Rehabilitation Trends in Patients With COVID-19 Requiring Invasive Ventilation

In patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) with a high acuity of illness and a prolonged period of mechanical ventilation, the time to commencement of rehabilitation was often delayed because of the severity of an individual’s condition.

Researchers conducted a single-center, prospective, noninterventional, observational study (ClinicalTrials.gov Identifier: NCT04396197) in patients with a COVID-19 diagnosis admitted to the ICU at the Queen Elizabeth Hospital Birmingham (QEHB) in Birmingham, United Kingdom. Results of the analysis were published in the Annals of the American Thoracic Society.

Investigators sought to describe the clinical status, demographics, level of rehabilitation, and mobility status at ICU discharge in individuals with COVID-19. Adult patients were enrolled who had been admitted to the ICU at QEHB from March through April 2020 with a confirmed diagnosis of COVID-19 and had received mechanical ventilation for more than 24 hours. The rehabilitation status of all participants was measured daily with use of the Manchester Mobility Score (MMS) to identify the time taken to first mobilize (defined as an MMS of ≥2, ie, sitting on the edge of the bed or higher) and the location of hospital discharge, as 1 of the following categories: home with no rehabilitation; home with rehabilitation; or inpatient rehabilitation facility.

A total of 177 patients were identified, with 110 of them surviving to ICU discharge and thus included in the analysis. The mean participant age of those who survived to ICU discharge was 53±12 years. Overall, 75% of the participants were men; the majority of the patients were of White (48%) or Asian (35%) ethnicity. In the patient cohort, 87% were classified as overweight or obese (body mass index [BMI], 25).

During their time spent in the ICU, patients needed prolonged periods of invasive ventilation (mean, 19±10 days), 90% received neuromuscular blockade, and 67% were placed in the prone position on at least 1 occasion. The mean time to patients’ first mobilization was 14±7 days, with a median MMS at discharge from the ICU of 5 (range, 4-6), which denotes that patients were able to stand or take some steps to a chair with or without any assistance.

The time to mobilization was significantly longer in participants with higher BMI

(P <.001). Furthermore, older individuals and those with more comorbidities were significantly more likely to require additional rehabilitation following discharge (P =.012 and P =.017, respectively).

A major limitation of the analysis was that it was a single-center, observational study with a small sample size that may not be representative of other patient populations. Additionally, because of the urgent focus and elevated numbers of individuals requiring critical care, limited information was collected with respect to the rehabilitation period.

The investigators concluded that despite the significant strain on health care services during the COVID-19 pandemic, they were able to deliver a high level of rehabilitation services to patients in the ICU, even during the peak of the surge in hospital admissions. They emphasized that ongoing planning for future surges need to take this critical aspect of care into consideration to ensure that rehabilitation can still be prioritized in this patient population.

Reference

McWilliams D, Weblin J, Hodson J, Veenith T, Whitehouse T, Snelson C; on behalf of the QEHB Covid-19 research team. Rehabilitation levels in COVID-19 patients admitted to intensive care requiring invasive ventilation: an observational study. Ann Am Thorac Soc. Published online September 11, 2020. doi:10.1513/AnnalsATS.202005-560OC