How to treat coronavirus patients in post-ICU care clinics

By Christopher Cheney

Indiana University Health is using an ambulatory post-ICU care clinic to treat COVID-19 patients who survived ICU care and are experiencing coronavirus symptoms after hospital discharge.

According to an article published by The BMJ, about 10% of all people who have COVID-19 become so-called long haulers, with symptoms that persist for weeks or months after the acute phase of their illness. The number of long haulers could be much higher among hospitalized COVID-19 patients. In an article published in the Journal of the American Medical Association, 87.4% of hospitalized COVID-19 patients reported the persistence of at least one symptom.

Since June 2020, the ICU Survivor Center at Indiana University Health Methodist Hospital in Indianapolis has treated about 100 COVID-19 patients who survived ICU-level care. The patients are experiencing a range of symptoms, according to Sikandar Khan, DO, medical director at the ICU Survivor Center and a research scientist at the Regenstrief Institute in Indianapolis.

• 60% of patients have had physical function issues such as muscle weakness or difficulty with balance
• 44% of patients have had sleep problems
• 38% of patients have had post-traumatic stress disorder symptoms
• Other symptoms include fatigue, headache, anxiety, and depression

“Some are very fatigued even six months after hospital discharge. They may be having headaches. They might be having a lot of difficulty with sleep. So, virtually all of our patients have some complaint in terms of their general well-being and effects on quality of life,” Khan says.

ICU Survivor Center care model

The ICU Survivor Center is an interdisciplinary clinic, Khan says.

“The goal of the clinic is to maximize the recovery of critical illness survivors. We know from scientific literature that patients who survive critical illness have symptoms of post-intensive care syndrome, which can be physical function problems, mental health challenges, and cognitive issues such as changes in memory. All of this leads to a quality of life impairment,” he says.

The ICU Survivor Center’s staff includes pharmacists, pulmonary critical care specialists, chaplains for spiritual support, ICU nurses, social workers, and rehab specialists. The ambulatory clinic also has referral partners such as psychiatrists and neuroscience faculty.

COVID-19 patients receive care similar to that given to other ICU survivors, Khan says. “It is a lot of the same specialties because we see the same burden in patients who have survived critical illness with COVID-19. These patients have fatigue, muscle weakness, muscle pain, headaches, and autonomic nervous system impairments such as palpitations and shortness of breath. These patients see me as well as a few of the specialists who are focused on rehab such as physical rehab and cognitive rehab.”

The ICU Survivor Center also is treating COVID-19 patients with telemedicine, he says. “Our first preference is a video visit if a patient wants to have telehealth services. With video, you can really engage with the patient. If patients are not equipped with a camera—either on their phone or their computer—we will do phone visits. With the phone visits, we will usually recommend that they come in for one in-person visit, so we can get a full assessment.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders. This story originally ran on HealthLeaders Media.