Strong sedatives needed to rescue coronavirus patients may also make recovery difficult | Coronavirus

After a break earned after 6 weeks of treatment Coronavirus Dr. Kyle Happel, a patient, pulmonologist at the University Medical Center ICU and an emergency care specialist at the LSU Health Science Center, is forced to “chart stalking” some of his previous charges.

“You just want to know if they’re doing well, are they still alive,” Happel said.

Many of the people he treated had ventilators, so most could fall down with the disease. However, for a successful person, a long-term recovery in the hospital can be a longer recovery at home because of the excessive time spent on drugs and respiratory tract.

During the normal period, patients with ICU may remain on the ventilator for 3 or 4 days. However, it is not uncommon for patients with coronavirus to remain on the ventilator for 1-2 weeks, and sometimes for more than a month. And those patients need large amounts of sedatives, analgesics, and paralytics.

“The amount of sedative needed to help people is astronomical and has never been seen before,” said a nurse at Ochsner ICU, who has decades of experience.

For patients who have been taking unprecedented amounts of drugs in the ICU for more than a month, the physical and mental sacrifice of coronavirus often causes delirium, and doctors worry about a long way to a true recovery. I am. Even if the coronavirus did not kill the patient within a few weeks, they could live for many years under the influence of it.

“Many of these people will be unable to return to the same level of daily functioning and daily life,” Happel said. “In most cases, they will not be the same people as before. Some may require long-term acute care or placement in a skilled nursing facility. Sometimes dialysis may be necessary In survivors, there is a significant prevalence. ”

According to the largest mortality study of patients suffering from coronavirus in the ventilator, the vast majority who went to the ventilator do not drop out. Of the 98 British ventilated patients, only 33 were discharged.

Other studies are more calm. A small Chinese study killed 19 of 22 ventilated patients.

The ventilator itself is dangerous to the patient. This can be a life-saving measure, but continuing too long can cause complications.

“I tend to think of ventilators as a race,” Happel said. “It’s a race for you to get off before you develop complications: lung injury or pneumonia.”

When patients with coronavirus remain on the ventilator, they develop resistance to drugs that allow plastic tubes to pass through their throat.

Fentanyl, a synthetic opioid used as both a sedative and an analgesic, is essential.

“We used metric tons,” Happel said.

In some hospitals, such as Our Lady of the Lake in Baton Rouge, so many patients needed high levels of medication, so the maximum dose for nurses was relaxed.

Bad O’Neill, director of the hospital’s medical department, said:

The longer the ventilator is used, the more familiar the patient will be with the drugs they need to treat.

“All opiates-fentanyl, morphine, deltoids-patients may develop resistance,” O’Neal said, the hospital still treating patients admitted during the first wave of late March. I am doing it. “Sometimes we need to constantly climb up to the patient.”

Because powerful opiates and other narcotics are addictive and not intended for long-term use, doctors seek to provide patients with minimal drug therapy at the ICU.

Addiction can lead to withdrawal if the patient can slowly leave the ventilator, which is another difficult battle.

Demand for sedatives, paralytics, and painkillers surged 73% nationwide in March, according to Vizient, Inc., which is negotiating drug prices for hospitals nationwide. Hospitals in Louisiana also faced a shortage due to the large number of patients on ventilators.

Ochsner ICU When a nurse tries to get fentanyl from the pharmacy, she receives a message. “It has a serious shortage and they will offer you an alternative.” Instead, she and her colleagues used a more potent form of fentanyl, and then switched to another opiate, ziraudid. It was

According to Ochsner Health’s statement e-mailed from the hospital’s public relations team, “a collaborative team … we worked together to develop a treatment protocol for multiple scenarios and an equivalent alternative to all the drugs needed!” “.

Beyond withdrawal, patients are also at a much higher risk of post-intensive care syndrome, a series of health problems that continue after extended stays. One in three patients with ICU experiences delirium, making it difficult to eat, sleep, think, and remember where they are. Dr. E. Wesley Erie, a practitioner and emergency care physician at the Vanderbilt Medical Center, said high levels of sedation could last for years.

“Too long, too long,” said Ely from Shreveport, who received a medical degree from Turrain. He has also seen patients leave the ICU with muscle weakness, newly acquired dementia, depression and PTSD. “We now have a man trying to wake up on a ventilator after 30 days. They are sick, get out of it, are weak, and are almost immobile.”

It is too early for studies to show the long-term effects of COVID-19. However, the long-term outcome of patients with acute respiratory distress syndrome provides some clues. To One studyPatients had poor quality of life due to continued decline in lung function for 1-2 years after lung injury. In a large review of the medical literature, ARDS patients Also experienced High levels of depression, anxiety, PTSD 6 months to 2 years after staying in ICU. Approximately 44% lost their jobs a year after staying, and only half returned to work four months later.

“General health-related quality of life was significantly reduced compared to the matched population in all studies,” the author wrote in a study published in the journal Current Opinion of Critical Care in 2018. I am.

If the patient leaves the ICU, it takes time to recover for a long time. In particular, older family members may not have been able to do it before they became ill.

“Even if they’re out of the hospital, brain recovery can take months,” Happel said. “Patients don’t want to be impaired, but it’s a function of long-term, serious illness.”