For COVID-19 patients who respond successfully to intensive care treatment and are able to be discharged from hospital, the road to recovery can still be a lengthy one. The Guardian reports that the latest report into patients admitted into critical care for coronavirus so far in England, Wales and Northern Ireland showed that of 2,249 patients for whom data was available, only 344 (15%) had been discharged alive. A similar number had died (346 patients), while the majority – the remaining 1,559 – were still in critical care.
As it is early days in the spread of the virus, the report says tthe figures from the Intensive Care National Audit and Research Centre (IANARC) do not paint a complete picture. Additionally, little is known about what the recovery process looks like, but what is clear is that it will take time, even after leaving hospital.
It is a general rule that the sicker you are, the longer it will take to recover. As such, COVID-19 patients who have been on a ventilator will face the toughest convalescence. The first step for those patients will be for their doctors to decide they can be taken off sedation and they will then try to get them breathing through the machine themselves. Only when the patient is able to do this will the clinicians remove the breathing tube, enabling the patients to speak, which in some cases – depending on how long they have been intubated – will be the first time in a while.
The ICNARC figures show that of those who have required ventilation in the UK so far, only a third (127 out of 388) have survived. The report says even after coming off the ventilator, the patient will still need assistance getting enough oxygen and this is likely to be through a mask or, possibly, a continuous positive airway pressure ventilator (Cpap), which sits somewhere between a mask and ventilator on the intensity scale.
The patient will stay on the ICU until they are safe to move to a ward – one intensive care doctor told The Guardian this would probably take one to three days after coming off ventilation – where reduced intervention is needed.
But even then, the report says, the struggle is still far from over. At the bare minimum, to leave the ICU, sedation will have to have worn off and their breathing must have improved to the necessary threshold. Once they are transferred on to a ward, where they are likely to spend a week or so, being able to breathe without oxygen assistance is a prerequisite for being discharged from hospital.
Work will also begin in hospital on remedying the rapid weight loss and resultant weakness the patient will have suffered through muscle wastage as the body went into crisis mode during ventilation. In the first week after ventilation even sitting up in a chair can be a major first step, but as movement increases the muscles improve and get stronger day by day.When the patient leaves hospital they will still be restricted for weeks to months in terms of exercise, due to both the damage to their lungs and their muscles.
Also, the report says, wide ranging psychological problems, from depression to PTSD (post-traumatic stress disorder) are associated with time spent in an ICU. Patients can also suffer from hallucinations coming out of sedation, which can cause problems such as flashbacks at a later date.
[link url="https://www.theguardian.com/world/2020/apr/07/the-road-to-recovery-for-covid-19-patients"]Full report in The Guardian[/link]
[link url="https://www.icnarc.org/About/Latest-News/2020/04/04/Report-On-2249-Patients-Critically-Ill-With-Covid-19"]ICNARC report[/link]