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)

PICS Mental Cognitive Physical health function function Executive Function Pulmonary Anxiety/ASD Memory Neuromuscular PTSD Attention Physical Function Depression Visuo-spatial Mental Processing Speed Quality of life Crit Care Med 2012, Needham

Physical function and quality of life 6 min walking distance SF-36 Herridge, NEJM 2011

Recovery from ICUAW 40% Incidence of ICUAW 35% 30% 25% 20% 36% 15% 22% 10% 15% 14% 9% 5% 0% hospital 3 months 6 months 12 months 24 months discharge N=127 N=136 N=127 N=130 N=173 Fan, CCM 2014 Fan, Crit Care Med 2014

Cognitive impairement after critical illness 3 months: 40% ≈ moderate traumatic brain injury 26% ≈ mild Alzheimer’s disease 12 months: 34% ≈ moderate traumatic brain injury 24% ≈ mild Alzheimer’s disease Panharipande, NEJM 2013

Psychiatric symptoms 5 years following ARDS Bienvenu, Int Care Med 2018 Bienvenu, Int Care Med 2018

Incidence of ‘any’ PICS Difficult to determine: - Variable domains - Variable outcome measures - Variable populations - Variable follow-up periods Annachiara, Crit Care Med 2018

Return to work and lost earnings 5y following ARDS 31% never returned to work in 5-years Kamdar, Thorax 2020

Risk factors for long-term outcomes Age “LEGACY OF Gender CRITICAL ILLNESS” 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 “LEGACY OF CRITICAL ILLNESS” Arabi, ICM 2017

Risk factors for long-term outcomes Duration of MV “LEGACY OF Duration of ICU stay CRITICAL ILLNESS” ICUAW Delirium Drugs Glucose dysregulation Hypoxia Hypotension Arabi, ICM 2017

Impact of ICU-acquired neuromuscular complications on 5y outcomes Mortality aHR (per point increase): N= 596 0.946 (0.928-0.968), P=0.001 Morbidity N= 205 Van Aerde , Int Care Med 2020

Duration of delirium and outcomes at 12 months Global cognition ADL Brummer Crit Care Med 2014 Panharipande, NEJM 2013

Risk factors for long-term outcomes “LEGACY OF CRITICAL ILLNESS” Arabi, ICM 2017

Early Mobilization and Physical Activity Iwashyna TJ AJRCCM 2012: 186:302

Critical Care Medicine 2019

Critical Care Medicine 2019

Principles of exercise training

MODALTIES FOR PHYSICAL TRAINING STABLE-COOPERATIVE Exercise training Mobilisation – Body positioning Active muscle (resistance) training Passive static and dynamic muscle Stretching and range of motion exercise Transcutaneous electrical muscle stimulation UNSTABLE-BED RIDDEN-UNCOOPERATIVE

https://www.sciencedirect.com/science/article/pii/S183695532030028X

Post-ICU and Hospital Discharge Rehabilitation Iwashyna TJ AJRCCM 2012: 186:302

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 Symptomen CT thorax (+ US ledematen) COVID-19 infectie Biochemie + SARS-CoV-2 Ab - RT-PCR en/of Functionele Longfunctie - suggestieve CT thorax evaluatie 6MWD (+ ergospiro) Handgrijpkracht (+ quadriceps,…) Levenkwaliteit Outcome Mortaliteit Gehospitaliseerd en ontslagen naar huis Nood aan revalidatie Impact van revalidatie (leeftijd, ambulant) + Alle ICU In functie van comorbiditeit/ernst/ICU verblijf/behandeling

Temporal pattern in CT changes SARS-CoV SARS-CoV-2 Wang et al. Radiology 2020 Ooi et al. Radiology 2004

opname 6 wk na ontslag 63 j man, ICU voor HFNC 45% gedurende 3 dagen 6 wk na ontslag opname 50 j vrouw, immuungecompromitteerd ICU voor MV gedurende 4 dagen

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/m 2 ) 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%)

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Donderdag 14 mei 2020 19:00-20:00