Acute Functional Outcomes in Critically Ill COVID-19 Patients

Tay, Matthew Rong Jie; Ong, Poo Lee; Puah, Ser Hon; Tham, Shuen Loong

doi:10.3389/fmed.2020.615997

Cited by 8 publications

(11 citation statements)

References 35 publications

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“… 32 , 33 , 51 , 52 Notably, functional mobility decline in our cohort was primarily attributable to impaired gait independence. Two previous studies found that 83–92% of COVID-19 survivors were discharged from hospital as autonomous walkers 32 , 53 in contrast to the 45.7% of independent walkers in our cohort. Differences in effectiveness of local rehabilitation practices, longer length of stay in acute wards and the specific ceiling effects of the varying outcome measures used may have all contributed to this disparity.…”

Section: Discussioncontrasting

confidence: 77%

“…This is in agreement with recent work showing reduced acute functional status in invasively ventilated COVID-19 patients. 29,51,53 Previous studies in ARDS survivors and other critically ill patient populations also found that these are poor prognostic factors for long-term physical decline. 58,59 Early recognition of patients most at-risk of functional mobility decline, and support with advance care planning and targeted rehabilitation interventions may help improve long-term outcome in COVID-19 survivors.…”

Section: Discussionmentioning

confidence: 99%

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Intensive Care Unit- Acquired Weakness and Hospital Functional Mobility Outcomes Following Invasive Mechanical Ventilation in Patients with COVID-19: A Single-Centre Prospective Cohort Study

Núñez-Seisdedos

Lázaro-Navas

López-González

et al. 2022

J Intensive Care Med

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Background: Acute physical function outcomes in ICU survivors of COVID-19 pneumonia has received little attention. Critically ill patients with COVID-19 infection who require invasive mechanical ventilation may undergo greater exposure to some risk factors for ICU-acquired weakness (ICUAW). Purpose: To determine incidence and factors associated with ICUAW at ICU discharge and gait dependence at hospital discharge in mechanically ventilated patients with COVID-19 pneumonia. Methods: Single-centre, prospective cohort study conducted at a tertiary hospital in Madrid, Spain. We evaluated ICUAW with the Medical Research Council Summary Score (MRC-SS). Gait dependence was assessed with the Functional Status Score for the ICU (FSS-ICU) walking subscale. Results: During the pandemic second wave, between 27 July and 15 December, 2020, 70 patients were enrolled. ICUAW incidence was 65.7% and 31.4% at ICU discharge and hospital discharge, respectively. Gait dependence at hospital discharge was observed in 66 (54.3%) patients, including 9 (37.5%) without weakness at ICU discharge. In univariate analysis, ICUAW was associated with the use of neuromuscular blockers (crude odds ratio [OR] 9.059; p = 0.01) and duration of mechanical ventilation (OR 1.201; p = 0.001), but not with the duration of neuromuscular blockade (OR 1.145, p = 0.052). There was no difference in corticosteroid use between patients with and without weakness. Associations with gait dependence were lower MRC-SS at ICU discharge (OR 0.943; p = 0.015), older age (OR 1.126; p = 0.001), greater Charlson Comorbidity Index (OR 1.606; p = 0.011), longer duration of mechanical ventilation (OR 1.128; p = 0.001) and longer duration of neuromuscular blockade (OR 1.150; p = 0.029). Conclusions: In critically ill COVID-19 patients, the incidence of ICUAW and acute gait dependence were high. Our study identifies factors influencing both outcomes. Future studies should investigate optimal COVID-19 ARDS management and impact of dyspnea on acute functional outcomes of COVID-19 ICU survivors.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Intensive Care Unit- Acquired Weakness and Hospital Functional Mobility Outcomes Following Invasive Mechanical Ventilation in Patients with COVID-19: A Single-Centre Prospective Cohort Study

Núñez-Seisdedos

Lázaro-Navas

López-González

et al. 2022

J Intensive Care Med

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“…In accordance with previous research, we observed that COVID-19 ICU patients are prone to ICUAW at ICUand hospital discharge, defined as a MRC-SS ≤48 [1,[10][11]. Furthermore, we showed that compared to other pneumosepsis patients, COVID-19 patients scored lower on physical functioning tests upon ICU discharge.…”

Section: Discussionsupporting

confidence: 91%

“…In accordance with previous research, we observed that COVID‐19 ICU patients are prone to ICUAW at ICU and hospital discharge, defined as an MRC‐SS of ≤48. 1 , 10 , 11 Furthermore, we showed that compared with other pneumosepsis patients, COVID‐19 patients scored lower on physical functioning tests upon ICU discharge. Contrastingly, COVID‐19 patients showed significantly more improvement of physical functioning on the MRC‐SS and the CPAx instruments during post‐ICU hospital stay, regardless of baseline characteristics, adequacy of protein administration during ICU stay, and duration of ward LOS.…”

Section: Discussionmentioning

confidence: 70%

Physical recovery of COVID‐19 pneumosepsis intensive care survivors compared with non‐COVID pneumosepsis intensive care survivors during post–intensive care hospitalization: The RECOVID retrospective cohort study

Moonen

Strookappe

Zanten

2021

J Parenter Enteral Nutr

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Background. Coronavirus Disease 2019 pneumosepsis survivors are at a high risk of developing ICU acquired weakness (ICUAW), due to high incidence of acute respiratory distress syndrome and the common need for prolonged invasive ventilation. It remains unknown if regular post-pneumosepsis physical rehabilitation strategies are suitable for this extraordinary patient category.Methods. We retrospectively compared the physical recovery of COVID-19 and non-COVID pneumosepsis ICU survivors between ICU-and hospital discharge, defined as the difference in performance on the Medical Research Council Sum-Score (MRC-SS), Chelsea Critical Care Physical Assessment tool (CPAx), and percentage of predicted handgrip strength (POP-HGS). An ANCOVA model was built using age, sex, Barthel-index, BMI, admission APACHE-II score, adequacy of protein delivery during ICU stay and ward length of stay as covariates. Results. 35 COVID-19 ICU patients could be compared to 21 non-COVID pneumosepsis ICU survivors. All patients scored ≤48 on the MRC-SS at ICU discharge, indicating ICUAW. ICUAW had resolved in more COVID-19, than in non-COVID patients upon hospital discharge, although not significantly (52% vs. 22%, p=.081). When controlling for covariates, COVID-19 patients performed worse on all physical functioning assessments upon ICU discharge, but had improved more at hospital discharge on the MRC-SS (ɳ 2 =0.214, p=.002) and CPAx (ɳ 2 =0.153, p=.011). POP-HGS remained lower in COVID-19 patients throughout hospital stay. Conclusion. COVID-19 ICU-survivors are a vulnerable group concerning ICUAW, but they show better tendency towards physical rehabilitation than non-COVID pneumosepsis ICU-survivors during the post-ICU hospitalization period regarding MRC-SS and CPAx. COVID-19 ICU patients might benefit from early, more intensive physical therapy. Clinical Relevancy Statement. COVID-19 ICU survivors are at high risk for ICU-acquired weakness, which is well known to have immense personal and societal consequences. As the group of COVID-19 ICU survivors is

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“…Similarly, post-intensive care syndrome (PICS) has been described after shock, sepsis, hypoxia, ARDS or delirium, significantly increasing the risk of long-term cognitive and physical impairment [ 47 , 48 ]. Longer-term studies with follow-up and control groups are warranted to shed light on this aspect [ 49 – 51 ].…”

Section: Discussionmentioning

confidence: 99%

Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC

Dimitriadis

Meis²,

Neugebauer³

et al. 2022

Crit Care

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Background Neurologic manifestations are increasingly reported in patients with coronavirus disease 2019 (COVID-19). Yet, data on prevalence, predictors and relevance for outcome of neurological manifestations in patients requiring intensive care are scarce. We aimed to characterize prevalence, risk factors and impact on outcome of neurologic manifestations in critically ill COVID-19 patients. Methods In the prospective, multicenter, observational registry study PANDEMIC (Pooled Analysis of Neurologic DisordErs Manifesting in Intensive care of COVID-19), we enrolled COVID-19 patients with neurologic manifestations admitted to 19 German intensive care units (ICU) between April 2020 and September 2021. We performed descriptive and explorative statistical analyses. Multivariable models were used to investigate factors associated with disorder categories and their underlying diagnoses as well as to identify predictors of outcome. Results Of the 392 patients included in the analysis, 70.7% (277/392) were male and the mean age was 65.3 (SD ± 3.1) years. During the study period, a total of 2681 patients with COVID-19 were treated at the ICUs of 15 participating centers. New neurologic disorders were identified in 350 patients, reported by these centers, suggesting a prevalence of COVID-19-associated neurologic disorders of 12.7% among COVID-19 ICU patients. Encephalopathy (46.2%; 181/392), cerebrovascular (41.0%; 161/392) and neuromuscular disorders (20.4%; 80/392) were the most frequent categories identified. Out of 35 cerebrospinal fluid analyses with reverse transcriptase PCR for SARS-COV-2, only 3 were positive. In-hospital mortality was 36.0% (140/389), and functional outcome (mRS 3 to 5) of surviving patients was poor at hospital discharge in 70.9% (161/227). Intracerebral hemorrhage (OR 6.2, 95% CI 2.5–14.9, p < 0.001) and acute ischemic stroke (OR 3.9, 95% CI 1.9–8.2, p < 0.001) were the strongest predictors of poor outcome among the included patients. Conclusions Based on this well-characterized COVID-19 ICU cohort, that comprised 12.7% of all severe ill COVID-19 patients, neurologic manifestations increase mortality and morbidity. Since no reliable evidence of direct viral affection of the nervous system by COVID-19 could be found, these neurologic manifestations may for a great part be indirect para- or postinfectious sequelae of the infection or severe critical illness. Neurologic ICU complications should be actively searched for and treated.

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Acute Functional Outcomes in Critically Ill COVID-19 Patients

Cited by 8 publications

References 35 publications

Intensive Care Unit- Acquired Weakness and Hospital Functional Mobility Outcomes Following Invasive Mechanical Ventilation in Patients with COVID-19: A Single-Centre Prospective Cohort Study

Intensive Care Unit- Acquired Weakness and Hospital Functional Mobility Outcomes Following Invasive Mechanical Ventilation in Patients with COVID-19: A Single-Centre Prospective Cohort Study

Physical recovery of COVID‐19 pneumosepsis intensive care survivors compared with non‐COVID pneumosepsis intensive care survivors during post–intensive care hospitalization: The RECOVID retrospective cohort study

Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC

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