The test is not the end: what will happen to those who are seriously ill COVID-19, after discharge from the hospital

For recovered patients with the coronavirus, who were on the ventilator for artificial lung ventilation (ALV), the statement of the test is not over , says Science.

Испытания не заканчиваются: что ждет тех, кто тяжело болел COVID-19, после выписки из больницы

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In addition to the complications of the disease itself, there are effects of the prolonged stay in intensive care. Doctors to develop rehabilitation programs, but their wide use is still far.

Among hospitalized patients with severe COVID-19 there are those who are lucky. It’s the people that have been connected to devices of artificial ventilation of lungs, to make it easier to breathe, which recovered and was discharged from the hospital. Today patients return home, and doctors turn their attention to the potential impact of the virus on intensive therapy, which helped patients to survive.

“In the coming months, all we are primarily faced with the question of how to help these people to recover and be healed completely,” says pulmonologist and critical care physician with the medical faculty of Yale University Lauren Ferrante.

COVID-19 affects not only the lungs but also the kidneys, blood vessels, heart, brain and other organs. Doctors do not yet know what long-term health disorders caused by a virus, but it is possible to guess, having examined severe cases of pneumonia, during which, as during the COVID-19, begins the inflammation of the pulmonary alveoli. Such infection may lead to acute respiratory distress syndrome, when these air sacs in the lungs fill with fluid. Most patients eventually recover normal lung function, but sometimes the acute respiratory distress syndrome leading to pulmonary fibrosis, resulting in prolonged problems with breathing, says Ferrante.

After severe pneumonia combination of chronic diseases and prolonged inflammation increases the risk of other diseases, including heart attack, stroke and kidney failure, says the epidemiologist and emergency physician Gjende Sachin (Sachin Yende), working at the medical center of the University of Pittsburgh. According to him, COVID-19 can cause a serious increase in such risks.

Patients, who spent some time in intensive care, regardless of their disease after discharge may be faced with a whole set of physical, cognitive and mental disorders. Survivors coronavirus patients in intensive care units are particularly vulnerable to such risks, partly due to the fact that in the case of severe lung damage many patients for a long time on the ventilator under the influence of soothing medicines, said resuscitator Dale Needham (Needham Dale), working at the medical faculty of Johns Hopkins University.

In those few patients who survive for a long time after lying on a ventilator, it is often weakness and muscle atrophy. If you get very sick patient to move, helping him to lift his arms and legs, and eventually to sit, stand and walk, this will reduce the weakness and lets you quickly disconnect it from the vent. But in some hospitals due to the lack of protective clothing physiotherapists try to stay away from sick COVID-19.

Another danger is the clouding of consciousness called the state of muddled thinking, which can cause long-term intellectual disorder such as memory impairment. “When COVID delirium occurs very often,” says pulmonologist and intensive care specialist E. Wesley Ely (E. Wesley Ely), working at Vanderbilt University.

One reason is the virus itself that can infect the brain. However sedatives that give order to suppress painful cough and to relieve patient discomfort from the breathing tube, increase the risk of delusional state. And when inventory is a widely used sedative drugs in hospitals over physicians resort to other drugs that can cause “intense and prolonged delirium,” says Eli.

Eli with colleagues over many years have developed guidelines for patient care in intensive care, and among other things there is an indication of a daily basis to interrupt the flow of narcotics and sedatives, checking whether the patient is to recover, to breathe and to move the ventilator without drugs. “But it requires constant monitoring, which is impossible in overcrowded emergency rooms, says Eli. All there trying their best…. But we must not abandon what we have learned over the last 20 years.”

The danger of Contracting the disease also interferes with the doctors to communicate with patients, although it calms them down and sometimes gives you the opportunity to refuse the drugs that cause delirium. “We invented a system that is not suitable for the elderly… relatives are not allowed to visit them, doctors come in masks, dressed in protective suits. It’s very scary,” says geriatrician Sharon Inouye (Sharon Inouye), working at the medical faculty of Harvard University in the system of health care seniors Hebrew SeniorLife.

Some of the doctors begin to doubt the need to use the respirator in the early stages of the disease. “If we put on a ventilator more people than you need, this will definitely affect their condition after recovery,” says intensive care specialist from the University of Washington in Seattle K. Terry hock (C. Terri Hough).

Some hospitals have already experienced the initial growth in the number of diseases, and scientists are beginning to look to the future. Team Eli inspects rehabilitation programs for people suffering from intellectual disorders after being hospitalized in serious condition. The team Gjende is implementing a project of care for discharged patients with pneumonia and sepsis, which includes remote monitoring, treatment and home visits to prevent re-hospitalization.

And someone is preparing for the surge of mental illness among the survivors, such as anxiety disorder, depression and PTSD. Hawk with colleagues is testing a mobile application that promotes mindfulness and stress discharged from the hospital. According to her, the collaborative approach to overcoming the consequences of the gives that have survived the disease in severe form of hope, which they didn’t have before.

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