Outcomes of critically ill COVID-19 survivors and caregivers: a case study-centred narrative review

Abstract

Purpose Critical illness is a transformative experience for both patients and their family members. For COVID-19 patients admitted to the intensive care unit (ICU), survival may be the start of a long road to recovery. Our knowledge of the post-ICU long-term sequelae of acute respiratory distress syndrome (ARDS) and severe acute respiratory syndrome (SARS) may inform our understanding and management of the long-term effects of COVID-19. Source We identified international and Canadian epidemiologic data on ICU admissions for COVID-19, COVID-19 pathophysiology, emerging ICU practice patterns, early reports of long-term outcomes, and federal support programs for survivors and their families. Centred around an illustrating case study, we applied relevant literature from ARDS and SARS to contextualize knowledge within emerging COVID-19 research and extrapolate findings to future long-term outcomes. Principal findings COVID-19 is a multisystem disease with unknown long-term morbidity and mortality. Its pathophysiology is distinct and unique from ARDS, SARS, and critical illness. Nevertheless, based on initial reports of critical care management for COVID-19 and the varied injurious supportive practices employed in the ICU, patients and families are at risk for post-intensive care syndrome. The distinct incremental risk of COVID-19 multiple organ dysfunction is unknown. The risk of mood disorders in family members may be further exacerbated by imposed isolation and stigma. Conclusion Emerging literature on COVID-19 outcomes suggests some similarities with those of ARDS/SARS and prolonged mechanical ventilation. The pathophysiology of COVID-19 is presented here in the context of early outcome data and to inform an agenda for longitudinal research for patients and families.

Prolonged intensive care: muscular functional, and nutritional insights from the COVID-19 pandemic

“…ICUAW and diaphragmatic dysfunction increase LOS, mechanical ventilation, weaning failure, care costs, morbidity, and in-hospital mortality [ 16 ]. Risk factors associated with ICUAW are predominant in every critical COVID-19 patient: immobility and the use of neuromuscular blockers and corticosteroids [ 28 ].…”

“…Knowledge of previous functional status will help clinicians identify risk factors for developing PIC, such as sarcopenia, frailty, and level of independence in daily life activities [ 37 ]. Frailty and functional deterioration in critically ill COVID-19 patients allow clinicians to estimate their risk of developing new infections, organ failure, and poor long-term outcomes [ 28 ].…”

“…The catastrophic consequences of critical illness have been described for several years. In patients with ARDS due to COVID-19, the risk of PIC is high and can lead to the development of future disabilities and death even outside the hospital [ 28 , 57 , 58 ]. Preventive measures for these issues have been well-described in the literature [ 59 - 64 ].…”