Health systems need to start ramping up services for helping people recover from intensive care treatment for coronavirus, doctors are warning. After spending several weeks on a ventilator, people will need extensive physical and mental rehabilitation for weeks afterwards.
鈥淲e鈥檙e going to have an epidemic of post-intensive care rehab requirements for people who survived,鈥� says Kathryn Mannix, a palliative care doctor in north-east England. 鈥淭hey鈥檙e not going to come back home well.鈥�
Many countries are now treating unprecedented numbers of covid-19 patients in intensive care whose lung function has worsened to the point they need mechanical ventilation. To have a tube聽put down their throat and a machine take over their breathing, they need to be sedated into unconsciousness and receive drugs that paralyse their muscles.
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Many people at this stage are deteriorating further, with failure of other organs, such as the heart or kidneys. In the UK, 聽half of people with covid-19 who need ventilation are dying.
For those who survive, the sedation can be slowly lessened 鈥� this is a very frightening and bewildering experience, says Brian Cuthbertson at Sunnybrook Hospital in Toronto, Canada. As the opioid medication is reduced, they may聽suffer hallucinations and agitation, like someone coming off heroin. 鈥淎 classic terrifying delusion is that the nurse is trying to kill you,鈥澛爃e says.
After ventilation, people also feel extremely weak, partly thanks to ordinary muscle wasting because they may have lain聽in bed for several weeks, and also due to their muscle tissue being broken down as they were critically ill.
At first, people may be too weak even to breathe for themselves, so the time they spend off the ventilator has to be slowly increased. For this, the patient needs to have a tracheostomy, when a breathing tube is put into a hole in their neck instead of going down their mouth, so they can easily switch back and forth between breathing independently and on the machine.
In time, physiotherapists will begin helping the patient to start moving around and becoming more independent. But even once they are discharged from hospital, they may need many more weeks or months of exercises before they have regained their strength.
For reasons that aren鈥檛 clear, people who have been in intensive care may also have memory or concentration problems and higher rates of depression, anxiety and other mental health conditions. Studies suggest about one in 10 experience post-traumatic stress disorder, involving flashbacks and nightmares.
Although few ventilated covid-19 patients have yet left hospital in the UK, doctors are warning they seem to be taking longer to be weaned off ventilator support. 鈥淭his disease seems to affect the lungs worse. It leaves people very weak,鈥� says Carl Waldmann at the Royal Berkshire Hospital in Reading, UK.
This could be because people with coronavirus need higher levels of sedation and paralysis drugs, says Cuthbertson. 鈥淭he drive to breathe [for themselves] is so high, we have to give very deep sedation.鈥�
Another issue is that many covid-19 patients are being looked after by staff who don鈥檛 usually work in intensive care, says Stephen Brett at Imperial College London. 鈥淓xperienced intensive care nurses are more used to supporting people who are recovering consciousness in a new, frightening place.鈥�
Even before the coronavirus pandemic, there had been a growing movement in hospitals to provide more aftercare for patients, such as physio and psychological support, led in the UK by the Faculty of Intensive Care Medicine. 鈥淭he epidemic has put this need under the microscope,鈥� says Waldmann, the body鈥檚 former president. 鈥淣ow we must prepare for a large increase in numbers.鈥�
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