COVID-19 patients who have been admitted to the ICU face a long recovery, even after their discharge. Hear about the unique challenges they face from Regenstrief research scientists Sikandar Khan, D.O., M.S., and Babar Khan, M.D., M.S.

Transcript

Phil Lofton:
Intensive care is a medical specialty that’s gotten a lot of discussion during the COVID-19 pandemic, whether in terms of potential scarcity of vital resources like intensive care beds or ventilators, or in terms of the difficulties faced by clinicians and their patients.

There’s been less discussion, however, of what life will look like for ICU survivors once they are discharged, and what challenges they’ll face in the years to come.

In this episode, we’ll talk to Dr. Sikandar Khan and Dr. Babar Khan, no relation, two intensive care physicians who have spent their careers improving the lives of patients during their stay in the ICU and after their discharge, and we’ll hear about their experiences during the pandemic, as well as their thoughts about the road ahead for COVID-19 survivors.

Welcome to the Problem. I’m your host, Phil Lofton.

[THEME]

If you’ve been listening to The Problem for a while, you might remember Dr. Sikandar Khan.

Sikandar Khan:
I’m Sikandar Khan, I’m a pulmonary critical care physician at the Indiana University School of Medicine as well as a physician scientist at the Center for Aging Research at Regenstrief Institute.

So, my normal clinical duties encompass both outpatient and inpatient clinical medicine. So, outpatient involves me seeing patients who have a pulmonary disorder in my clinic at Methodist Hospital as well as ICU survivors at Methodist, and on the inpatient side, I see patients who are admitted to the Intensive Care Unit at Eskenazi as well as university hospitals.

Phil:
During the pandemic, Dr. Khan and Regenstrief’s other intensive care practitioners have been working hard to make sure that patients who are dealing with the worst symptoms of COVID-19 are getting the best possible care. But these patients face a hard journey.

Sikandar Khan:
We are seeing a lot of patients who are younger. So, we’re seeing the whole spectrum from 60 years and older all the way down to in their early twenties. And these patients due to the severity of illness and being on mechanical ventilation or be exposed to very high doses of sedatives. They’re also being exposed to neuromuscular blockade or paralytic drugs. So, they do not move at all and they do not fight the ventilator. But the collateral damage that happens then is you start to lose up to 25% of your muscle mass within just the first 48 hours of being on so much sedation and being on a drug that doesn’t allow you to move. So, they’re going to have tremendous amounts of post intensive care syndrome, which will include physical impairments. So, loss of muscle strength, loss of muscle mass. It will include cognitive impairments. In prior studies, up to 40% of respiratory failure survivors had cognitive impairment even a year out from the initial hospitalization. They are also likely to have depression, PTSD, anxiety after they survive the ICU. And all of this leads to a marked decrease in their quality of life, their ability to return to the baseline functional status they used to have, and the ability to take care of their families. And it’s going to put a tremendous burden on their loved ones and their caregivers. Because this road to recovery is going to be, in some cases, two years or more for these patients.

Phil:
Dr. Khan joined us last season to talk about delirium, a serious condition that can affect patients who are admitted to intensive care.

Sikandar Khan:
Delirium is characterized by a change in the mental status of the patient. There is a fluctuation in their level of consciousness and how awake they are. There’s also inattention; they are not able to hold their attention on a task or shift their attention such as you and I can. And there’s also a lot of disorganized thinking. What we see in the intensive care unit, is a form of brain failure where the brain is simply not functioning as it normally does.

Delirium is something that affects more than 7 million hospitalized patients every single year.

It’s associated with hallucinations, inability to think clearly, and a lack of awareness of the environment. It’s sometimes called ICU psychosis or sundowning, and for patients and their families, it can be really traumatic.

Phil:
Regenstrief research scientist Dr. Babar Khan, another intensive care clinician, and an expert on ICU recovery, shared his thoughts on why COVID -19 ICU patients are at particularly high risk of bad ICU outcomes.

Babar Khan:
It’s a little too early to completely elaborate on the differences of recovery trajectories in COVID-19 ICU survivors compared to other ICU survivors. What we can project based on our work in the past and now working with COVID-19 patients that the COVID-19 patients who are admitted to the intensive care unit have a higher burden of lung involvement and heart involvement. They are receiving mechanical ventilation for longer duration. So being on mechanical ventilation for longer duration can predispose you to have some adverse consequences that constitute most intensive care syndrome. But compared to a regular ICU survivor, a COVID 19 survivor who is just staying on the ventilator for longer duration who we have to sedate a little bit heavier so that they can work with mechanical ventilation. They are not mobilized as early because of the consequences of oxidation and keeping them immobilized so that we can have them breathe better. Then the direct effects of COVID-19 on the brain resulting in delirium. All of this is going to constitute a higher burden, of course, intensive care syndrome among COVID-19 survivors. That’s why we will project now the longer-term data at this time will be available once they are close to six months and 12 months after discharge. And that way we can tell exactly how, if you compare them to a regular ICU survivor, what, what would be the impact? The other thing is that the longer that you are on mechanical ventilation, the more your lungs are being affected. You have acute lung injury or acute respiratory distress syndrome which results in this results in a breathing difficulties that can persist for years after ICU discharge based on our prior lung injury work. So we would suspect that we will see the same complications in COVID-19 subjects combined.

Phil:
If you, or your family has been admitted to and discharged from the ICU during the pandemic, don’t panic. Dr. Sikandar Khan says there are still resources out there that can help you or your loved ones in long-term recovery.

Sikandar Khan:
There’s a few modalities that they can take advantage of. One of them is to ask whether there’s an ICU survivor clinic that they can be referred to. There certainly are in Indiana. And if they’re able to get seen at one of those clinics, there are more options for them. There are also resources online. There’s a lot of groups on Twitter and Facebook that can help you get connected to those resources. The Society of Critical Care Medicine website has great resources for patients and their families. So, they can certainly go to those websites and get connected because there may be things that can really make a difference to their quality of life, such as taking them off harmful medications, as well as instituting protocols or sleep, as well as memory as well as physical function to really get them better as quickly as possible.

Phil:
And of course, Dr. Babar Khan reminds us that there are steps that all of us can take to help reduce the cases of COVID-19 that lead to a stay in the ICU.

Babar Khan:
A significant portion of patients are getting admitted to the ICU and they are having trouble breathing in the ICU, which is requiring them to be on the mechanical ventilator which in itself is associated with worse long-term outcomes among those survivors. I think one of the most important things as a community that we need to do is to prevent from getting COVID-19 virus infection. That thing is much better than you come to the ICU. And even after you survive there’s up to a 50% chance that you can have problems with post intensive care syndrome. So, if you can wear a mask, I think that would be one thing that can help prevent the spread of COVID-19 and also help you contracting COVID-19 infection.

Join us next time. We’ll see you then, on The Problem.

Music this episode was by Everlone and the Blue Dot Sessions. Our theme, and additional musical cues, were written and performed, as always, by BPAP Beats.

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