Functional status of mechanically ventilated COVID-19 survivors at ICU and hospital discharge

• Published in: Journal of intensive care 2021-03, Vol.9 (1), p.31-31, Article 31
• Main Authors: Musheyev, Benjamin, Borg, Lara, Janowicz, Rebeca, Matarlo, Michael, Boyle, Hayle, Singh, Gurinder, Ende, Victoria, Babatsikos, Ioannis, Hou, Wei, Duong, Tim Q
• Format: Article
• Language: English
• Subjects: Activities of daily living; Admission and discharge; Asthma; Blood pressure; Cardiovascular disease; Care and treatment; Comorbidity; Comparative analysis; Coronavirus disease 2019; Coronaviruses; Correlation analysis; COVID-19; COVID-19 sequela; Dehydrogenases; Demographics; Diabetes; Functional outcome; Hospital patients; Hospitals; Hypertension; Immunotherapy; Invasive mechanical ventilation; Laboratories; Late effects of COVID-19 infection; Lung diseases, Obstructive; Medical equipment; Mobility; Patients; Physiological apparatus; Rehabilitation; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Therapists; Therapy; Ventilation; Ventilators; Vital signs
• ISSN: 2052-0492; 2052-0492
• DOI: 10.1186/s40560-021-00542-y

A significant number of COVID-19 patients have been treated using invasive mechanical ventilation (IMV). The ability to evaluate functional status of COVID-19 survivors early on at ICU and hospital discharge may enable identification of patients who may need medical and rehabilitation interventions. The modified "Mental Status", ICU Mobility, and Barthel Index scores at ICU and hospital discharge were tabulated for 118 COVID-19 survivors treated with invasive mechanical ventilation (IMV). These functional scores were compared with pre-admission functional status, discharge durable medical equipment, discharge medical follow-up recommendation, duration on IMV, duration post-IMV, demographics, comorbidities, laboratory tests, and vital signs at ICU and hospital discharge. The majority of COVID-19 IMV patients were not functionally independent at hospital discharge (22% discharged with cane or rolling walker, 49% discharged with durable medical equipment, and 14% admitted to a rehabilitation facility), although 94% of these patients were functionally independent prior to COVID-19 illness. Half of the patients were discharged with supplemental oxygen equipment. The most prevalent medical follow-up recommendations were cardiology, vascular medicine, pulmonology, endocrinology, and neurology with many patients receiving multiple medical follow-up recommendations. Functional status improved from ICU discharge to hospital discharge (p < 0.001). Worse functional status at hospital discharge was associated with longer IMV duration, older age, male sex, higher number of comorbidities, and the presence of pre-existing comorbidities including hypertension, diabetes, chronic obstructive pulmonary disease, and immunosuppression (p < 0.05, ANOVA). The majority of IMV COVID-19 survivors were not functionally independent at discharge and required significant follow-up medical care. The COVID-19 circumstance has placed constraints on access to in-hospital rehabilitation. These findings underscore the need for prospective studies to ascertain the short- and long-term sequela in COVID-19 survivors.