Context: Recently, various news reports have pointed out that for some coronavirus positive patients who needed intensive care, the journey to recovery is a long one. After leaving the ICU, they may suffer from what is known as post-intensive care syndrome (PICS).
About Critically ill Covid-19 patients:
- WHO-China Joint Mission report: It examined 55,924 laboratory-confirmed cases of Covid-19, over 6.1 per cent were classified as critical, which means they experienced respiratory failure, shock and multiple organ failure.
- According to The Lancet: Critically ill Covid-19 patients are generally older, and have more comorbidities such as hypertension and diabetes.
- Acute Respiratory Distress Syndrome (ARDS) is one of the manifestations of Covid-19. It is a common reason for ICU admission and such a patient may need mechanical ventilation to deliver oxygen and remove carbon dioxide from the body.
About Post-Intensive Care Syndrome(PICS)
It is defined as a new or worsening impairment in physical (ICU-acquired neuromuscular weakness), cognitive (thinking and judgment), or mental health status arising after critical illness and persisting beyond discharge from the acute care setting.
It may be induced if a person was on prolonged mechanical ventilation, experienced sepsis, multiple organ failure and a prolonged duration of “bed-restore deep sedation”.
People on ventilators may also develop ICU-acquired muscle weakness (ICUAW).
Generalised weakness, fatigue, decreased mobility, anxious or depressed mood, sexual dysfunction, sleep disturbances and cognitive issues.
Such patients may experience neuromuscular weakness, which can manifest itself in the form of poor mobility and recurrent falls.
Psychological disability may arise in a person in the form of depression, anxiety and post-traumatic stress disorder (PTSD).
Patients who develop this may take at least a year to fully recover, until which time they may have difficulty in carrying out everyday tasks such as grooming, dressing, feeding, bathing and walking.
They may also develop problems related to cognitive function and other mental health issues, including difficulty in falling and staying asleep. Some of the patients may not be able to return to the jobs they had before illness.
It is recommended that to avoid PICS, patients’ use of deep sedation is limited and early mobility is encouraged, along with giving them “aggressive” physical and occupational therapy.
The patients should also be given the lowest dose of pain medications when possible, and should be put on lung or cardiovascular rehabilitation treatments along with treatments for depression, anxiety and PTSD.