for the rest of my life.”

As ForumDaily wrote earlier:

• 'Numerous cases': doctors called another non-obvious symptom of coronavirus
• For the treatment of COVID-19 will use worms: what other technologies and medicines are used
• May be harmful: some doctors refuse ventilators for the treatment of COVID-19

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