Post on 26-Oct-2020
Donderdag 14 mei 2020 19:00-20:00
Competentiecentrum Interne GeneeskundeDienst Longziekten
OPENING THE FUTURE
Donderdag 14 mei 2020 19:00-20:00
Kerncijfers 1 juni 2020 Sciensano
Donderdag 14 mei 2020 19:00-20:00
Donderdag 14 mei 2020 19:00-20:00
Donderdag 14 mei 2020 19:00-20:00
Donderdag 14 mei 2020 19:00-20:00
Post Intensive Care Syndroom: wat weten we?
Prof Greet Hermans (Inwendige Ziekten – Medisch Intensieve, UZL)
Post COVID-19 revalidatie: van ICU tot in de ambulante praktijk!
Prof Rik Gosselink (Revalidatie en kinesitherapie, Faber, KUL)
Post COVID-19 follow-up: hoe, wat, wanneer?
Dr Natalie Lorent (Longziekten – UZL)
Donderdag 14 mei 2020 19:00-20:00
3 topics, nadien interactieve discussie op basis van een aantal vragen
Vragen doorsturen via mail
Wie zich registreert en via de eigen link kijkt, krijgt accreditatie (> 50% uitgekeken en RIZIV-nummer)
Mentalhealth
Physicalfunction
Cognitivefunction
Anxiety/ASDPTSD
Depression
Executive FunctionMemoryAttention
Visuo-spatialMental Processing
Speed
PulmonaryNeuromuscular
Physical Function
PICS
Quality of life
Crit Care Med 2012, Needham
6 min walking distance SF-36
Herridge, NEJM 2011
Physical function and quality of life
0%
5%
10%
15%
20%
25%
30%
35%
40%
hospitaldischarge
3 months 6 months 12 months 24 months
Inci
denc
eof
IC
UAW
Fan, CCM 2014
36%
15%14%
9%
N=173 N=130 N=136 N=127 N=127
22%
Fan, Crit Care Med 2014
Recovery from ICUAW
Cognitive impairement after critical illness
Panharipande, NEJM 2013
3 months:
40% ≈ moderate traumatic brain injury26% ≈ mild Alzheimer’s disease
12 months:
34% ≈ moderate traumatic brain injury24% ≈ mild Alzheimer’s disease
Bienvenu, Int Care Med 2018Bienvenu, Int Care Med 2018
Psychiatric symptoms 5 years following ARDS
Incidence of ‘any’ PICS
Annachiara, Crit Care Med 2018
Difficult to determine:
- Variable domains- Variable outcome measures- Variable populations- Variable follow-up periods
Return to work and lost earnings 5y following ARDS
Kamdar, Thorax 2020
31% never returned to work in 5-years
“LEGACY OF CRITICAL ILLNESS”
Risk factors for long-term outcomes
Age GenderComorbidities FrailtyPre-ICU disabilitiesPre-ICU functional trajectory Premorbid psychiatric diseaseSocio economic status Arabi, ICM 2017
Risk factors for long-term outcomes
Type & severity of illness
Arabi, ICM 2017
“LEGACY OF CRITICAL ILLNESS”
Risk factors for long-term outcomes
Duration of MVDuration of ICU stayICUAWDeliriumDrugsGlucose dysregulationHypoxiaHypotension
Arabi, ICM 2017
“LEGACY OF CRITICAL ILLNESS”
MorbidityN= 205
MortalityN= 596
Van Aerde , Int Care Med 2020
Impact of ICU-acquired neuromuscular complications on 5y outcomes
aHR (per point increase): 0.946 (0.928-0.968), P=0.001
Duration of delirium and outcomes at 12 months
Panharipande, NEJM 2013 Brummer Crit Care Med 2014
Global cognition ADL
“LEGACY OF CRITICAL ILLNESS”
Risk factors for long-term outcomes
Arabi, ICM 2017
Iwashyna TJ AJRCCM 2012: 186:302
Early Mobilization and Physical Activity
Critical Care Medicine 2019
Critical Care Medicine 2019
Principles of exercise training
Exercise trainingMobilisation – Body positioningActive muscle (resistance) trainingPassive static and dynamic muscleStretching and range of motion exercise Transcutaneous electrical muscle stimulation
MODALTIES FOR PHYSICAL TRAINING
UNSTABLE-BED RIDDEN-UNCOOPERATIVE
STABLE-COOPERATIVE
https://www.sciencedirect.com/science/article/pii/S183695532030028X
Iwashyna TJ AJRCCM 2012: 186:302
Post-ICU and Hospital Discharge Rehabilitation
Multidisciplinary Supervised Program: evidence ?
The dramatic spread of the current COVID-19 epidemic in Italy has spurred into action also respiratory physicians and physiotherapists, who have been engaged for years in the care of patients with disabilities secondary to respiratory diseases and/or conditions. Their experience acquired in the management of chronic and acute respiratory failure is proving to be a fundamental asset for the management of patients during the COVID-19 epidemic. Hence, it is likely that the reorganization involved in taking care of this scenario will not be a short-term matter.
https://www.ersnet.org/covid-19-blog/covid-19-and-rehabilitation
TRAJECT UZ Leuven (Fysische geneeskunde)
(Pneumologie) (Geriatrie)
Follow-up traject post-COVID in UZ Leuven
+/-350 patiënten 6 weken (6 maanden) 12 maanden
Klinische evaluatie
In functie van comorbiditeit/ernst/ICU verblijf/behandeling
Functionele evaluatie
SymptomenCT thorax (+ US ledematen)Biochemie + SARS-CoV-2 Ab
Outcome MortaliteitNood aan revalidatieImpact van revalidatie
Longfunctie6MWD (+ ergospiro)Handgrijpkracht (+ quadriceps,…) Levenkwaliteit
COVID-19 infectie- RT-PCR en/of - suggestieve CT thorax
Gehospitaliseerd en ontslagen naar huis(leeftijd, ambulant) +Alle ICU
Temporal pattern in CT changes
SARS-CoV-2 SARS-CoV
Wang et al. Radiology 2020Ooi et al. Radiology 2004
63 j man, ICU voor HFNC 45% gedurende 3 dagen
50 j vrouw, immuungecompromitteerdICU voor MV gedurende 4 dagen
6 wk na ontslag
6 wk na ontslag
opname
opname
Pulmonary function in SARS-CoV survivors
Ong et al. ERJ 2004; Ong et al Chest 2005; Hui et al. Thorax; Wilcox and Herridge, Presse Médicale 2011
IgM and IgG in mild and severe cases of SARS-CoV2
Lou et al. ERJ, 2020 To KK et al. Lancet Infect Diseases, 2020
Preliminary results
Variables Discharged COVID-19 patients at week 6N=74
Male/female ratio 2/1
Median age (yrs, range) 58 (27-73)
Smoking habit, ever 29 (40%)
Comorbidities
BMI (kg/m2) 27,4
Cardiovascular disease 40 (54%)
Chronic lung disease 29 (39%)
ICU admission 12 (16%)
Median duration of ICU admission (in days; range) 6 (2-24)
Preliminary results
Variables Discharged COVID-19 patients at week 6N=74
Symptoms
Dyspnoea 29 (39%)
Cough 12 (16%)
Fatigue 41 (55%)
Return to work 21 (28%)
CT chest abnormalities 53 (71%)
Persistent ground glass opacities 47 (63%)
Reticular changes 2 (3%)
Restrictive pulmonary function test 10 (13%)
DLCO <80% 32 (43%)
Impaired %pred 6MWD 37 (50%)
Donderdag 14 mei 2020 19:00-20:00
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Donderdag 14 mei 2020 19:00-20:00