Cardiorespiratory Fitness and Neuromuscular Function of Mechanically Ventilated ICU COVID-19 Patients*

Millet, Guillaume Y.; Kennouche, Djahid; Foschia, Clément; Brownstein, Callum G.; Gondin, Julien; Lapole, Thomas; Rimaud, Diana; Royer, Nicolas; Thiéry, Guillaume; Gauthier, Vincent; Oujamaa, Lydia; Sorg, Marine; Vergès, Samuel; Doutreleau, Stéphane; Marillier, Mathieu; Prudent, Mélanie; Bitker, Laurent; Féasson, Léonard; Gergelé, Laurent; Stauffer, Émeric; Guichon, Céline; Morel, J.

doi:10.1097/ccm.0000000000005641

Cited by 5 publications

(13 citation statements)

References 40 publications

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“…The results are profound. Mean V o 2 max for this cohort measured 18.3 mL/kg/min ± 4.5 sd or 49% of predicted values (16).…”

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confidence: 83%

“…Potentially, all ICU survivors need exercise-based rehabilitation for complete recovery but first give them an opportunity to live without each daily activity representing a maximal effort. Use a F to A ICU Liberation bundle strategy to prevent the astonishing ICU-induced physical disability objectively demonstrated by Millet et al (16).…”

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confidence: 99%

“…History repeats itself with high levels of disability for survivors of COVID-19 ICU care exacerbated by this lack of A to F bundle preventative care (15). In this issue of Critical Care Medicine , Millet et al (16) provides remarkable objective measures describing the level of cardiorespiratory fitness and neuromuscular function of mechanically ventilated ICU survivors after COVID-19. This study is unique among ICU mobility literature for its application of exercise physiology objective measures of survivors’ physical fitness.…”

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confidence: 99%

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ICU-Induced Disability Persists With or Without COVID-19—This Is a Call for F to A Bundle Action*

Engel

2022

Critical Care Medicine

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In 2003, a landmark study by Herridge et al (1) demonstrated that young survivors of acute respiratory distress syndrome have persistent functional disability 1 year after discharge from the ICU with muscle wasting, weakness, and low endurance. This study triggered a wake-up call for critical care practitioners to focus recovery on more than patients' survival. Patients expect to return home from the hospital as people restored to community level independence, and instead, long-term disability following an ICU stay persists. Herridge et al (1) followed up with her cohort of ICU survivors 5-year postdischarge and found they still had not recovered physical fitness levels to their age-matched norms, with a median 6-minute walk distance of 436 m (76% of predicted distance); plus ongoing cognitive, psychologic, and financial burdens (2). In 2011, a data synthesis review published in Critical Care Medicine found that "ICU care influenced a wide range of long-term patient outcomes, with some impairments persisting for 5-15 years. The review authors concluded that impaired pulmonary function, greater healthcare utilization, and increased mortality are observed in intensive care survivors. Neuromuscular weakness and impairments in both physical function and related aspects of quality of life are common and may be long-lasting" (3). Attempting to mitigate post-ICU disability, the Society of Critical Care Medicine created a stakeholder's conference in 2012 improving the long-term outcomes after critical illness for patients and their families. Thirty-one invited stakeholders participated in the conference. The invited experts presented a summary of existing data, identifying long-term physical, cognitive, and mental health problems after intensive care and the results from studies of interventions to address these problems. Stakeholders provided concerns and strategies for improving care and mitigating these long-term health problems (4). At this conference, they created the term "postintensive care syndrome (PICS)" to capture the wide range of disabling sequelae in one phrase.In 2007, ICU clinicians pioneered critical care work to prevent PICS by keeping patients awake-including while on mechanical ventilation, and mobilizing out of bed within days of ICU admission. Bailey et al (5) recorded a total of 1,449 activity events in 103 ICU patients with a median Acute Physiology and Chronic Health Evaluation 2 score of 26. The activity events included 233 (16%) sit on bed, 454 (31%) sit in chair, and 762 (53%) ambulate. In patients with an endotracheal tube in place, there were a total of 593 activity events, of which 249 (42%) were

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“…The results are profound. Mean V o 2 max for this cohort measured 18.3 mL/kg/min ± 4.5 sd or 49% of predicted values (16).…”

mentioning

confidence: 83%

mentioning

confidence: 99%

mentioning

confidence: 99%

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ICU-Induced Disability Persists With or Without COVID-19—This Is a Call for F to A Bundle Action*

Engel

2022

Critical Care Medicine

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“…can dramatically change the conclusion about fatigability. Our group has recently used lower limbs fatiguing exercises scaled on body weight ( 29 – 32 ) since we believe that this is more representative of activities of daily living (walking, climbing stairs, etc.). By doing so, we were able to show that cancer patients ( 29 , 30 ) and people with multiple sclerosis ( 31 ) who suffered from chronic fatigue had greater levels of objective fatigability than their non-fatigued counterparts.…”

Section: Measuring Objective Fatigability Resistance: How?mentioning

confidence: 99%

“…By measuring voluntary and evoked forces at rest, at iso-workload and at task failure, this test assesses quadriceps strength (i.e., MVC), endurance (i.e., the total number of contractions) and fatigability (i.e., the progressive decline in MVC) in one session. The QIF test has already been used to assess various clinical populations such as patients with fibromyalgia syndrome ( 36 ), FSHD ( 37 , 38 ) or Covid-19 ICU survivors ( 32 ).…”

Section: Measuring Objective Fatigability Resistance: How?mentioning

confidence: 99%

Measuring objective fatigability and autonomic dysfunction in clinical populations: How and why?

Millet

Bertrand

Lapole

et al. 2023

Front. Sports Act. Living

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Fatigue is a major symptom in many diseases, often among the most common and severe ones and may last for an extremely long period. Chronic fatigue impacts quality of life, reduces the capacity to perform activities of daily living, and has socioeconomical consequences such as impairing return to work. Despite the high prevalence and deleterious consequences of fatigue, little is known about its etiology. Numerous causes have been proposed to explain chronic fatigue. They encompass psychosocial and behavioral aspects (e.g., sleep disorders) and biological (e.g., inflammation), hematological (e.g., anemia) as well as physiological origins. Among the potential causes of chronic fatigue is the role of altered acute fatigue resistance, i.e. an increased fatigability for a given exercise, that is related to physical deconditioning. For instance, we and others have recently evidenced that relationships between chronic fatigue and increased objective fatigability, defined as an abnormal deterioration of functional capacity (maximal force or power), provided objective fatigability is appropriately measured. Indeed, in most studies in the field of chronic diseases, objective fatigability is measured during single-joint, isometric exercises. While those studies are valuable from a fundamental science point of view, they do not allow to test the patients in ecological situations when the purpose is to search for a link with chronic fatigue. As a complementary measure to the evaluation of neuromuscular function (i.e., fatigability), studying the dysfunction of the autonomic nervous system (ANS) is also of great interest in the context of fatigue. The challenge of evaluating objective fatigability and ANS dysfunction appropriately (i.e.,. how?) will be discussed in the first part of the present article. New tools recently developed to measure objective fatigability and muscle function will be presented. In the second part of the paper, we will discuss the interest of measuring objective fatigability and ANS (i.e. why?). Despite the beneficial effects of physical activity in attenuating chronic fatigue have been demonstrated, a better evaluation of fatigue etiology will allow to personalize the training intervention. We believe this is key in order to account for the complex, multifactorial nature of chronic fatigue.

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Factors Associated with Fatigue in COVID-19 ICU Survivors

Kennouche,

Foschia,

Brownstein

et al. 2024

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose Approximately 30% of people infected with COVID-19 require hospitalization and 20% of them are admitted to an intensive care unit (ICU). Most of these patients experience symptoms of fatigue weeks post-ICU, so understanding the factors associated with fatigue in this population is crucial. Methods Fifty-nine patients [38-78 yr] hospitalized in ICU for COVID-19 infection for 32 [6-80] days including 23 [3-57] days of mechanical ventilation, visited the laboratory on two separate occasions. The first visit occurred 52 ± 15 days after discharge and was dedicated to questionnaires, blood sampling and cardiopulmonary exercise testing, while measurements of the knee extensors neuromuscular function and performance fatigability were performed in the second visit 7 ± 2 days later. Results Using the FACIT-F questionnaire, 56% of patients were classified as fatigued. Fatigued patients had worse lung function score than non- fatigued (i.e. 2.9 ± 0.8 L vs 3.6 ± 0.8 L; 2.4 ± 0.7 l vs 3.0 ± 0.7 L for forced vital capacity and forced expiratory volume in one second, respectively) and forced vital capacity was identified as a predictor of being fatigued. Maximal voluntary activation was lower in fatigued patients than non-fatigued patients (82 ± 14% vs 91 ± 3%) and was the only neuromuscular variable that discriminated between fatigued and non-fatigued patients. Patient-reported outcomes also showed differences between fatigued and non-fatigued patients for sleep, physical activity, depression and quality of life (p < 0.05). Conclusions COVID-19 survivors showed altered respiratory function 4 to 8 weeks after discharge, that was further deteriorated in fatigued patients. Fatigue was also associated with lower voluntary activation and patient-reported impairments (i.e. sleep satisfaction, quality of life or depressive state). The present study reinforces the importance of exercise intervention and rehabilitation to counteract cardiorespiratory and neuromuscular impairments of COVID-19 patients admitted in ICU, especially individuals experiencing fatigue.

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Cardiorespiratory Fitness and Neuromuscular Function of Mechanically Ventilated ICU COVID-19 Patients*

Cited by 5 publications

References 40 publications

ICU-Induced Disability Persists With or Without COVID-19—This Is a Call for F to A Bundle Action*

ICU-Induced Disability Persists With or Without COVID-19—This Is a Call for F to A Bundle Action*

Measuring objective fatigability and autonomic dysfunction in clinical populations: How and why?

Factors Associated with Fatigue in COVID-19 ICU Survivors

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