Rehabilitation Levels in COVID-19 Patients Admitted to Intensive Care Requiring Invasive Ventilation: An Observational Study.

McWilliams, David, Weblin, Jonathan, Hodson, James, Veenith, Tonny, Whitehouse, Tony and Snelson, Catherine (2020) Rehabilitation Levels in COVID-19 Patients Admitted to Intensive Care Requiring Invasive Ventilation: An Observational Study. Annals of the American Thoracic Society. ISSN 2325-6621.

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Official URL: https://www.atsjournals.org/doi/10.1513/AnnalsATS....

Abstract

RATIONALE

Patients with severe COVID-19 have complex organ support needs that necessitate prolonged stays in the intensive care, likely to result in a high incidence of neuromuscular weakness and loss of well being. Early and structured rehabilitation has been associated with improved outcomes for patients requiring prolonged periods of mechanical ventilation, but at present no data are available to describe similar interventions or outcomes in COVID-19 populations.

OBJECTIVES

To describe the demographics, clinical status, level of rehabilitation and mobility status at ICU discharge of patients with COVID-19.

METHODS

Adults admitted to ICU with a confirmed diagnosis of COVID-19 and mechanically ventilated for >24 hours were included. Rehabilitation status was measured daily using the Manchester Mobility Score (MMS) to identify the time taken to first mobilise (defined as sitting on the edge of the bed or higher) and highest level of mobility achieved at ICU discharge.

RESULTS

A total of n=177 patients were identified, of whom n=110 survived to ICU discharge and were included in the subsequent analysis. Whilst on ICU, patients required prolonged periods of mechanical ventilation (mean 19 ± 10 days), most received neuromuscular blockade (90%) and 67% were placed in the prone position on at least one occasion. The mean ± SD time to first mobilise was 14 ± 7 days, with a median MMS at ICU discharge of 5 (interquartile range: 4-6), which represents participants able to stand and step round to a chair with or without assistance. Time to mobilise was significantly longer in those with higher BMI (p<0.001), whilst older patients (p=0.012) and those with more comorbidities (p=0.017) were more likely to require further rehabilitation post-discharge.

CONCLUSION

The early experience of the COVID-19 pandemic in the UK resembles the experience in other countries, with high acuity of illness and prolonged period of mechanical ventilation required for those patients admitted to ICU. Whilst the time to commence rehabilitation was delayed due to this severity of illness, rehabilitation was possible within the ICU, and led to increased levels of mobility from waking prior to ICU discharge. Clinical trial registered with ClinicalTrials.gov (NCT04396197).

Item Type: Article
Subjects: WB Practice of medicine > WB450 Rehabilitation
WC Communicabable diseases
Divisions: Clinical Support > Infectious Diseases
Emergency Services > Acute Medicine and AMU
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Depositing User: Mr Philip O'Reilly
Date Deposited: 23 Sep 2020 13:42
Last Modified: 23 Sep 2020 13:42
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3468

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