Post-Intensive Care Unit Multidisciplinary Approach in Patients with Severe Bilateral SARS-CoV-2 Pneumonia

Abstract

Background: Short and long-term sequelae after admission to the intensive care unit (ICU) for coronavirus disease 2019 are to be expected, which makes multidisciplinary care key in the support of physical and cognitive recovery. Objective: To describe, from a multidisciplinary perspective, the sequelae one month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia. Design: Prospective cohort study. Environment: Multidisciplinary outpatient clinic. Population: Patients with severe COVID-19 pneumonia, post-ICU admission. Methods: A total of 104 patients completed the study in the multidisciplinary outpatient clinic. The tests performed included spirometry, measurement of respiratory muscle pressure, loss of body cell mass (BCM) and BCM index (BCMI), general joint and muscular mobility, the short physical performance battery (SPPB or Guralnik test), grip strength with hand dynamometer, the six-minute walk test (6-MWT), the functional assessment of chronic illness therapy-fatigue scale (FACIT-F), the European quality of life-5 dimensions (EQ-5D), the Barthel index and the Montreal cognitive assessment test (MoCA). While rehabilitation was not necessary for 23 patients, 38 patients attended group rehabilitation sessions and other 43 patients received home rehabilitation. Endpoints: The main sequelae detected in patients were fatigue (75.96%), dyspnoea (64.42%) and oxygen therapy on discharge (37.5%). The MoCA showed a mean score compatible with mild cognitive decline. The main impairment of joint mobility was limited shoulder (11.54%) and shoulder girdle (2.88%) mobility; whereas for muscle mobility, lower limb limitations (16.35%) were the main dysfunction. Distal neuropathy was present in 23.08% of patients, most frequently located in lower limbs (15.38%). Finally, 50% of patients reported moderate limitation in the EQ-5D, with a mean score of 60.62 points (SD 20.15) in perceived quality of life. Ivyspring International PublisherConclusions: Our findings support the need for a multidisciplinary and comprehensive evaluation of patients after ICU admission for COVID-19 because of the wide range of sequelae, which also mean that these patients need a long-term follow-up. Impact on clinical rehabilitation:This study provides data supporting the key role of rehabilitation during the follow-up of severe patients, thus facilitating their reintegration in society and a suitable adaptation to daily living.

Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study

“…As previously observed, comparing with other causes of pneumonia, it can be inferred that COVID-19 pneumonia has a lower late mortality rate among ICU survivors [ 24 ]. The cause behind reduced long-term mortality rates for COVID patients remains unclear, as the incidence of pulmonary anatomical abnormalities and compromised physiological function is significantly high among individuals diagnosed with ARDS as a consequence of COVID-19 [ 6 ]. Additionally, research findings indicate that COVID-19 patients necessitating MV exhibit heightened levels of inflammatory markers, multiple organ dysfunction, and increased rates of in-hospital mortality [ 24 – 26 ].…”

“…However, the understanding and evidence concerning long-term outcomes in individuals who required critical care due to COVID-19 diagnosis are currently limited. A prospective cohort study conducted in Spain in 2021, evaluating the sequelae occurred at the first month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia, concluded that these patients need a long-term follow-up due to its expected bad prognosis, and this should be extended beyond 30 days after ICU discharge [ 6 ]. However, evidence regarding the optimal duration for follow-up care in individuals who have survived COVID-19 after being admitted to the ICU is still lacking [ 7 ].…”