About 60% of patients with covid who enter a icu develop the well-known post Icu Syndrome, a set of physical, neurocognitive and psychiatric symptoms that derive from having spent so much time in these units. “It is a syndrome that can affect any patient in an ICU, but it is especially frequent in covid-19″, explains the head of Intensive Medicine at the Vall d’Hebron Hospital, Ricard Ferrer. In Vall d’Hebron, there have been patients who have been more than 100 days in the icu due to covid. At the Hospital del Mar, the record is six and a half months (about 195 days).
The physical involvement of patients suffering from a post-ICU syndrome is due to the fact that they have been for a long time bedridden, for which they need physical rehabilitation. The cognitive impairment It comes in the form of disorientation. And the psychiatric includes the possibility of developing Post traumatic stress, anxiety or depression, which is due to having suffered a very acute stress.
Physicians often begin physical rehabilitation in the ICU to prevent
“To prevent this, we started physical rehabilitation when they are still in the icu. For the most cognitive part, we try to make the patient as accompanied as possible although with covid it has been very difficult,” says Ferrer. Although these patients end up recovering, very few of them, even 90 days later, They have returned to their normal lives. “Most have not returned to work yet,” says the internist.
Symptom overlap
In addition, as explained by the head of the section responsible for monitoring the ICU at Hospital del Mar, Mapi Garcia, in coronavirus patients other symptoms due to infection overlap. “They are patients who, when they leave the ICU, suffer symptoms that derive from these prolonged stays in ICUs and of one’s own Viral infection. They have to deal with all these consequences, recovery is slow and it requires a lot of effort,” says Garcia.
The unintubated patient is in the ICU for less than a week. The intubated, between two and three weeks. And the one who needs an ecmo, from four to six
The main sequels left for patients with coronavirus in ICUs are respiratory. “It is a consequence of the fact that they have been on a respirator for a long time and that the virus itself produces lung damage” Garcia points out. In fact, as Ferrer points out, many of these patients develop a fibrosis pulmonary.
“The patient who enters an ICU but for whom we can avoid intubation is less than a week. The intubated, between two and three weeks. The maximum level of severity is that in which the patient needs support with ecmo [oxigenación por membrana extracorpórea]: usually four to six weeks in the ICU” adds Ferrer. After two weeks with mechanical ventilation, the patient must undergo a tracheotomy.
multidisciplinary approach
According to García, the key to dealing with all this set of sequels is the “multidisciplinary management”. “Pulmonologists, intensivists and physiotherapists work together to face recovery as early as possible. And there are two other key points: the patient effort and family support”, says this doctor from Hospital del Mar.
Post-ICU syndrome has been described for 10 years and doctors are paying more and more attention to it
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“Bringing the sick out to see the Mediterranean is part of our ICU humanization program and is part of the emotional therapy. We have seen that emotionally the patient is doing very well,” he adds. This program is aimed at patients with covid who have been in the ICU for a long time.
As Ferrer explains, the post-ICU syndrome is described in the medical literature Since 10 years ago and doctors are paying more and more attention to it. “Before, the patient was discharged from the ICU and followed up from the ward, but now the intensivists They already visit these patients in the ICU and give them specific long-term follow-up,” he says. The covid, he concludes, has made this syndrome “more relevant”.