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

Abstract

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

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

“…In agreement with our results, available studies reported high rates of ICUAW in mechanically ventilated adults with COVID-19. During the pandemic first surge, clinically- assessed ICUAW rates were 52% (n = 26/50) 30 and 100% (n = 35) 31 at ICU discharge, in 2 retrospective studies; and 100% at awakening (n = 110) 32 and 69% (n = 16/23) at the time of extubation 33 in two further prospective studies. Interestingly, these high rates contrast with lower event rates observed in earlier large historical trials of mechanically ventilated adults with non-COVID-19 ARDS ranging 34–36% 34 , 35 consequently, our data raise the question of whether critically ill COVID-19 survivors experience ICU neuromuscular complications more frequently relative to other ARDS populations.…”

“…Table 2 shows secondary outcomes. Overall FSS-ICU scores at hospital discharge were significantly lower in patients with ICUAW at ICU discharge (26 (19-31) versus 34 (29)(30)(31)(32)(33)(34)(35)). A total of 38 patients (54.3%) were discharged newly gait dependent, out of which, 11 (15.7%) were not able to attempt to walk (FSS walking = 0).…”

Neuromuskuläre Manifestationen beim Long-COVID-Syndrom

“…Patienten, die aufgrund von COVID-19 behandelt wurden, hatten eine geringere Muskelkraft, aber erholten sich rascher als die Vergleichsgruppe. Limitiert ist die Studie aufgrund ihrer geringen Fallzahl (insgesamt nur 56 eingeschlossene Patienten) und auch hinsichtlich ihrer Methodik, da nur retrospektiv und die ICUAW nicht elektrophysiologisch bestätigt wurde [ 40 ].…”

Early and final outcome of patients suffered from muscle weakness aquired in COVID Intensive Care Unit – How precise we can be about eary and final outcome of patients at the time of the end of mechanical ventilation?

“…Moonen i sur. su uspoređivali MRC rezultat i tijek oporavka kod bolesnika koji su razvili ICUAW sa COVID pneumosepsom i ne-COVID bolesnika sa pneumosepsom i došli do zaključka da je ICUAW u COVID bolesnika po otpustu iz bolnice sa manjim MRC rezultatom, ali da se tim bolesnicima mišićna slabost brže oporavlja 46 .…”