COVID-19 Patients Long-Term Lung and Heart Damage – But They Can Cure Over Time


CT scan of the lungs of the patient with COVID-19 damaging in red. Credit: Gerlig Wiedman & Team, Department of Radiology, Medical University of Innsbruck

Coronavirus patients recover more quickly after coming out of ventilators or undergoing rehabilitation as soon as possible after leaving intensive care.

COVID-19 Patients may have long-term lung and heart damage but, for many, it tends to improve over time, according to earlier, prospective follow-up of coronovirus-infected patients, presented at the European Respiratory Society International Congress Gone.[1]

In the COVID-19 ‘hot spot’ in the Tyrolian region of Austria, researchers recruited coronovirus patients who were admitted to the University Clinic of International Clinic in Innsbruck, St. Vincenz Hospital in Zams or Cardio-Pulmonary Rehabilitation Center. In Münster, Austria. In his presentation at the virtual conference today (Monday), he reported the first 86 patients enrolled between April 29 and June 9, although he now has more than 150 patients attending.

Patients were to return for evaluation six, 12 and 24 weeks after discharge from the hospital. During these visits, clinical examinations, laboratory tests, analysis of the amount of oxygen and carbon dioxide in arterial blood, lung function tests, computed tomography (CT) scans, and echocardiograms were performed.

At the time of their first visit, more than half of the patients had at least one persistent symptom, mainly shortness of breath and coughing, and CT scans still showed lung damage in 88% of patients. However, by the time of his next visit 12 weeks after discharge, symptoms had improved and lung damage had been reduced by 56%. At this stage, it is too early to get results from the 24-week evaluation.

“The bad news is that people show lung weakness from COVID-19 weeks after discharge; The good news is that the loss diminishes over time, which suggests that the lungs are a mechanism to repair themselves, ”said Dr. Sabina Sahanik, a clinical PhD student at the University Clinic in Innsbruck and the team The study, which was carried out in part, included Evan Tansiewski, Associate Professor at Innsbruck, Professor Judith Loeffler-Rag and Dr. Thomas Sonweber is included.

Coronavirus patient rehabilitation

COVID-19 patients undergoing muscle training for rehabilitation. Sincerely: Pulmonary Rehabilitation Center Dualfit Sante

The average age of 86 patients involved in this presentation was 61 and 65% of them were male. About half of them were current or former smokers and 65% of hospitalized COVID-19 patients were overweight or obese. Eighteen (21%) were in an intensive care unit (ICU), 16 (19%) had aggressive mechanical ventilation, and the average length of hospital stay was 13 days.

A total of 56 patients (65%) showed persistent symptoms at the time of their six-week visit; Shortness of breath (dyspnea) was the most common symptom (40 patients, 47%), followed by cough (13 patients, 15%). By the 12-week visit, shortness of breath was improved and was present in 31 patients (39%); However, 13 patients (15%) were still coughing.

Lung function tests include FEV1 (air volume can be forcibly exhaled in a second), FVC (total amount of air expelled forcibly), and DLCO (blood to test how well oxygen passes from the lungs. Includes a test for). These measurements also improved between six and 12-week visits. At six weeks, 20 patients (23%) showed FEV1 less than 80% normal, 18 patients (21%) showed improvement at 12 weeks, 24 patients (28%) showed FVC less than 80% normal, leading to improvement Occurred at 12 weeks with 16 patients (19%), and 28 patients (33%) showing less than 80% DLCO in general, an improvement from 19 patients (22%) at 12 weeks.

CT scans showed that the score defining the severity of total lung damage decreased from eight points at six weeks to four points at twelve weeks.[2] Inflammation and fluid damage in the lungs caused by coronavirus, which appears on CT scans, known as white patches, also known as ‘ground glass’; It was present in 74 patients (88%) at six weeks and 48 patients (56%) at 12 weeks.

At the six-week visit, the echocardiogram revealed that 48 patients (58.5%) had dysfunction of the left ventricle of the heart at this time when it is resting and thinning (diastole). Biological indicators of heart damage, blood clots and inflammation were all significantly elevated.

Dr. Sahanik said: “We do not believe that left ventricular diastolic dysfunction is specific to COVID-19, but the severity of the disease in general is higher. Luckily, in the Innsbruck cohort, we did not consider any severe in the post-acute phase. Did not observe coronovirus-related heart disease. The diastolic dysfunction that we saw improved with time. ”

They concluded: “The findings of this study demonstrate the importance of implementing structured follow-up care for patients with severe COVID-19 infection. Importantly, CT revealed lung damage in this patient group that was not identified by lung function tests. Knowing that patients have been affected for a long time by coronoviruses can enable treatment of symptoms and lung damage much earlier and have a significant impact on further medical recommendations and advice. ”

In another poster presentation to Congress[3], Ms. Yara Al Chikhani, PhD student at the Dionulefitte Sante Clinic for Pulmonary Rehabilitation and HP2 Lab at Grenoble Alps University, France, said that the sooner COVID-19 patients started a pulmonary rehabilitation program after exiting the ventilator, That is better And their rapid recovery.

Patients with severe COVID-19 may spend weeks in intensive care on a ventilator. On top of severe infection and inflammation, there is a lack of physical movement, severe loss of muscles. Breathing muscles are also affected, which weakens the ability to breathe. Pulmonary rehabilitation, which includes physical exercise and advice on managing symptoms, including shortness of breath and post-traumatic stress disorder, is important to help patients recover fully.

Ms. Al Chikhani performs a walking test to evaluate the weekly progress of 19 patients[4] Who spent an average of three weeks of intensive care and two weeks in a pulmonary ward before being transferred to the Dualfit Sente Clinic for pulmonary rehabilitation. Most were still unable to walk when they arrived, and they spent an average of three weeks in rehab. Walking tests measured how far patients could walk in six minutes. Initially, they were able to walk an average of 16% of the distance, in theory, they should be able to walk normally when healthy. After three weeks of pulmonary rehabilitation, it increased on average to 43%, which was a significant gain but still a serious loss.

Ms Al Chikhani said: “The most important finding was that patients who were admitted to pulmonary rehabilitation shortly after intensive care progressed faster than those who spent a longer period in a pulmonary ward, Where they remained inactive. The sooner rehabilitation began and the longer it lasted, the faster and better the patients’ ability to walk and breathe and gain in muscle. Patients who began rehabilitation the week after coming out of their ventilators progressed faster than those admitted after two weeks. But how they can begin rehabilitation soon depends on patients being medically stabilized by their doctors. Despite significant improvement, the average duration of three weeks in rehabilitation was not enough for him to fully recover.

“These findings suggest that doctors should begin rehabilitation as soon as possible, so that patients should try to spend as little time as they can be inactive and enroll with motivation in a pulmonary rehabilitation program. If their If the doctors decide to be safe, then patients should start physical therapy practice by staying in the hospital’s pulmonary ward. ”

Thierry Trosters, who was not involved in the study, is the president of the European Respiratory Society and a professor in rehabilitation science at KU Leuven, Belgium. He said: “Since the onset of the COVID-19 pandemic, there is a lot of evidence that many patients suffer debility after prolonged effects from coronovirus. Dr. Sahanic’s presentation is important because it is important for these patients. One of the first, widespread potential follow-up and demonstrates the severe, long-term effect of COVID-19 on the lungs and heart. It is heartening to hear that more than half of the patients in this study reported their lungs after 12 weeks of hospital discharge. And showed damage to the heart, and that about 40% were still suffering from symptoms such as shortness of breath. However, the good news is that patients improve and this will certainly help the rehabilitation process, as in the second presentation. Has been discussed.

“MS. Al Chikhani’s research complements this information and shows how necessary it is for patients to initiate pulmonary rehabilitation because they are physically able to do so. That’s why rehabilitation can also be started in the ward Is, if the programs are adapted to the patient’s abilities. This is entirely in line with our Society’s recent statement where we also advocate systematic rehabilitation. It is clear from both of these studies that rehabilitation includes physical and psychological components , Should be available to patients as soon as possible and this should continue for weeks, even if they are not discharged from the hospital even months later to give patients the best chance of a good recovery. Governments, National Health Services and Employers should be made aware of these findings and plan accordingly. ”[5]

References:

[1] Abstract number: OA4143, “Severely maintaining the following pulmonary debility SARS-CoV-2 Infection, preliminary results from CovILD study ”, by Sabina Sahanic and others; “Covering Cover – Best Essence” Session, 18.00 pm CEST, Monday 7 September. https: //K4.ersnet.org /prod /v2 /Front /program /Session? E =259 more sessions =12607

[2] The severity score has a maximum of 25 points.

[3] Abstract number: PA938, “Weekly recovery of physical abilities during pulmonary rehabilitation of post-extinction COVID-19 patients by Yar Al Chikhani” and others; “New insights into the determinants of patient-reported outcomes in chronic respiratory diseases” e-poster session, online from Monday 24 August. https: //K4.ersnet.org /prod /v2 /Front /program /Session? E =259 more sessions =12,283

[4] Two more patients have been added since the abstract, with 17 patients for Congress.

[5] “COVID-19: Interim Guidance on Rehabilitation at the Hospital and Post-Hospital Phase from a Respiratory Society and the American Thoracic Society-Coordinated International Task Force” and others. European Respiratory Journal 2020; DOI: 10.1183 / 13993003.02197-2020: https: //ERJ.ersjournals.com /material/soon /2020 /07 /30 /13,993,003.02197-2020