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COVID-19 Treatment Guidelines

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A clinic under development at UCHealth aims to care for COVID-19 patients who survive COVID-19 but face a difficult recovery from ventilator care and long ICU stints

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Most survivors of respiratory failure develop post-intensive care syndrome (PICS). PICS can persist for months to years and may severely impair quality of life. In a fast literature update posted on May 20, 2020, Anica Law, MD, a clinician at Beth Israel Deaconess Medical Center and former fellow in the Division of Pulmonary and Critical Care Medicine at Massachusetts General Hospital, describes PICS and the measures that potentially improve outcomes of COVID-19 patients who survive an ICU stay.

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When a COVID-19 survivor leaves the hospital, recovering physically may not be the only feat they’re faced with overcoming. For many patients who have undergone intensive care, studies have shown that there is also a likelihood for cognitive and psychological complications, which can linger for months, or even years.

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Patients who have survived COVID-19 may have to face another battle: post-intensive care syndrome, which is similar to post-traumatic stress disorder. And their family members could also experience the same feelings. Post-traumatic stress disorder, or PTSD, is similar to post-intensive care syndrome, or PICS.

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As the new coronavirus continues to spread across the United States, some areas of the country are at or near the peak of new infections, according to many health experts. But wide areas of the country are predicted to see new infections continue to grow for quite some time, with a corresponding increase in hospitalizations, admission to hospital intensive care units (ICUs) and fatalities.

There’s strong evidence that people with diabetes are more likely to develop severe symptoms and complications of COVID-19 (the disease caused by the virus). According to the Centers for Disease Control and Prevention (CDC), this higher risk applies to people with both type 1 and type 2 diabetes. That’s especially true if your blood glucose levels are frequently higher than levels in people without diabetes, or if you’ve developed certain diabetes-related health problems like heart disease or kidney disease.

To get cutting-edge diabetes news, strategies for blood glucose management, nutrition tips, healthy recipes, and more delivered straight to your inbox, sign up for our free newsletter!

If you’re at higher risk for severe COVID-19, it’s especially important to protect yourself from exposure to the coronavirus, and to have critical supplies on hand in case you get sick and can’t leave your house for the duration. But it’s also important to know what to expect if you develop symptoms that are severe enough to require hospitalization and admission to the ICU.

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The latest findings are honing in on the clinical conditions associated with COVID-19, along with the specific care pathways needed for patients, once stabilized, to fully recover.

Specialized care after the initial hospital stay is proving to play a critical role.

Hospitalized COVID-19 patients often experience significant pulmonary complications, including severe pneumonia and acute respiratory distress-like syndrome. Further, many physicians are reporting that patients are developing post-intensive care syndrome (PICS) due to an intensive care unit (ICU) stay measured in weeks rather than days. The virus is also resulting in strokes, and causing sepsis, which can lead to multi-system failure and leave a patient with lasting damage to the lungs and other organs.

This brief details COVID-19 patient care management strategies and research on how the clinical expertise of LTAC hospitals is uniquely suited for post-COVID patients.

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Some patients who have been infected with SARS-COV-2 have new, recurring, or ongoing symptoms and clinical findings more than four weeks after infection, sometimes after initial symptom recovery. Post-COVID conditions can occur in patients who had varying degrees of illness during acute infection, including those who had mild or asymptomatic infections. Medical and research communities are still learning about these post-acute symptoms and clinical findings.

Post-COVID conditions are being referred to by a wide range of names, including post-acute COVID-19, long-term effects of COVID, long COVID, post-acute COVID syndrome, chronic COVID, long-haul COVID, late sequelae, and others, as well as the research term post-acute sequalae of SARS-COV-2 infection (PASC).external icon Although standardized case definitions are still being developed, in the broadest sense, it can be considered a lack of return to a usual state of health following acute COVID-19 illness. It might also include development of new or recurrent symptoms that occur after the symptoms of acute illness have resolved.

Scientific knowledge is still limited about these effects, including what causes them and how often they occur. Interim terminology will be updated as more information becomes available.

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In the early days of caring for critically ill patients with acute respiratory distress syndrome, sepsis or multiple organ failure, we were grateful when they survived their illness. We used any interventions we could think of to increase the likelihood of survival. We didn’t really think about what came after patients’ intensive care unit (ICU) experience; we were just happy they survived. However, we came to find out that despite our best efforts, these patients had a high risk of developing delirium and postdischarge sequelae.

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Systemic disparities place minority populations at the greatest risk of contracting and dying from Covid-19, and there is robust literature documenting how structural racism has adversely impacted the well-being of Black, Latinx, and Indigenous people. To date, the predominant focus has been on how disparities impact patients before and during hospitalization with Covid-19. However, disparities in the post-hospitalization period remain unaddressed. Specifically, patients recovering from Covid-19 are at risk for a host of physical, cognitive, and psychiatric sequelae of critical illness, collectively termed “post-intensive care syndrome (PICS).” In the present article, we review the literature on disparities in PICS, highlight the personal toll of Covid-19 on our patients, and suggest solutions to anticipated challenges. We outline a three-pronged approach involving (1) the prevention of critical illness, (2) the deployment of short-term post-hospitalization initiatives, and (3) the implementation of long-term post-hospitalization and community-based solutions.

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Most people find that it takes time to recover physically and mentally from a critical illness. Physically you may notice differences such as muscle weakness, breathlessness or difficulty swallowing. Mentally you may feel sad, worried, have memory problems or frightening nightmares.

You might be told that you are experiencing Post-Intensive Care Syndrome (PICS). PICS is a term given to a group of symptoms that people may experience after a stay in intensive care. These symptoms may affect your body, your mind, or your emotions, and may also be experienced by members of your family. If this label has been used by a health professional to describe your symptoms, don’t worry they will improve, but it may take some time.

It is important to be patient with yourself and not expect to get completely back to normal straight away. Most people’s recovery from critical illness takes several weeks or months. It is normal for recovery to be gradual, so you may need to pace yourself as you try to return to your daily activities. Your family may also be affected by your time in intensive care, and you may find that relationships have changed, they can access advice and support here.

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▪Identify signs and symptoms of long COVID which occur after the acute phase of SARS-CoV-2 infection.
▪Identify potential multidisciplinary teams for patient care.
▪Describe common challenges to post-acute COVID-19 care.
▪Describe examples of patient-centered, interdisciplinary post-acute COVID-19 care.