Surviving COVID-19 and ARDS: What You Should Know
COVID-19 can cause symptoms ranging from mild to severe to no symptoms at all. People with severe symptoms may require hospitalization and a ventilator to breathe. People with existing health conditions like heart disease, diabetes, and chronic obstructive pulmonary disorder, and people with a compromised immune system are at higher risk for more severe complications. Physical therapists are working alongside other health care providers on the front lines treating patients with COVID-19.
Patients with COVID-19 may develop acute respiratory distress syndrome.
What Is Acute Respiratory Distress Syndrome?
ARDS is a serious condition that can develop over a few days or come on suddenly and quickly worsen. It occurs when a person can't get enough air and oxygen into their bloodstream because of a buildup of fluid in the lungs. Shortness of breath is often the first symptom. ARDS can affect people of any age as a result of infection, severe injury, or other illness.
How Is ARDS Treated?
In the hospital, a patient’s medical team will work to improve blood oxygen levels and identify and treat any other underlying causes. Treatment includes breathing assistance, blood transfusion, face-down positioning (sometimes called prone positioning), and nutrition and fluid management. Physical therapy is often prescribed to prevent skin breakdown that can lead to bed sores, to properly move patients, and to create a mobility plan during the hospital stay.
Patients who spend more than a few days on a ventilator are very weak and may require a physical therapist’s help to sit up on their own. A PT can help them progress from laying in bed, to sitting, to standing, to moving from the bed to a chair. PTs monitor a patient’s vital signs to ensure safety during therapy sessions.
Eventually, they will work up to taking short walks before they can safely go home or to a rehab facility for more physical therapist treatment.
What Are the Effects of ARDS?
People who experience ARDS are at a much higher risk for developing other complications. These problems include scarring of the lungs, blood clots, secondary infections, or a collapsed lung. While some people recover completely, most people who survive ARDS will have some lasting effects. And they will need the help of a PT to get back as much function as possible. Lasting effects can include:
- Difficulty breathing. It can take up to two years for people recovering from ARDS to regain lung function. A PT can help patients maximize their lung capacity.
- Depression. It is common for people who survive ARDS to experience a period of depression.
- Memory loss and trouble thinking clearly. People who require a ventilator to help them breathe experience lower levels of oxygen in their blood. This, along with medicines used while on a ventilator, can lead to memory loss and confusion.
- Muscle weakness and fatigue. Requiring ventilator support means a person is not using their muscles and this causes them to weaken, sometimes significantly.
Managing Long-Term Effects
Limiting the severity of complications, restoring muscle strength, reducing fatigue, improving lung function, and returning the patient to independence are the main goals of rehabilitation after ARDS. After discharge from intensive care, rehabilitation and monitored exercise are recommended as soon as possible. The sooner rehabilitation begins the lesser the chance of continued muscle disuse and the sooner patients can gain back the strength they lost in the hospital. When patients regain enough strength, a PT will prescribe regular physical activity to help maintain and improve heart, lung, and muscle function.
PTs are movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education.
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Reviewed by Sharon Gorman, PT, DPTSc, a board-certified clinical specialist in geriatric physical therapy, and Traci Norris, PT, DPT, a board-certified clinical specialist in geriatric physical therapy and certified exercise expert for aging adults, on behalf of the Academy of Acute Care Physical Therapy.