Recovery From COVID-19 and Acute Respiratory Distress Syndrome

The Potential Role of an Intensive Care Unit Recovery Clinic: A Case Report

Kirby P. Mayer; Jamie L. Sturgill; Anna G. Kalema; Melissa K. Soper; Sherif M. Seif; Evan P. Cassity; Jimmi Hatton Kolpek; Esther E. Dupont-Versteegden; Ashley A. Montgomery-Yates; Peter E. Morris

Disclosures

J Med Case Reports. 2020;14(161) 

In This Article

Abstract and Introduction

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.

Introduction

The emergence of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a significant impact on patients, families, healthcare systems, and communities. On March 11, 2020, the World Health Organization officially declared the SARS-CoV-2 virus outbreak a pandemic, officially known as coronavirus disease 2019 (COVID-19).[1] Patients diagnosed with COVID-19 have a broad range of presentations, from asymptomatic carriers to those with severe critical illness with pneumonia, acute respiratory distress syndrome (ARDS), and multiorgan failure. In this case report, we describe the trajectory of recovery in a young, healthy patient diagnosed with COVID-19 who developed ARDS. We suggest the importance of intensive care unit (ICU) follow-up clinics to treat patients surviving mechanical ventilation or long-term ICU stay for Covid-19.

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