Competentiecentrum Interne Geneeskunde Dienst Longziekten OPENING - - PowerPoint PPT Presentation

Donderdag 14 mei 2020 19:00-20:00

Competentiecentrum Interne Geneeskunde Dienst 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)

Mental health Physical function Cognitive function

Anxiety/ASD PTSD Depression Executive Function Memory Attention Visuo-spatial Mental Processing Speed Pulmonary Neuromuscular 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%

hospital discharge 3 months 6 months 12 months 24 months

Incidence of ICUAW

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 injury 26% ≈ mild Alzheimer’s disease

12 months:

34% ≈ moderate traumatic brain injury 24% ≈ mild Alzheimer’s disease

Bienvenu, Int Care Med 2018 Bienvenu, 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 Gender Comorbidities Frailty Pre-ICU disabilities Pre-ICU functional trajectory Premorbid psychiatric disease Socio 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 MV Duration of ICU stay ICUAW Delirium Drugs Glucose dysregulation Hypoxia Hypotension

Arabi, ICM 2017

“LEGACY OF CRITICAL ILLNESS”

Morbidity N= 205 Mortality N= 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 training Mobilisation – Body positioning Active muscle (resistance) training Passive static and dynamic muscle Stretching 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 Symptomen CT thorax (+ US ledematen) Biochemie + SARS-CoV-2 Ab Outcome Mortaliteit Nood aan revalidatie Impact van revalidatie Longfunctie 6MWD (+ ergospiro) Handgrijpkracht (+ quadriceps,…) Levenkwaliteit COVID-19 infectie

• RT-PCR en/of
• suggestieve CT thorax

Gehospitaliseerd en

• ntslagen naar huis

(leeftijd, ambulant) + Alle ICU

Temporal pattern in CT changes

SARS-CoV-2 SARS-CoV

Wang et al. Radiology 2020 Ooi et al. Radiology 2004

63 j man, ICU voor HFNC 45% gedurende 3 dagen 50 j vrouw, immuungecompromitteerd ICU voor MV gedurende 4 dagen

6 wk na ontslag 6 wk na ontslag

• pname
• pname

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 6 N=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 6 N=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