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