ARTICLE: Survivorship after COVID-19 ICU stay
AUTHORS: Megan M. Hosey and Dale M. Needham
JOURNAL: Nat Rev Dis Primers. 2020; 6(1): 60.
Our understanding of the epidemiology of the severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) infection and associated COVID-19 illness continues to evolve. Statistics from early in the pandemic indicate that ~1 in 5 infected individuals are hospitalized, and 1 in 10 may be admitted to an intensive care unit (ICU), with most of these critically ill patients experiencing acute respiratory distress syndrome (ARDS) and requiring mechanical ventilation1. Although most individuals infected with SARS-CoV-2 seem to be asymptomatic or experience mild symptoms (such as persistent cough, with chest pain and chest tightness), the pandemic has resulted in an unprecedented spike in the incidence of ARDS and critical illness. The success of critical care medicine in reducing mortality will result in a large number of survivors of COVID-19. Up to 80% of patients surviving acute respiratory failure after receiving mechanical ventilation in the ICU experience new or worsened physical, cognitive and/or mental health impairments that persist beyond hospital discharge, collectively known as the post-intensive care syndrome2. Although old age, pre-existing physical frailty, psychological symptoms (for example, anxiety and depression) and cognitive impairment (for example, dementia) are risk factors, even those without such risk factors are at risk for long-lasting sequelae. Optimizing the COVID-19 survivorship experience, based on this knowledge, demands careful implementation of evidence-based critical care interventions combined with robust rehabilitation programmes that begin in the ICU and continue after discharge.
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