ICU Acquired Weakness in patients with respiratory failure

Difficulties in the Treatment of Complications and Rehabilitation after COVID-19. A Clinical Case

The severe course of the new coronavirus infection (COVID-19) is associated with multiple life-threatening complications that lead to delayed initiation of active rehabilitation and unfavorable long-term treatment outcomes. Tracheoesophageal fistula is one of these complications. The specific feature of this event in COVID-19 is delayed tissue regeneration which requires a non-standard approach to management of such patients.

The article presents a clinical case of a pregnant patient after a complicated severe course of COVID-19 with the development of tracheoesophageal fistula, sepsis, and weakness syndrome acquired in ICU. The combination of complications of the disease led to a prolonged (about five months) period of rehabilitation.

Modern standard components of intensive therapy of such patients including regular monitoring of endotracheal/tracheostomy tube cuff pressure, dynamic assessment of nutritional status and its correction, rational antimicrobial therapy, screening of psychiatric disorders and early rehabilitation, will minimize the number of both early and delayed complications of COVID-19.  

REHABILITATION DURING THE COVID-19 PANDEMIC

The COVID-19 pandemic has affected the entire healthcare system, from emergency care, intensive care units, internal medicine wards, outpatient care to home care. The pandemic continues and brings a large number of patients with COVID-19-associated postintensive care syndrome suffering from physical, mental and cognitive impairments that threaten their return to normal life. The complexity and severity of illness in patients recovering from severe COVID-19 requires a coordinated and systematic approach to be applied as early as possible during the recovery phase. Considering the multiorgan dysfunction, debility, pulmonary, neurological, neuromuscular and cognitive complications, rehabilitation professionals can play an important role in the recovery process for individuals with COVID-19. Complications of COVID-19 can be reduced by 1) multidisciplinary rehabilitation, which begins early and continues throughout the hospital stay, 2) providing patient/family education for self-care after discharge from inpatient rehabilitation, and 3) continuing rehabilitation care in the outpatient setting, and at home either in person or with the help of telerehabilitation.