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THURSDAY, May 7, 2020 (HealthDay News) -- The ordeal faced by critically ill COVID-19 patients likely won't end even if they pull through and survive their life-threatening infection, experts fear.

Some of these survivors will be emotionally scarred by their time spent in an intensive care unit (ICU), and they are at increased risk of psychological problems, such as anxiety, depression and post-traumatic stress disorder (PTSD).

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The article discusses post-intensive care syndrome and its relation to diabetes. As the pandemic continues to spread across the world, there has been a phenomenal increase in hospitalizations, admission to hospital intensive care units (ICUs) and fatalities. During these times people with diabetes are at the risk of developing severe symptoms and complications of COVID-19 According to the Center for Disease Control and Prevention (CDC) both type 1 and type 2 diabetics are at a higher risk. It’s even riskier if your blood glucose levels are frequently high or if you’ve developed diabetes-related problems like heart or kidney disease. Being at higher risk for severe COVID-19, protection from exposure to the virus is important. In case you get sick, you should have enough critical supplies since leaving the house is not an option. It is also important that you know the situation at hand in case you require hospitalization.

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Of all his years, 2020 was exceptionally challenging for Vietnam veteran Matthew Thomas. After the 75-year-old Aurora resident tested positive for Covid-19 in mid-May, doctors had to intubate him for 33 days so he didn’t go into respiratory failure. While Thomas survived, his 33-year-old son, diagnosed with Covid-19 shortly before his father was hospitalized, passed away.

Thomas also faced widespread effects from Covid-19, stemming from the time spent intubated and in intensive care. “The byproduct of the disease is that my muscles went to sleep,” says Thomas, who says his muscles became so weak that he could not use his arms and legs.

“I couldn’t do anything. I couldn’t even stand up,” he says.

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You didn’t die. You battled COVID-19 in intensive care for more than a week. You were on a ventilator but pulled through. Now you are disabled.

This will happen to a significant number of people who discharge home after fighting COVID-19. It is typical of the course that post-intensive care syndrome (PICS) takes by creating or worsening physical impairment as well as causing cognitive and psychological impairment among patients who have been critically ill.

Neuromuscular weakness is the most common form of physical impairment that individuals acquired during a stay in the ICU, with more than 25% having poor mobility, recurrent falls, or quadri or tetra paresis.

Physical symptoms often resolve within 12 months after discharge from an acute care setting. However, research shows that ICU-acquired weakness can last as long as 24 months.

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The number of Americans hospitalized with the virus is increasing again, reaching 41,000 late last week, many with a circle of loved ones holding vigil in their minds, even if they can’t sit at the bedside. A decade ago, critical care clinicians coined the term post-intensive care syndrome, or PICS. It describes the muscle weakness, cognitive changes, anxiety and other physical and mental symptoms that some ICU patients cope with after leaving the hospital. Those complications are fallout from the medications, immobility and other possible components of being critically ill. Now they worry that some family members of critically ill COVID patients may develop a related syndrome, PICS-Family.

Studies show that about one-fourth of family members, and sometimes more, experience at least one symptom of PICS-Family, including anxiety, depression, post-traumatic stress disorder or “complicated grief” — grief that is persistent and disabling — when their loved one has been hospitalized, according to a 2012 review article published in the journal Critical Care Medicine. Dr. Daniela Lamas, a critical care physician at Boston’s Brigham and Women’s Hospital, believes relatives and friends of coronavirus patients may be particularly vulnerable.

Hospital rules designed to prevent the spread of the virus have robbed them of the opportunity to sit with their loved ones, watching clinicians provide medical care and gradually processing what’s happening between physician updates, Lamas said. In pre-pandemic times, a nurse “would explain what they had heard [from the doctor] and help them come to terms with unacceptable realities,” she said.

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The next few months will be full of grim updates about the spread of the new coronavirus, but they will also be full of homecomings. Patients hospitalized with severe COVID-19, some having spent weeks breathing with the help of a mechanical ventilator, will set about resuming their lives. Many will likely deal with lingering effects of the virus—and of the emergency treatments that allowed them to survive it.

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PICS can manifest as problems with physical function, cognition and mental health, according to a fact sheet from the American Thoracic Society. PICS is a relatively under-recognized issue, despite the fact that it affects a large number of people treated in an ICU, according to Patricia Ohtake, PT, Ph.D., an associate professor in the physical therapy program in the University at Buffalo's School of Public Health and Health Professions. Ohtake has tailored her recent research on the rehabilitation of ICU survivors to reflect working with COVID-19 patients, particularly how physical therapy can aid in their recovery at home.

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Background

Psychological morbidity in both patients and family members related to the intensive care unit (ICU) experience is an often overlooked, and potentially persistent, healthcare problem recognized by the Society of Critical Care Medicine as Post-intensive Care Syndrome (PICS). ICU diaries are an intervention increasingly under study with potential to mitigate ICU-related psychological morbidity, including ICU-related post-traumatic stress disorder (PTSD), depression and anxiety. As we encounter a growing number of ICU survivors, in particular in the wake of the coronavirus pandemic, clinicians must be equipped to understand the severity and prevalence of significant psychiatric complications of critical illness.
Methods

We compared the efficacy of the ICU diary, written by family and healthcare workers during the patient's intensive care course, versus education alone in reducing acute PTSD symptoms after discharge. Patients with an ICU stay >72 h, who were intubated and mechanically ventilated over 24 h, were recruited and randomized to either receive a diary at bedside with psycho education or psycho education alone. Intervention patients received their ICU diary within the first week of admission into the intensive care unit. Psychological symptom screening with IES-R, PHQ-8, HADS and GAD-7 was conducted at baseline within 1 week of ICU discharge and at weeks 4, 12, and 24 after ICU discharge. Change from baseline in these scores was assessed using Wilcoxon rank sum tests.
Results

From September 26, 2017 to September 25, 2018, our team screened 265 patients from the surgical and medical ICUs at a single large academic urban hospital. 60 patients were enrolled and randomized, of which 35 patients completed post-discharge follow-up, (n = 18) in the diary intervention group and (n = 17) in the education-only control group. The control group had a significantly greater decrease in PTSD, hyperarousal, and depression symptoms at week 4 compared to the intervention group. There were no significant differences in other measures, or at other follow-up intervals. Both study groups exhibited clinically significant PTSD symptoms at all timepoints after ICU discharge. Follow-up phone interviews with patients revealed that while many were interested in getting follow-up for their symptoms, there were many barriers to accessing appropriate therapy and clinical attention.
Conclusions

Results from psychological screening tools demonstrate no benefit of ICU diaries versus bedside education-alone in reducing PTSD symptoms related to the intensive care stay. However, our study finds an important gap in clinical practice – patients at high risk for PICS are infrequently connected to appropriate follow-up care. Perhaps ICU diaries would prove beneficial if utilized to support the work within a program providing wrap-around services and close psychiatric follow up for PICS patients. This study demonstrates the high prevalence of ICU-related PTSD in our cohort of survivors, the high barrier to accessing care for appropriate treatment of PICS, and the consequence of that barrier—prolonged psychological morbidity.

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Many are struggling to overcome a range of troubling residual symptoms of the coronavirus, and some problems may persist for months, years or even the rest of their lives. Patients who are returning home after being hospitalised for severe respiratory failure from the virus are confronting physical, neurological, cognitive and emotional issues.

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A stay in the hospital's Intensive Care Unit (ICU) can be daunting. Wires, tubes, beeping monitors, unfamiliar noises lurking in the background, and the constant fear of whether you will make it through the illness.
For critically ill patients who survive, the near-death experience can leave a lasting impact on their health. The road to recovery, then, stretches way beyond getting off the ventilator and coming back home.
Post Intensive Care Syndrome (PICS) is characterized by physical, cognitive and psychological symptoms that appear after a patient leaves the ICU.

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Early on, patients with both mild and severe Covid-19 say they can’t breathe. Now, after recovering from the infection, some of them say they can’t think.

Even people who were never sick enough to go to a hospital, much less lie in an ICU bed with a ventilator, report feeling something as ill-defined as “Covid fog” or as frightening as numbed limbs. They’re unable to carry on with their lives, exhausted by crossing the street, fumbling for words, or laid low by depression, anxiety, or PTSD.

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COVID-19 may lead to severe acute respiratory dis-tress syndrome requiring intensive care unit (ICU) sup-port. Patients surviving respiratory distress could develop post-intensive care syndrome (PICS) that includes ICU-acquired weakness (ICUAW). Nearly 66% ofCOVID-19 patients have clinically important muscle weakness following discharge [1]. Therefore, communication between the critical care and rehabilitation physician is important to evaluate the physical function ofCOVID-19 survivors to start rehabilitation timely.