When they leave an intensive care unit, more than 50% of patients retain physical and/or psychological sequelae. Covid-19 has brought to light the interest in managing post-resuscitation syndrome. Studies and projects are carried out at the Toulouse University Hospital.
During the Covid-19 epidemic, several thousand people in France were admitted to intensive care due to acute respiratory distress. This influx and the associated media coverage have in particular made it possible to highlight the question of the care of patients after this heavy hospitalization. Because, Covid or not, 50% to 70% of patients leaving intensive care have a post-resuscitation syndrome which impacts their quality of life.
At the Toulouse University Hospital Center (CHU), the resuscitation teams worked on post-hospitalization. About fifty patients were evaluated six months after their discharge from the hospital. They had been admitted to intensive care for acute respiratory distress syndrome (ARDS) linked to Covid-19 during the first two waves of the epidemic (1).
6 months after discharge, 7 out of 10 patients present with depressive syndromes
“We looked at whether they had any physical problems (pain, mobility problems, loss of autonomy), whether they were tired, whether they had lost sensory and motor skills (the fact of having positioned them on their stomach may have compressed nerve areas) or, for those who had been placed on circulatory and respiratory assistance (ECMO), if they had retained motor deficits. We also followed the disorders of loss of taste, smell, appetite, the psychological consequences (anxiety, depression, post-traumatic stress) and their nutritional status (they generally lost 15 kg of muscle)”, explains the Dr Fanny Bounes, anesthetist-resuscitator in the multi-purpose intensive care unit at Rangueil hospital, secretary of the resuscitation committee of the French Society of Anesthesia and Resuscitation (SFAR).
If it is still difficult to see what, in the post-resuscitation syndrome, is Covid or not, the Toulouse study shows without ambiguity that the quality of life of patients is altered. “In 7 cases out of 10, after six months, the patients present depressive syndromes, 10% have anxiety disorders and 10% post-traumatic stress disorder”, relates the resuscitator who pursues the objective that a follow-up course multidisciplinary can be proposed at the end of resuscitation.
Inform patients and their families
“As part of a study carried out by the Nantes University Hospital on pain three months after leaving intensive care, we questioned more than 200 patients from the Toulouse University Hospital. We used it to see patients again in teleconsultation and rediscuss pain, psychological disorders, their nutritional status, even the scars left by a tracheostomy or the installation of a central venous catheter”.
The Haute Autorité de Santé (HAS), in a framework note published in February 2022, invites professionals to define patients at risk of developing post-resuscitation syndrome, to take care of them early, to improve care pathways and to inform patients and their families about this syndrome.
“Clearly, before Covid, few people were interested in post-resuscitation syndrome. We knew these disorders in patients who entered intensive care following influenza, an accident, sepsis. When they got home, they couldn’t go back to work, couldn’t drive, had memory problems. This period highlighted these risks of sequelae”, concludes Dr Fanny Bounes.