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1.
Crit Care ; 25(1): 382, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1506095

ABSTRACT

BACKGROUND: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. METHODS: In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. RESULTS: Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51-70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06-13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, - 0.19 [- 0.28 to - 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. CONCLUSIONS: At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020.


Subject(s)
COVID-19/epidemiology , Critical Illness/epidemiology , Disabled Persons , Recovery of Function/physiology , Return to Work/trends , Aged , Aged, 80 and over , Australia/epidemiology , COVID-19/diagnosis , COVID-19/therapy , Cohort Studies , Critical Illness/therapy , Female , Follow-Up Studies , Health Status , Humans , Male , Middle Aged , Mortality/trends , Prospective Studies , Time Factors , Treatment Outcome
2.
Physiotherapy ; 2021.
Article in English | ScienceDirect | ID: covidwho-1433732

ABSTRACT

Objectives To evaluate short-term change in oxygenation and feasibility of physiotherapy-assisted prone or modified prone positioning in awake, ward-based patients with COVID-19. Design Retrospective observational cohort study. Setting General wards, single-centre tertiary hospital in Australia. Participants Patients were included if ≥18 years, had COVID-19, required FiO2 ≥ 0.28 or oxygen flow rate ≥4 L/min and consented to positioning. Main outcome measures: Feasibility measures included barriers to therapy, assistance required, and comfort. Short-term change in oxygenation (SpO2) and oxygen requirements before and 15 minutes after positioning. Results Thirteen patients, mean age 75 (SD 14) years;median Clinical Frailty Scale score 6 (IQR 4 to 7) participated in 32 sessions of prone or modified prone positioning from a total of 125 ward-based patients admitted with COVID-19 who received physiotherapy intervention. Nine of thirteen patients (69%) required physiotherapy assistance and modified positions were utilised in 8/13 (62%). SpO2 increased in 27/32 sessions, with a mean increase from 90% (SD 5) pre-positioning to 94% (SD 4) (mean difference 4%;95%CI 3 to 5%) after 15 minutes. Oxygen requirement decreased in 14/32 sessions, with a mean pre-positioning requirement of 8 L/min (SD 4) to 7 L/min (SD 4) (mean difference 2 L/min;95%CI 1 to 3 L/min) after 15 minutes. In three sessions oxygen desaturation and discomfort occurred but resolved immediately by returning supine. Conclusion Physiotherapy-assisted prone or modified prone positioning may be a feasible option leading to short-term improvements in oxygenation in awake, ward-Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation based patients with hypoxemia due to COVID-19. Further research exploring longerterm health outcomes and safety is required.

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