Critical COVID-19 disease: Clinical course and rehabilitation of neurological deficits

Abstract

BackgroundThe COVID-19 disease frequently causes neurological symptoms. Critically ill patients often require neurorehabilitation for manifestations like intensive care unit (ICU) acquired weakness or encephalopathy. The outcome of these patients, however, is largely unknown. Here we report the clinical course of critical affected COVID-19 patients from hospital admission to discharge from inpatient neurorehabilitation.MethodsProspective cohort study. COVID-19 patients admitted to neurorehabilitation were included based on a laboratory-confirmed SARS-CoV-2 infection. Assessments [modified Rankin Scale (mRS), Barthel-Index, Fatigue-Severity-Scale-7 and health-related quality of life (EQ-5D-5L)] were conducted at admission and before discharge from inpatient care. Data were compared to the preclinical health status.ResultsSixty-one patients (62 ± 13 years, 16 female) were included in the analysis. Most patients had been treated on ICU (n = 58; 57 ± 23 days) and had received invasive ventilation (n = 57; 46 ± 21 days). After discharge from ICU, patients spent on average 57 ± 26 days in neurorehabilitation. The most frequent neurological diagnoses were ICU-acquired weakness (n = 56) and encephalopathy (n = 23). During rehabilitation overall disability improved [mRS median (IQR) 4.0 (1.0) at inclusion and 2.0 (1.0) at discharge]. However, the preclinical health state [mRS 0.0 (0.0)] was not regained (p < 0.001). This was also reflected by the Barthel-Index [preclinical 100.0 (0.0), at inclusion 42.5 (35.0), at discharge 65.0 (7.5); p < 0.001]. Patients had only minor fatigue during inpatient care. Quality of life generally improved but was still low at discharge from hospital.ConclusionPatients with neurological sequelae after critical COVID-19 disease showed substantial deficits at discharge from inpatient care up to 4 months after the initial infection. They were restricted in activities of daily living and had reduced health-related quality of life. All patients needed continued medical support and physical treatment.

Severe Post-COVID-19 Condition after Mild Infection: Physical and Mental Health Eight Months Post Infection: A Cross-Sectional Study

“…However, hardly any one of the individuals interested in participating in the study had been hospitalized during the acute COVID-19 disease. The severity of the symptoms was substantial and appeared comparable to the severity experienced by critically ill individuals due to COVID-19 who required intensive care therapy and mechanical ventilation (as we reported previously [16]). However, up to now, scientific investigations about severe post-COVID-19 conditions in non-hospitalized individuals are rare.…”

Reduced health-related quality of life, fatigue, anxiety and depression affect COVID-19 patients in the long-term after chronic critical illness

“…Symptoms may even be prominent 1 year after ICU treatment, with physical, mental and cognitive impairments reported in 74%, 26% and 16% of the patients respectively 19 . In accordance with the reduced health state, health-related quality of life was also shown to be reduced in COVID-19 ICU survivors 14 , 20 , 21 . Additionally, ICU admission and (duration of) mechanical ventilation were found to be predictors for a low health-related quality of life 21 – 23 .…”

“…Part of this study population were described previously in a study on the clinical course during neurorehabilitation 20 and a study about severe post-COVID-19 condition 28 .…”

Post Covid: Ein Überblick über Symptome, Risikofaktoren, Pathophysiologie und Therapieansätze

“…14% (95% 13% (95% 36% (95% KI 27-46) 19% (95% KI 10% (95% 23% (95% KI [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] kardiovaskuläres System Risikofaktoren für Post Covid…”

“…Auch in unserer eigenen Studie konnte eine Steigerung der körperlichen Funktion über den Verlauf der Neurorehabilitation hinweg gezeigt werden. Deutlich wurde jedoch auch, dass die sehr schwer betroffenen Patienten, die im Mittel 45 Tage invasiv beatmet werden mussten, bei Entlassung aus der Rehabilitation die präklinische Funktion noch nicht wieder erreicht hatten 25 .…”