Recovery from COVID-19 and acute respiratory distress syndrome: the potential role of an intensive care unit recovery clinic: a case report

Abstract

Background In this case report, we describe the trajectory of recovery of a young, healthy patient diagnosed with coronavirus disease 2019 who developed acute respiratory distress syndrome. The purpose of this case report is to highlight the potential role of intensive care unit recovery or follow-up clinics for patients surviving acute hospitalization for coronavirus disease 2019. Case presentation Our patient was a 27-year-old Caucasian woman with a past medical history of asthma transferred from a community hospital to our medical intensive care unit for acute hypoxic respiratory failure due to bilateral pneumonia requiring mechanical ventilation (ratio of arterial oxygen partial pressure to fraction of inspired oxygen, 180). On day 2 of her intensive care unit admission, reverse transcription–polymerase chain reaction confirmed coronavirus disease 2019. Her clinical status gradually improved, and she was extubated on intensive care unit day 5. She had a negative test result for coronavirus disease 2019 twice with repeated reverse transcription–polymerase chain reaction before being discharged to home after 10 days in the intensive care unit. Two weeks after intensive care unit discharge, the patient returned to our outpatient intensive care unit recovery clinic. At follow-up, the patient endorsed significant fatigue and exhaustion with difficulty walking, minor issues with sleep disruption, and periods of memory loss. She scored 10/12 on the short performance physical battery, indicating good physical function. She did not have signs of anxiety, depression, or post-traumatic stress disorder through self-report questionnaires. Clinically, she was considered at low risk of developing post–intensive care syndrome, but she required follow-up services to assist in navigating the healthcare system, addressing remaining symptoms, and promoting return to her pre–coronavirus disease 2019 societal role. Conclusion We present this case report to suggest that patients surviving coronavirus disease 2019 with subsequent development of acute respiratory distress syndrome will require more intense intensive care unit recovery follow-up. Patients with a higher degree of acute illness who also have pre-existing comorbidities and those of older age who survive mechanical ventilation for coronavirus disease 2019 will require substantial post–intensive care unit care to mitigate and treat post–intensive care syndrome, promote reintegration into the community, and improve quality of life.

Severe covid-19 pneumonia: pathogenesis and clinical management

“…Post-ICU recovery programs staffed by a team of providers (ie, pulmonologists, intensivists, pharmacists, advanced practice providers, nurses, physical and occupational therapists, respiratory therapists, social workers, case managers, and mental health providers) can diagnose and treat PICS impairments. [228][229][230] These clinics also facilitate access to necessary subspecialties (tables 3, 4). The comprehensive approach of post-ICU clinics mirror the magnitude that critical illness affects multiple domains of a patient's health.…”

Clinical features of a young patient with COVID-19 presented with ARDS and severe thrombocytopenia

“…Post-ICU recovery programs staffed by a team of providers (i.e. pulmonologists, intensivists, pharmacists, advanced practice providers, nurses, physical and occupational therapists, respiratory therapists, social workers, case managers, and mental health providers) can diagnose and treat PICS impairments [15][16][17].…”

Neutrophil-to-Lymphocyte Ratio and Covid-19 Symptom-based Severity at Admission

“…Immediate treatment in this unit could improve the outcome of the treatment. 16,17 The changes of NLR value during admission in moderate to severe symptom Covid-19 compared to the NLR value on hospital discharge could predict the outcome. The chance of survival is greater in moderate to severe symptom Covid-19, whose NLR value is decreasing.…”