ABSTRACT
To describe the functional outcomes of patients with critically ill coronavirus disease 2019 (COVID-19) after transfer out of intensive care unit (ICU). Retrospective observational cohort study. National designated center for patients with COVID-19. 51 consecutive critically ill COVID-19 patients admitted to the ICU. Patients were referred for physical therapy after transferring out from ICU if they had functional impairments. Functional outcomes were measured primarily with the Functional Ambulation Category (FAC), and divided into 2 categories: dependent ambulators (FAC 0-3) and independent ambulators (FAC 4-5). Secondary outcomes measured included ADL dependence of patients and the need for supplemental oxygen. All patients were premorbidly independent in walking and in basic ADLs, and did not require supplementary oxygen. Upon transfer out of ICU, there were 24 patients (47.1%) who were dependent walkers (defined as FAC of 0-3) with 22 patients (43.1%) who were dependent in 1 or more basic ADLs. However, upon discharge, a majority achieved independence in ambulation and basic ADLs (92.2% and 90.2% respectively). All 41 patients (80.4%) who required continuous supplementary oxygen upon transferring out of ICU did not require supplementary oxygen on discharge. On multivariate analysis, we found that a Charlson Comorbidity Index of 1 or more (odds ratio 14.02, 95% CI 1.15-171.28, P=0.039) and a longer length of ICU stay (odds ratio 1.50, 95% CI 1.04-2.16, P=0.029) were associated with dependent ambulation upon discharge from ICU. Critically ill COVID-19 survivors have a high level of impairment following discharge from ICU. Such patients should be screened for impairment and managed appropriately by rehabilitation professionals, so as to achieve good functional outcomes on discharge. None to disclose.
ABSTRACT
Platypnea-orthodeoxia syndrome, characterized by dyspnoea and arterial desaturation while upright, is a rare complication of acute respiratory distress syndrome. We report here 2 patients with COVID-19 pneumonia, who were diagnosed with platypnea-orthodeoxia syndrome during commencement of rehabilitation, 18 and 9 days respectively after admission to the intensive care unit. Both patients presented with normocapnic hypoxaemia. One patient required mechanical ventilation with supplemental oxygen during intensive care, while the other required high-flow nasal oxygen therapy. The manifestations of platypnea-orthodeoxia syndrome were most prominent during physiotherapy, when verticalization was attempted, and hindered further mobilization out of bed, including ambulation. This report describes the clinical manifestations of platypnea-orthodeoxia syndrome and the rehabilitative strategies carried out for these 2 patients. The platypnea-orthodeoxia syndrome in these patients resolved after 65 and 22 days respectively from the day of detection. This report highlights this potentially under-recognized phenomenon, which may be unmasked during rehabilitation of patients with COVID-19 pneumonia. Good functional outcomes were achieved with a combination of verticalization training with supplemental oxygen support, respiratory techniques training and progressive endurance and resistance training, whilst awaiting resolution of the platypneaorthodeoxia syndrome.
ABSTRACT
Background: COVID-19 (Coronavirus Disease 2019) is a global cause of morbidity and mortality currently. We aim to describe the acute functional outcomes of critically ill coronavirus disease 2019 (COVID-19) patients after transferring out of the intensive care unit (ICU). Methods: 51 consecutive critically ill COVID-19 patients at a national designated center for COVID-19 were included in this exploratory, retrospective observational cohort study from January 1 to May 31, 2020. Demographic and clinical data were collected and analyzed. Functional outcomes were measured primarily with the Functional Ambulation Category (FAC), and divided into 2 categories: dependent ambulators (FAC 0-3) and independent ambulators (FAC 4-5). Multivariate analysis was performed to determine associations. Results: Many patients were dependent ambulators (47.1%) upon transferring out of ICU, although 92.2% regained independent ambulation at discharge. On multivariate analysis, we found that a Charlson Comorbidity Index of 1 or more (odds ratio 14.02, 95% CI 1.15-171.28, P = 0.039) and a longer length of ICU stay (odds ratio 1.50, 95% CI 1.04-2.16, P = 0.029) were associated with dependent ambulation upon discharge from ICU. Conclusions: Critically ill COVID-19 survivors have a high level of impairment following discharge from ICU. Such patients should be screened for impairment and managed appropriately by rehabilitation professionals, so as to achieve good functional outcomes on discharge.