Disparities in the recovery from critical illness due to COVID-19
Disparities in the recovery from critical illness due to COVID-19
复制标题
DOI：
10.1016/s2215-0366(20)30292-3
复制
发表时间：
2020-08-01
影响因子：
64.3
通讯作者：
Alba, George A.
中科院分区：
文献类型：
--
作者：
FJohnson, Shawn;Tiako, Max Jordan Nguemeni;Alba, George A.
长期存在的结构性不平等使我们的社会容易受到COVID-19造成的破坏的影响--其毒性受到种族、民族和社会经济的严重影响--随之而来的是严重疾病幸存者的迅速增长，其中黑人、土著人和拉丁裔人的比例不成比例。很少有文章提到COVID-19幸存者面临的迫在眉睫的心理健康危机中可能存在的差异。重症监护室的幸存者有神经精神和认知后遗症的风险，被称为重症监护后综合征（PICS），特别是需要长时间机械通气并出现谵妄的患者-这两种情况在严重的COVID-19感染中经常遇到。需要长时间机械通气的幸存者中约有一半会出现焦虑和抑郁，四分之一会出现创伤后应激障碍（PTSD），一半会出现神经认知障碍，有些患者出院后可能会持续2年。1很少有研究讨论了PICS对少数群体社区的不同影响，但现有数据表明，少数群体面临的PICS风险要大得多。在危重创伤患者中，有色人种患者的PTSD发生率最高，黑人和拉丁裔患者的生活质量指标较差，神经行为并发症较多，社区融合受损，与白色患者相比，接受治疗或就业的可能性较小。2
Long-standing structural inequalities have rendered our society sus ceptible to the devastation wrought by COVID-19—its virulence buoyed by stark racial, ethnic, and socioeconomic disparities—leaving in its wake a burgeoning population of survivors of critical illness disproportionately comprised of Black, Indigenous, and Latinx people. Few articles have addressed the potential for disparities in the looming mental health crisis facing COVID-19 survivors. Survivors of the intensive care unit are at risk of neuropsychiatric and cognitive sequelae, referred to as post-intensive care syndrome (PICS), particularly patients who require prolonged mechanical ventilation and develop delirium—both of which are frequently encountered in severe COVID-19 infection. Approximately half of the survivors who require prolonged mechanical ventilation develop anxiety and depression, onequarter develop post-traumatic stress disorder (PTSD), and half demonstrate neurocognitive impairments that, in some, might persist for 2 years following hospital discharge. 1 Few studies have addressed the differential impact of PICS on minority communities, but existing data suggest minorities are at substantially greater risk for PICS. Among critically ill trauma patients, patients of Colour experience the highest rates of PTSD, and Black and Latinx patients demonstrate worse quality-of-life measures, more neurobehavioural complications, impaired community integration, and are less likely to receive treatment or be employed compared with white patients. 2