This is the 'robot portrait' of the post-ICU sequelae in patients with Covid-19

• RAQUEL SERRANO / CRISTINA G. LUCIO

  Madrid

Updated on Monday, 3January2022-02: 17

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• Direct Latest news of the coronavirus

• Testimony Sergio's blank year because of Covid

The 'robot portrait' of the 'return to normal life' of a patient

would be that of "a patient who is going to have

in his day-to-day life and that you will probably need

; that you will possibly need

for a period of time - which in turn, will limit the type of activity you can do, since you will probably to have persistent fatigue - and that, in many cases, will be accompanied by a

to be able to do routine things that I enjoyed before. "

This is how

, from the Intensive Medicine Service of the Puerta de Hierro-Majadahonda Hospital, in Madrid,

summarizes

the

that patients with Covid-19 who have been admitted to face days, even many months later in the ICU to be able to fight the virus that brought them to them.

Alcántara, like all Spanish health professionals,

that SARS-CoV-2 has caused in thousands of people and the

- those of Covid-19 and those of the ICU - who have suffered and will continue to suffer for a long time.

Sergio Casinelli, who turned 74 at the Puerta de Hierro UCI, is one of them.

He has lived

in this unit fighting against a disease that

since Christmas 2020. And

, along with a great multidisciplinary team,

.

Now, he is already out of the UCI and, as he explained, "this has been

, as if he had jumped from Christmas 2020 to Christmas 2021."

If it weren't for

that the virus has left on your body, you might not believe what they tell you.

It is precisely these alterations - a mixture of those

and well known to intensivists, but also

- that, from now on, Sergio and all the thousands of people affected by this coronavirus will have to cope in order to recover.

Because, according to Alcántara, these types of sequels

.

"You never know"

"Although, logically, the older we become, the more fragile we become, they

. To think: 'I am 30 years old and I am going to leave the ICU with the same 30 years and I am going to recover quickly and very well', sometimes it doesn't happen.

. "

The

of patients affected by Covid-19 in the ICU is usually, "if they go well," says Alcántara,

.

But this window can be

, reaching

for Sergio Casinelli, but even

.

What is beyond any doubt is that the

, in which intensivists, anesthetists, pulmonologists, physiotherapists, nurses work ... is

.

"Without this teamwork of different professionals it would not have been possible to get Sergio and other people out of the ICU."

The intensivist combines

that these patients present

in

: respiratory type, polyneuropathies related to immobility, and cognitive and pain alterations.

The

derive from the fact that many patients who need

long present processes as

, among others, requiring mechanical ventilation noninvasive long. "After discharge from the ICU, some of them require

the ward, which in many cases prolongs hospital discharge. But, in addition, many patients will need some type of support, such as

and even

"explains Alcántara.

Polyneuropathies

, caused by

, cause symptoms of

of strength and generalized muscle weakness

that "make those affected extremely dependent. On many occasions,

, so they need a lot of

to be able to have a new one .

some independence in their daily life and carry out transfers as simple as going from bed to a chair or going to the toilet alone, for example. "

In Sergio Casinelli's case, the

he has suffered - he has

many kilos during this period - are complicating his ability to

. "In addition, in the time that he has been admitted, he has also suffered

, some serious, and

that he suffered previously, before Covid-19 came into his life,

have

," recalled Alcántara.

Thus, both for respiratory and physical sequelae,

enter the scene

who carry out respiratory and limb mobility physiotherapy, "already in the ICU. Afterwards, it continues in the ward and, on many occasions, must be prolonged at home ".

The vast majority of patients who have undergone ICU have problems related to

.

In fact, this is one of the aspects that most interests professionals - it is currently being debated and reviewed - and is known as post-ICU syndrome.

How did I do this before?

"Many of the patients are left with

; some cannot return to their

because they feel completely incapable of carrying out activities that were previously simple for them. 'How did I do this before and now I don't know how to do it?' 'I can't read, I can't concentrate' are some of the most repeated phrases. Treating this aspect is of the utmost importance so that they end up

", considers Alcántara.

Intensivists are well aware that to avoid or minimize the appearance of cognitive problems after the ICU stay "it is very important to determine what

,

-when it appears in the ICU- and install a treatment".

In addition to clinical measures, there is a

decisive to avoid this deterioration: the

. "For us, it is essential that these patients are accompanied as much of the time as possible by

, by people who encourage them. It is absolutely important to prevent cognitive deterioration from appearing. Because, once it is installed, you have to resort to the work of physiotherapists, rehabilitators, psychiatrists, neurologists: a multidisciplinary approach by professionals to

"says Alcántara.

In Sergio's case,

, his wife, has been

who has been by his side all this time.

Although she could barely see him for months,

.

He comes and goes every day, by bus, from his house to the hospital and he gets emotional recalling what happened, all the sorrows and the few joys that he has had to live this last year.

To this complicated panorama, there

that complicates global treatment: that those affected by Covid-19 who require intensive care carry, in addition,

.

Sergio, for example, had a respiratory problem, which has been added to a

that he already had and for which he now needs to undergo

. "When intubated in the ICU, blood pressure drops and the

. If, in addition, it was already fragile kidneys due to previous renal failure, for example, the problem worsens."

A similar situation is reproduced if upon admission to the ICU there is

: "The

, as with certain

that, as in Sergio's case and caused by infection, led to amputation of his left hand. "These problems

, depending on the severity of the previous condition: some progress during the ICU stay and others may return to their basal state," explains Alcántara.

Despite the efforts made by the multidisciplinary hospital teams, it has not yet been possible to specify what is

that would indicate that a person admitted to the ICU begins to develop sequelae.

"

, it

. There are some who are 10 days old and come out with cognitive impairment and with horrific problems of delirium and nightmares. However, there are others who are hospitalized for 40 days and come out relatively well. It depends a lot on the cause he brought them to the ICU. "

The

. Patients admitted due to an infection, regardless of the etiology, are more likely to have

. And, of course,

stroke, brain hemorrhage - are more prone to presenting problems, as are

with previous cognitive problems. "

In this

, patients admitted to the ICU can

caused by the

and those derived from

. "If in the patients affected by Covid-19 who say that they later have myalgia, fatigue ... you add that they have needed admission to the ICU, it is evident that it is a

. In the end, they need rehabilitation and long-term supports

. " "They

" says Sergio resigned.

In this sense, Alcántara emphasizes that there are already many hospital centers -in Madrid the one in La Paz is a pioneer- that are betting on what are called

, in which

doctors

see their patients upon discharge from the ICU and They carry out a

that have remained in order to try to redirect them.

Chronic Hospital, key in this context

"The colleagues from La Paz are pioneers and references in this

consultation

in which a very interesting field of study and approach opens up. The sequelae of our patients are usually so serious that many

are talking about the

ICU ".

Patients who have required admission to the ICU due to Covid-19 have

.

But not everything can be restricted to the hospital setting.

It is necessary

and subsequent assistance in centers to minimize or eradicate the consequences.

"If the recovery does not continue, all

use," says Alcántara, who argues that the solution would be to

.

"In Spain, care for

, but care for the chronically ill is forgotten

."

According to the criteria of The Trust Project

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