Intensive Care Unit–Acquired Weakness in Patients With COVID-19: Occurrence and Associated Factors

Abstract

Objective The primary objective of this study was to identify the occurrence and factors associated with intensive care unit (ICU)–acquired weakness (ICUAW) in patients with COVID-19. Secondarily, we monitored the evolution of muscle strength and mobility among patients with ICUAW and patients without ICUAW and the association of these variables with length of stay, mechanical ventilation (MV), and other clinical variables. Methods In this prospective observational study, patients admitted to the ICU for >72 h with COVID-19 were evaluated for muscle strength and mobility at 3 times: when being weaned from ventilatory support, discharged from the ICU, and discharged from the hospital. Risk factors for ICUAW were monitored. Results The occurrences of ICUAW at the 3 times evaluated among the 75 patients included were 52%, 38%, and 13%. The length of the ICU stay (29.5 [16.3–42.5] versus 11 [6.5–16] days; P ≤ .001), the length of the hospital stay (43.5 [22.8–55.3] versus 16 [12.5–24] days; P ≤ .001) and time on MV (25.5 [13.8–41.3] versus 10 [5–22.5] days; P ≤ .001) were greater in patients with ICUAW. Muscle strength and mobility were lower at all times assessed in patients with ICUAW (P < .05). Bed rest time for all patients (relative risk = 1.14; 95% CI = 1.02–1.28; P = .03 per week) and use of corticosteroids (relative risk = 1.01; 95% CI = 1.00–1.03; P = .01 per day) for those who required MV were factors independently associated with ICUAW. Muscle strength was found to have a positive correlation with mobility and a negative correlation with lengths of stay in the ICU and hospital and time on MV. Conclusions The occurrence of ICUAW was high upon patients’ awakening in the ICU but decreases throughout hospitalization; however, strength and mobility remained compromised at hospital discharge. Bed rest time and use of corticosteroids (for those who needed MV) were factors independently associated with ICUAW in patients with COVID-19.

Implementation of Early Rehabilitation in Severe COVID-19 Respiratory Failure

“…However, based on studies of other ICU patient populations, there is no reason to assume that implementation of mobility interventions is any higher in individuals admitted to the ICU due to COVID-19 42,43. Based on the limited evidence for individuals with COVID-19, ICUAW continues to be concerning and prevalent in this population 10,11,17…”

“…Intensive care unit acquired weakness has been correlated with increased length of ICU stay, difficulty weaning from mechanical ventilation, impaired mobility performance, diminished exercise tolerance, decreased independence with activities of daily living at discharge, and lower quality of life 8,17. A recent prospective observational study of 75 patients with COVID-19 admitted to the ICU for more than 72 hours found that bed rest time was independently associated with the development of ICUAW 11…”

“…4,5 Patients with COVID-19 often experience respiratory failure but may have additional symptoms including anorexia, nausea and diarrhea, myocarditis, skeletal muscle myopathy, and generalized debility. [6][7][8][9][10][11][12][13][14] These patients are at risk of substantial deconditioning as they are confined to bed from systemic symptoms as well as profound hypoxemia.…”

“…8,17 A recent prospective observational study of 75 patients with COVID-19 admitted to the ICU for more than 72 hours found that bed rest time was independently associated with the development of ICUAW. 11 The physiologic processes underlying the pathogenesis of ICUAW are not fully understood. The etiology is likely multifactorial and may be attributable to myogenic processes resulting in critical illness myopathy, neurogenic processes resulting in critical illness polyneuropathy, or a combination resulting in mixed critical illness neuromyopathy.…”

“… 8 , 17 A recent prospective observational study of 75 patients with COVID-19 admitted to the ICU for more than 72 hours found that bed rest time was independently associated with the development of ICUAW. 11 …”