Intensive Care Admission and Early Neuro-Rehabilitation. Lessons for COVID-19?

Abstract

Coronavirus disease 2019 (COVID-19) requires admission to intensive care (ICU) for the management of acute respiratory distress syndrome in about 5% of cases. Although our understanding of COVID-19 is still incomplete, a growing body of evidence is indicating potential direct deleterious effects on the central and peripheral nervous systems. Indeed, complex and long-lasting physical, cognitive, and functional impairments have often been observed after COVID-19. Early (defined as during and immediately after ICU discharge) rehabilitative interventions are fundamental for reducing the neurological burden of a disease that already heavily affects lung function with pulmonary fibrosis as a possible long-term consequence. In addition, ameliorating neuromuscular weakness with early rehabilitation would improve the efficiency of respiratory function as respiratory muscle atrophy worsens lung capacity. This review briefly summarizes the polymorphic burden of COVID-19 and addresses possible early interventions that could minimize the neurological and systemic impact. In fact, the benefits of early multidisciplinary rehabilitation after an ICU stay have been shown to be advantageous in several clinical conditions making an early rehabilitative approach generalizable and desirable to physicians from a wide range of different specialties.

S1-Leitlinie Post-COVID/Long-COVID

“…Kognitive Störungen beim PICS und so auch für COVID-19-Betroffene gezeigt [182] betreffen gehäuft Aufmerksamkeits-und Gedächtnis-sowie Exekutivfunktionen, emotionale Störungen sowohl Angststörungen als auch depressive Störungen. Bei schweren und kritischen Verläufen einer SARS-CoV-2-Infektion bestehen individuell unterschiedliche Kombinationen aus Lähmungen, kognitiven und emotionalen Störungen teilweise über lange Zeit fort und bedürfen der medizinischen Rehabilitation, sowohl post-akut [183,184] als auch ggf. (erneut) im weiteren Verlauf.…”

COVID-19: Short and Long-Term Effects of Hospitalization on Muscular Weakness in the Elderly

“…Consequently, much consideration has been given to when to start these interventions, i.e., medical boards in various countries generally advise against these measures in the acute phase especially in critical patients [ 55 ]. Nevertheless, a few institutions tend to start them during mechanical ventilation [ 56 ].…”

“…Routines including limb mobilization are essential to avoid side effects on the musculoskeletal system (pressure ulcers, critical illness myopathy, plantar flexor contractures or heterotopic ossification) especially for those patients after a prolonged pronation passive mobilization therapy following ARDS [ 58 ]. A few institutions employ lower body ergometers to achieve passive leg movements; this could be of special interest wherever the nurse-to-patient ratio may interfere with clinical assistance [ 56 ].…”

Case Report: Behavioral Unresponsiveness in Acute COVID-19 Patients: The Utility of the Motor Behavior Tool-Revised and 18F-FDG PET/CT

“…Indeed, establishing a rapid diagnostic procedure and reliable prognosis outcome is crucial for patients who might benefit from an early treatment (24). Above all, we recommend applying an early and intensive neuro-rehabilitation program for severe COVID-19 patients with behavioral unresponsiveness, which aims at maximizing patient function to achieve the highest possible level of independence (33,34).…”