Safety and Feasibility of an Interdisciplinary Treatment Approach to Optimize Recovery From Critical Coronavirus Disease 2019

Abstract

OBJECTIVES: Examine the safety and feasibility of a multimodal in-person or telehealth treatment program, administered in acute recovery phase for patients surviving critical coronavirus disease 2019. DESIGN: Pragmatic, pre-post, nonrandomized controlled trial with patients electing enrollment into one of the two recovery pathways. SETTING: ICU Recovery Clinic in an academic medical center. PATIENTS: Adult patients surviving acute respiratory failure due to critical coronavirus disease 2019. INTERVENTIONS: Patients participated in combined ICU Recovery clinic and 8 weeks of physical rehabilitation delivered: 1) in-person or 2) telehealth. Patients received medical care by an ICU Recovery Clinic interdisciplinary team and physical rehabilitation focused on aerobic, resistance, and respiratory muscle training. MEASUREMENTS AND MAIN RESULTS: Thirty-two patients enrolled with mean age 57 ± 12, 62% were male, and the median Sequential Organ Failure Assessment score was 9.5. There were no differences between the two groups except patients in telehealth pathway (n = 10) lived further from clinic than face-to-face patients (162 ± 60 vs 31 ± 47 kilometers, t = 6.06, p < 0.001). Four safety events occurred: one minor adverse event in the telehealth group, two minor adverse events, and one major adverse event in the in-person group. Three patients did not complete the study (two in-person and one telehealth). Six-minute walk distance increased to 101 ± 91 meters from pre to post (n = 29, t = 6.93, p < 0.0001), which was similar between the two groups (110 vs 80 meters, t = 1.34, p = 0.19). Self-reported levels of anxiety, depression, and distress were high in both groups with similar self-report quality of life. CONCLUSIONS: A multimodal treatment program combining care from an interdisciplinary team in an ICU Recovery Clinic with physical rehabilitation is safe and feasible in patients surviving the ICU for coronavirus disease 2019 acute respiratory failure.

Effect of Combined Exercise Training Physical and Functional Capacity in Post-Covid Patients

“…An important nding of the present study is the great improvement in functional capacity after supervised combined exercise training, corroborating others with similar protocols and outcomes [27][28][29][30][31][32]. The handgrip strength increased in our study ~ 32,7% post-COVID rehabilitation.…”

“…This result presented a higher improvement when compared to Mayer et al [31] study, that evaluated handgrip strength after 8-week moderate-intensity rehabilitation and observed an improvement of ~ 15,1% and Nambi et al [32] with post-COVID sarcopenic patients in which observed improvement of ~ 10,9% after 8-week low-intensity rehabilitation. This magnitude difference probably occurred due Mayer et al [31] performed an ICU recovery previous to outpatient rehabilitation and Nambi et al [32] analyze community-dwelling elderly with post-COVID, and both studies had higher baseline values than compared to present study. About STS, De Souza et al [28] showed a signi cant improvement after 6-week home-based rehabilitation (~ 53,5%).…”

“…Mayer et al [31] and Udina et al [35] demonstrated a faster gait speed after intervention, although Mayer et al [31] observed an improvement only in supervised rehabilitation, but not in telerehabilitation, and Udina et al [35] observed that ICU patients had greater change in gait speed test after early rehabilitation. Our ndings corroborate these previous studies, which showed a great improvement in gait speed test after supervised rehabilitation with mostly ICU patients.…”

Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome

“…Patients were excluded if they had a hospitalization in last 12-months or history of COVID-19. At the baseline testing, there were no missing data for patients enrolled in the study. Nineteen (critical-COVID) and 9 (severe-COVID) patients included in this study were co-enrolled in a nonrandomized rehabilitation intervention cohort study 36,37 and thus had data available at two-time-points (1-month and 3-months post discharge). Patients were excluded from all three groups if they had an acute or chronic neurologic, neurodegenerative, or orthopedic condition or disease that influenced cognition or motor performance.…”

Upcoming and urgent challenges in critical care research based on COVID-19 pandemic experience

“…COVID-19 promoted innovative approaches such as telemedicine and virtual reality [75]. As an example, the out-patient clinics for long-COVID-19 or cognition improvement are promising [76,77], as they provide multidisciplinary and personalised care [78,79]. Longterm symptoms are being evaluated in multicentric studies aiming to recruit 10 000 patients (CO-FLOW and PHOSP-COVID) [80,81].…”