ABSTRACT
Introduction: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has been responsible for one of the largest global viral outbreaks in recent years.1 Admissions to intensive care units (ICU) have increased. A common consequence of prolonged ICU admission is ICUacquired weakness (ICUAW).2 Rehabilitation in ICU is well established to be beneficial in combating ICUAW and should be started as early as clinically possible.3 Objectives: This study aimed to explore the haemodynamic effects of initial active rehabilitation in this complex patient population. Methods: During April to June 2020, continuous, prospective cardiovascular and respiratory data (heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and peripheral oxygen saturation (SpO2) were measured for fifteen minutes before, during and for 30 minutes after the initial active rehabilitation session. Active rehabilitation was defined as a sit over the edge of the bed with assistance from therapists as theminimumachieved in the session. The length of the active rehabilitation session, the type of rehabilitation and reason for stopping the session were recorded. Inclusion and exclusion criteria were established a priori. Data were analysed via non-parametric ANOVA. Results: Initial active physiotherapy rehabilitation was observed in 23 patients (17 male, median age 45 years (IQR 36,51)). Median length of mechanical ventilation prior to starting active rehabilitation was 34 days (IQR 26,40). Four patients were receiving extra-corporeal membrane oxygenation (ECMO) and three patients had been extubated prior to rehabilitation. All patients achieved a sit over the edge of the bed with one patient progressing to a stand. Median length of treatment time was 11 minutes (IQR 8,14). Group analysis did not identify any statistically significant changes in HR (p=0.975), SBP (p=0.907), DBP (p=0.783), MAP (p=0.625) or SpO2 (p=0.666) across the four study periods. There was no clinically significant change across the variables (range -0.5% reduction to 5.9% increase) with minimal changes in cardiovascular changes. No medical intervention such as titration of medication or additional ventilatory support was required during the sessions or as reason for stopping. Conclusion: This service evaluation suggests that initial active rehabilitation in a group of critically ill adults with COVID-19 at a specialist centre can be performed safely without detrimental cardiovascular changes.
ABSTRACT
OBJECTIVE: To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19). DESIGN: Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. SETTING: Three New York City hospitals. POPULATION: Pregnant women >20 weeks of gestation admitted for delivery. METHODS: Data were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests. MAIN OUTCOME MEASURES: Prevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology. RESULTS: Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID-19 versus women without COVID-19 (48.3% versus 11.3%, P < 0.001). CONCLUSION: Among pregnant women with COVID-19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 remote from delivery. TWEETABLE ABSTRACT: COVID-19 at delivery: more caesarean deliveries, postpartum complications and intraplacental thrombi.