DENVER, Colo. (Ivanhoe Newswire)— There have been 5.8 million confirmed cases of COVID-19 in the United States. 180,000 have died. For those who recovered, the path can be a long one – rehab after COVID. The more time spent in the ICU and on a ventilator, the harder and longer it will be to get back to normal … or get to a new normal.
From brain fog …
“It was like the flu on steroids,” shared COVID-19 survivor Clarence Troutman.
To fatigue … and trouble breathing.
“I could not draw in any air whatsoever,” Troutman recalled.
Living a month on a ventilator, Clarence Troutman is now COVID-free, but he knows surviving the disease was just the beginning.
“It was almost in some ways like being a newborn baby,” Troutman described.
“There’s a lot of retraining, strengthening, and a whole process to get people back to living their lives,” explained William Niehaus, MD, who specializes in physical medicine & rehabilitation at University of Colorado Hospital.
“It just, really took a lot of intensive rehab,” added Kat Aksamit, PT, DPT, NCS, a physical therapist at University of Colorado Hospital.
Doctors found that many patients need a team of therapists to relearn how to walk, talk, and even problem solve, as the disease attacks every organ from the lungs to the heart to the brain.
“Being on a ventilator for an extended period of time causes muscle wasting, it affects multiple organ systems,” expounded Dr. Niehaus.
A recent study showed a majority of survivors had inflammation in the heart which can lead to cardiac disease and heart failure. Strokes are also a growing concern.
“We’re seeing a lot of neurologic damage with people that have had COVID disease and a lot of blood clots,” elaborated Dr. Niehaus.
University of Colorado Hospital was one of the first facilities to begin actively rehabbing patients that are still COVID positive. Clarence started his rehab just three days after being off the ventilator.
“We had to kind of bring everything back a step at a time,” recalled Troutman.
Five months later …
“Things are coming around slowly but surely,” Troutman concluded.
Hospitals around the country are revamping their rehab procedures … evaluating patients daily, revising how much rehab patients can handle. Some hospitals are using biocontainment units to keep patients from spreading contaminated air.
Contributors to this news report include: Cyndy McGrath, Executive Producer; Marsha Lewis, Field Producer; Rusty Reed, Videographer; Roque Correa, Editor.
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TOPIC: FROM BRAIN FOG TO HEART DAMAGE: REHAB AFTER COVID
REPORT: MB #4786
INTUBATION: Roughly one in four patients admitted to ICUs in the U.S. each year have acute respiratory failure requiring mechanical ventilation. Intubation is the process of inserting a tube, called an endotracheal tube (ET), through the mouth and then into the airway. This is done so that a patient can be placed on a ventilator to assist with breathing during anesthesia, sedation, or severe illness. The tube is then connected to a ventilator, which pushes air into the lungs to deliver a breath to the patient. Among other procedures, Intubation is also performed for respiratory failure. There are many reasons why a patient may be too ill to breathe on their own. They may have an injury to the lungs, they might have severe pneumonia, or have a breathing problem such as COPD. There are some potential issues that can arise when a patient remains on a ventilator for an extended period. Common risks include trauma to the teeth, mouth, tongue, and/or larynx, accidental intubation in the esophagus (food tube) instead of the trachea (air tube), trauma to the trachea, bleeding, inability to be weaned from the ventilator, requiring tracheostomy, aspirating (inhaling) vomit, saliva or other fluids while intubated, pneumonia, sore throat, hoarseness, and erosion of soft tissue.
REHABILITATION AFTER BEING INTUBATED: After being on mechanical ventilation patients experience enormous catabolic stress, extended periods of inactivity, and usually go without their usual caloric intake. Many are rendered profoundly debilitated by the experience, and weakness and loss of muscle mass represents a second dangerous illness, putting them at risk for infections, falls, and poor resiliency to other illnesses. “Early mobilization” is a term for rehabbing patients after being intubated. Trained physical therapists and nurses walk intubated patients down the hall with portable ventilators or ambu bags and a physical therapist works with the ventilated patients in their beds. Benefits of early rehabilitation after MV include improved exercise capacity, functional status at hospital discharge, decreased duration of MV, and shorter ICU and hospital stay.
(Sources: https://pulmccm.org/randomized-controlled-trials/rehab-physical-therapy-icu-actually-help/, http://rc.rcjournal.com/content/57/10/1663)
REHABBING COVID-19 ICU PATIENTS: For COVID-19 patients leaving the ICU, recovering from the virus is just the beginning. Patients who receive ICU-level care may develop ICU-related weakness, which can damage the nerves and muscles in the body. They may have weakness in their lower legs and/or hands and fingers, which makes walking difficult, as well as activities of daily living, like getting dressed and showering. Also, a good number of COVID ICU patients are dealing with delirium, which is a period of acute confusion when patients are unable to pay attention consistently and often have trouble forming memories. Anecdotally, the delirium has appeared worse for many patients with COVID-19. Inpatients being treated for COVID-19 should be mobilized as soon as it is safe, meaning skilled-care providers should help them move and walk. Outpatients with physical or cognitive issues need to be seeing a physical medicine and rehabilitation physician. They may also need physical, occupational or speech therapy. Many will also need psychologic care to help them cope with their life after COVID-19. There is also a psychological adjustment as COVID ICU care can contribute to anxiety, depression, and post traumatic type response. Virtual care is the biggest change in how rehabilitation care is delivered in the COVID-19 era and it seems like it is here to stay.
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