Hyaluronan with Different Molecular Weights Can Affect the Gut Microbiota and Pathogenetic Progression of Post-Intensive Care Syndrome Mice in Different Ways.

Post-intensive care syndrome (PICS) poses a serious threat to the health of intensive care unit (ICU) survivors, and effective treatment options are currently lacking. With increasing survival rates of ICU patients worldwide, there is a rising interest in developing methods to alleviate PICS symptoms. This study aimed to explore the potential of using Hyaluronan (HA) with different molecular weights as potential drugs for treating PICS in mice. Cecal ligation and puncture (CLP) were used to establish a PICS mice model, and high molecular weight HA (HMW-HA) or oligo-HA were used as therapeutic agents. Pathological and physiological changes of PICS mice in each group were monitored. 16S rRNA sequencing was performed to dissect gut microbiota discrepancies. The results showed that both molecular weights of HA could increase the survival rate of PICS mice at the experimental endpoint. Specifically, 1600 kDa-HA can alleviate PICS in a short time. In contrast, 3 kDa-HA treatment decreased PICS model survivability in the early stages of the experiment. Further, via 16S rRNA sequence analysis, we observed the changes in the gut microbiota in PICS mice, thereby impairing intestinal structure and increasing inflammation. Additionally, both types of HA can reverse this change. Moreover, compared to 1600 kDa-HA, 3 kDa-HA can significantly elevate the proportion of probiotics and reduce the abundance of pathogenic bacteria (Desulfovibrionaceae and Enterobacteriaceae). In conclusion, HA holds the advantage of being a potential therapeutic drug for PICS, but different molecular weights can lead to varying effects. Moreover, 1600 kDa-HA showed promise as a protective agent in PICS mice, and caution should be taken to its timing when considering using 3 kDa-HA.

Long-term consequences in Covid-19 and Non-Covid-19 patients survivors of critical illness. A descriptive study.

Background: Critically ill patients may develop health problems related to their illness, injury, mechanical ventilation or other treatments. Such problems cannot be totally prevented and can continue after the patient leaves the hospital. Aim: To explore the level of anxiety, depression, post-traumatic stress Intensive Care Unit and quality of life in Intensive Care Unit survivors. A comparison analysis between Covid-19 patients and Non-Covid-19 patients was conducted. Methods: A prospective observational study exploring psychological, emotional, and behavioral difficulties experienced in patients admitted to Intensive Care Unit was performed. The study was conducted in an Italian adult 8-bed Intensive Care Unit, from July 2020 to April 2021, and followed-up until 25th May 2022. Data were collected during Intensive Care Unit stay (data collection of demographic and clinical characteristics) and 6 and 12 months after Intensive Care Unit discharge (interviews). Results: A total of 143 patients participated in the study, of which 54 were admitted for Covid-19 (37.76%). Depression symptoms were observed more among Non-Covid-19 patients compared to Covid-19 patients at six months (p= .037) and 12 months (p< .001) after Intensive Care Unit discharge. The quality of life perceived by the Intensive Care Unit patients surveyed improved between 6 and 12 months after discharge (Eq-VAS mean=62.03, + 11.2 vs Eq-VAS mean=66.6, + 9.8) (p=.034). Six months after Intensive Care Unit discharge, the mean of the perception of quality of life, for Covid-19 patients was 63.91 (sd ± 9.30), greater than Non-Covid-19 patients of the same period, which was 60.18 (sd ± 8.63) (p= .038). Conclusions: Within 1 year from the acute infection, most hospital survivors of Covid-19 had good physical and functional recovery over time with better outcomes than other Intensive Care Unit patients and had returned to their original work and life.

Objective and subjective cognition in survivors of COVID-19 one year after ICU discharge: the role of demographic, clinical, and emotional factors.

BACKGROUND: Intensive Care Unit (ICU) COVID-19 survivors may present long-term cognitive and emotional difficulties after hospital discharge. This study aims to characterize the neuropsychological dysfunction of COVID-19 survivors 12 months after ICU discharge, and to study whether the use of a measure of perceived cognitive deficit allows the detection of objective cognitive impairment. We also explore the relationship between demographic, clinical and emotional factors, and both objective and subjective cognitive deficits. METHODS: Critically ill COVID-19 survivors from two medical ICUs underwent cognitive and emotional assessment one year after discharge. The perception of cognitive deficit and emotional state was screened through self-rated questionnaires (Perceived Deficits Questionnaire, Hospital Anxiety and Depression Scale and Davidson Trauma Scale), and a comprehensive neuropsychological evaluation was carried out. Demographic and clinical data from ICU admission were collected retrospectively. RESULTS: Out of eighty participants included in the final analysis, 31.3% were women, 61.3% received mechanical ventilation and the median age of patients was 60.73 years. Objective cognitive impairment was observed in 30% of COVID-19 survivors. The worst performance was detected in executive functions, processing speed and recognition memory. Almost one in three patients manifested cognitive complaints, and 22.5%, 26.3% and 27.5% reported anxiety, depression and post-traumatic stress disorder (PTSD) symptoms, respectively. No significant differences were found in the perception of cognitive deficit between patients with and without objective cognitive impairment. Gender and PTSD symptomatology were significantly associated with perceived cognitive deficit, and cognitive reserve with objective cognitive impairment. CONCLUSIONS: One-third of COVID-19 survivors suffered objective cognitive impairment with a frontal-subcortical dysfunction 12 months after ICU discharge. Emotional disturbances and perceived cognitive deficits were common. Female gender and PTSD symptoms emerged as predictive factors for perceiving worse cognitive performance. Cognitive reserve emerged as a protective factor for objective cognitive functioning. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04422444; June 9, 2021.

Long-Term Evolution of Activities of Daily Life (ADLs) in Critically Ill COVID-19 Patients, a Case Series.

BACKGROUND: The most common long-term symptoms of critically ill COVID-19 patients are fatigue, dyspnea and mental confusion. Adequate monitoring of long-term morbidity, mainly analyzing the activities of daily life (ADLs), allows better patient management after hospital discharge. The aim was to report long-term ADL evolution in critically ill COVID-19 patients admitted to a COVID-19 center in Lugano (Switzerland). METHODS: A retrospective analysis on consecutive patients discharged alive from ICU with COVID-19 ARDS was performed based on a follow-up one year after hospital discharge; ADLs were assessed through the Barthel index (BI) and the Karnofsky Performance Status (KPS) scale. The primary objective was to assess differences in ADLs at hospital discharge (acute ADLs) and one-year follow-up (chronic ADLs). The secondary objective was to explore any correlations between ADLs and multiple measures at admission and during the ICU stay. RESULTS: A total of 38 consecutive patients were admitted to the ICU; a t-test analysis between acute and chronic ADLs through BI showed a significant improvement at one year post discharge (t = -5.211, p < 0.0001); similarly, every single task of BI showed the same results (p < 0.0001 for each task of BI). The mean KPS was 86.47 (SD 20.9) at hospital discharge and 99.6 at 1 year post discharge (p = 0.02). Thirteen (34%) patients deceased during the first 28 days in the ICU; no patient died after hospital discharge. CONCLUSIONS: Based on BI and KPS, patients reached complete functional recovery of ADLs one year after critical COVID-19.

The future of intensive care: delirium should no longer be an issue.

In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A-F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a 'home-like' (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.

Contributions to Critical Care from Psychological Science and Practice

In this chapter we highlight findings and practices from Psychology that can be applied to mitigate the impact of critical illness and the ICU environment on patients, families and staff. The substantial accumulating evidence for detrimental health effects of traumatic stress is highly relevant for the care of patients on the ICU, who are potentially traumatized by the experience and who may bring a history of trauma with them. The fields of trauma psychology and rehabilitation psychology share foundational principles to guide patient-centered and systemic changes to ICU care, and these principles guided our selection and presentation of material. Our discussion of how to implement these principles within a healthcare system is informed by selected findings from social, organizational and behavioral psychology, which also are summarized. © Oxford University Press 2022. All rights reserved.

COVID-19 in the perioperative setting: A review of the literature and the clinical landscape.

The COVID-19 pandemic has dramatically affected societies and healthcare systems around the globe. The perioperative care continuum has also been under significant strain due to the pandemic-tasked with simultaneously addressing surgical strains and backlogs, infection prevention strategies, and emerging data regarding significantly higher perioperative risk for COVID-19 patients and survivors. Many uncertainties persist regarding the perioperative risk, assessment, and management of COVID-19 survivors-and the energy to catch up on surgical backlogs must be tempered with strategies to continue to mitigate COVID-19 related perioperative risk. Here, we review the available data for COVID-19-related perioperative risk, discuss areas of persistent uncertainty, and empower the perioperative teams to pursue evidence-based strategies for high quality, patient-centered, team-based care as we enter the third year of the COVID-19 pandemic.

Le syndrome post-réanimation (SPR) et les programmes de réhabilitation post-réanimation

Résumé En 2021, l’enjeu d’une hospitalisation en réanimation n’est plus seulement la survie à la phase aiguë, mais d’obtenir une récupération des patients avec un minimum de séquelles. Le syndrome post-réanimation (SPR) touche environ 50–70 % des patients à leur sortie de réanimation. Cette entité comprend à distance de l’hospitalisation des troubles psychologiques, une altération des capacités neuromusculaires, des troubles cognitifs et des dysfonctions d’organes, altérant de la qualité de vie des patients et de leurs familles. La période COVID a accru considérablement le nombre de patients qui pourraient développer un PICS, et souligne à nouveau l’urgence de dépister ces patients, afin de prévenir et de limiter d’éventuelles séquelles de la réanimation. Le suivi systématique des patients après la réanimation est différent selon les pays, mais reste peu développé. L’intérêt et les modalités de réalisation de ce suivi sont débattus. Les objectifs sont : le dépistage précoce du PICS et l’orientation des patients dans une filière spécialisée. Le médecin anesthésiste-réanimateur doit être au cœur de la filière post-réanimation, afin de sélectionner les patients et de coordonner les acteurs du suivi. In 2021, the issue of intensive care hospitalization is no longer just survival in the acute phase, but also reducing the post-intensive care consequences. Post-intensive care syndrome (PICS) affects approximately 50–70% of patients upon discharge from intensive care. This entity includes psychological disorders, impaired neuromuscular capacities, cognitive disorders and organ dysfunctions that may persist for months or years impairing the quality of life of the patients and their families. The current COVID-19 crisis has incredibly increased the number of patients who could develop PICS, and support the urgent need for screening these patients, in order to prevent possible sequelae of intensive care. There are different types of “post-intensive care” follow-up, even their interest is debated. However, early detection of PICS is important to address the patients to supportive program of care. The intensive care physicians really need to identify PICS in their patients and coordinate their management distant from the ICU hospitalisation.

Relation between nutrition therapy in the acute phase and outcomes of ventilated patients with COVID-19 infection: a multicenter prospective observational study.

BACKGROUND: Optimal nutrition therapy has not yet been established for the acute phase of severe coronavirus disease 2019 (COVID-19) infection. OBJECTIVES: We aimed to examine the effects of nutrition delivery in the acute phase on mortality and the long-term outcomes of post-intensive care syndrome (PICS). METHODS: A multicenter prospective study was conducted on adult patients with COVID-19 infection requiring mechanical ventilation during an intensive care unit (ICU) stay. Daily total energy (kcal/kg) and protein (g/kg) deliveries in the first week of the ICU stay were calculated. The questionnaire for PICS evaluation was mailed within a median of 6 mo after hospital discharge. The primary outcome was in-hospital mortality, and secondary outcomes were the PICS components of physical impairment, cognitive dysfunction, and mental illness. RESULTS: Among 414 eligible patients, 297 who received mechanical ventilation for 7 d or longer were examined. PICS was evaluated in 175 patients among them. High protein delivery on days 4-7 correlated with a low in-hospital mortality rate. In contrast, high protein delivery on days 1-3 correlated with physical impairment. A multivariate logistic regression analysis adjusted for age, sex, BMI, and severity revealed that average energy and protein deliveries on days 4-7 correlated with decreased in-hospital mortality (OR: 0.94; 95% CI: 0.89, 0.99; P = 0.013 and OR: 0.40; 95% CI: 0.17, 0.93; P = 0.031, respectively). Nutrition delivery did not correlate with PICS outcomes after adjustments. In the multivariate regression using a restricted cubic spline model, in-hospital mortality monotonically decreased with increases in average nutrition delivery on days 4-7. CONCLUSIONS: In patents with COVID-19 on mechanical ventilation for ≥7 d, nutrition delivery in the late period of the acute phase was monotonically associated with a decrease in in-hospital mortality. Adequate protein delivery is needed on days 4-7.This trial was registered at https://www.umin.ac.jp as UMIN000041276.

A Decade of Post-Intensive Care Syndrome: A Bibliometric Network Analysis.

Background and Objectives: In 2012, the umbrella term post-intensive care syndrome (PICS) was introduced to capture functional long-term impairments of survivors of critical illness. We present a bibliometric network analysis of the PICS research field. Materials and Methods: The Web of Science core database was searched for articles published in 2012 or later using 'post-intensive care syndrome' and variant spellings. Using VOSviewer, we computed co-authorship networks of countries, institutions, and authors, as well as keyword co-occurrence networks. We determined each country's relative research effort and Category Normalized Citation Index over time and analyzed the 100 most-cited articles with respect to article type, country of origin, and publishing journal. Results: Our search yielded 379 articles, of which 373 were analyzed. Annual PICS research output increased from 11 (2012) to 95 articles (2020). Most PICS research originates from the US, followed by England, Australia, the Netherlands, and Germany. We found various collaborations between countries, institutions, and authors, with recent collaborative networks of English and Australian institutions. Article keywords cover aspects of cognitive, mental health, and physical impairments, and more recently, COVID-19. Only a few keywords and articles pertained to PICS prevention and treatment. Conclusions: Our analysis of Web of Science-indexed PICS articles highlights the stark increase in PICS research output in recent years, primarily originating from US- and Europe-based authors and institutions. Despite the research field's growth, knowledge gaps with respect to PICS prevention and treatment remain.

Neuropsychological functioning in post-ICU patients after severe COVID-19 infection: The role of cognitive reserve.

BACKGROUND: Cognitive manifestations associated with Severe Acute Respiratory Syndrome by Coronavirus 2 (SARS-CoV-2) are yet to be described in the existing literature. The aim of this exploratory study is to analyze the impact of severe SARS-CoV-2 infection on neuropsychological performance 6 months following hospital discharge, and to identify which medical variables predict worse outcome. In this context, we study if cognitive reserve (CR) may play a protective role on cognitive impairment. METHODS: We enrolled a cohort of 102 severe SARS-CoV-2 survivors who had been admitted to the Intensive Care Unit (ICU) and were contacted 6-months post discharge. A total of 58 agreed to participate in this 6-month follow-up study. Patients with previously known cognitive impairment were excluded. Demographic, clinical and laboratory data were collected. Firstly, to test the magnitude of neurocognitive sequalae two standard deviations below normative group were considered. Secondly, to analyze the main effects of medical variables on cognition and the interaction with cognitive reserve, ANCOVA analyses were performed. RESULTS: 53.4% obtained a score below the cutoff point (<26) in the screening test MOCA. ICU variables including mechanical ventilation, days of sedation or high CRP days were related with cognition. Cognitive Reserve (CR) interacted with delirium (F â€‹= â€‹6.8, p â€‹= â€‹0.01) and sedation days (F â€‹= â€‹9.40, p â€‹= â€‹0.003) to predict verbal memory and interacted with high CRP to predict phonemic fluency (F â€‹= â€‹6.47, p â€‹= â€‹0.01). Finally, no differences in neuropsychological performance were found depending on subjective cognitive impairment (SCI). However, patients with SCI had a higher score in the HAD anxiety subscale (t â€‹= â€‹-2.2; p â€‹< â€‹0.05). CONCLUSIONS: In our cohort, cognitive dysfunction was related with ICU variables such as delirium, mechanical ventilation, and inflammation. CR modulated the impact of these variables on cognition. Cognitive complaints were related with anxiety but not with cognitive performance. Despite some limitations, including the need of replication of the findings with larger samples and control groups, our study suggests that high CR may be protective for severe COVID-19-related cognitive impairment.

[COVID-19-New challenges in dysphagia and respiratory therapy]. / COVID-19 ­ neue Herausforderungen in der Dysphagie- und Atemtherapie.

Coronavirus disease 2019 (COVID-19) can lead to severe disease courses with multiple organ involvement, respiratory and neurological functional impairments. Swallowing disorders (dysphagia) in this patient group can result from primary damage to the central and peripheral neuronal swallowing network but also from the frequently prolonged intensive care treatment and mechanical ventilation. Clinical observations indicate persistence of dysphagia in post-acute COVID-19 syndrome (long COVID), so that these patients probably also need long-term interventions for rehabilitation of safe and sufficient oral feeding. Therefore, structured disease-specific monitoring of dysphagia symptoms should be integrated into the treatment of COVID-19 patients and respiratory therapy should be an essential part of dysphagia management to re-establish cough effectiveness and breathing-swallowing coordination. Challenges arise from necessary adjustments to established treatment standards to prevent infections. Furthermore, the selection and intensity of therapeutic measures have to be adapted to the capacities and the specific pathophysiology of COVID-19 and long COVID patients to prevent further functional deterioration.

Respiratory Therapists in an ICU Recovery Clinic: Two Institutional Experiences and Review of the Literature.

Post-intensive care syndrome is an increasingly recognized complication of critical illness, with patients reporting new problems in physical, mental health and/or psychosocial, and cognitive function for months to years after their acute illness. As a way of diagnosing and treating post-intensive care syndrome, many centers around the world have established ICU recovery clinics, which take a multidisciplinary approach to care after the ICU. Dyspnea and pulmonary dysfunction are frequently encountered concerns in the post-ICU population. Despite this, few ICU recovery clinics have described how respiratory therapists (RTs) can contribute to treating these symptoms. We reviewed the literature with regard to the roles of an RT in post-ICU follow-up, described our institutional experiences with having RTs as part of our ICU recovery clinics, and identified additional ways that RTs might contribute to a post-intensive care syndrome diagnosis and treatment. Although RTs can provide invaluable experience and contributions to an ICU recovery clinic, there are few articles in the published literature on the ways in which this can be accomplished. We, therefore, provide analogies to other multidisciplinary clinic models as well as our own experiences. Future studies should focus on examining the impact of respiratory therapy diagnostic testing and interventions in the ICU recovery clinic on both patient and provider outcomes.

Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies.

INTRODUCTION: Post-intensive care syndrome (PICS) has only recently been recognized as a new clinical entity in patients surviving their intensive care unit (ICU) stay due to critical illness. With increasing survival rates of ICU patients worldwide, there is a rising interest regarding post-ICU recovery. AREAS COVERED: First, based on the current literature a definition is provided of PICS, including the domains of impairments that comprise PICS along with the etiology and risk factors. Second, preventive measures and possible treatment strategies integrated in the follow-up care are described. Third, the authors will discuss the current SARS-Cov-2 pandemic and the increased risk of PICS in these post-ICU patients and their families. EXPERT OPINION: PICS is a relatively new entity, which not only encompasses various physical, cognitive, and psychological impairments but also impacts global health due to long-lasting detrimental socioeconomic burdens. Importantly, PICS also relates to caregivers of post-ICU patients. Strategies to reduce this burden will not only be needed within the ICU setting but will also have to take place in an interdisciplinary, multifaceted approach in primary care settings. Additionally, the SARS-Cov-2 pandemic has a high burden on post-ICU patients and their relatives.

Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives.

Intensive care unit survivors experience prolonged physical impairments, cognitive impairments, and mental health problems, commonly referred to as post-intensive care syndrome (PICS). Previous studies reported the prevalence, assessment, and prevention of PICS, including the ABCDEF bundle approach. Although the management of PICS has been advanced, the outbreak of coronavirus disease 2019 (COVID-19) posed an additional challenge to PICS. The prevalence of PICS after COVID-19 extensively varied with 28-87% of cases pertaining to physical impairments, 20-57% pertaining to cognitive impairments, and 6-60% pertaining to mental health problems after 1-6 months after discharge. Each component of the ABCDEF bundle is not sufficiently provided from 16% to 52% owing to the highly transmissible nature of the virus. However, new data are emerging about analgesia, sedation, delirium care, nursing care, early mobilization, nutrition, and family support. In this review, we summarize the recent data on PICS and its new challenge in PICS after COVID-19 infection.

Six-Month Outcomes in COVID-19 ICU Patients and Their Family Members: A Prospective Cohort Study.

BACKGROUND: The COVID-19 pandemic has resulted in a major influx of intensive care unit (ICU) admissions. Currently, there is limited knowledge on the long-term outcomes of COVID-19 ICU-survivors and the impact on family members. This study aimed to gain an insight into the long-term physical, social and psychological functioning of COVID-19 ICU-survivors and their family members at three- and six-months following ICU discharge. METHODS: A single-center, prospective cohort study was conducted among COVID-19 ICU-survivors and their family members. Participants received questionnaires at three and six months after ICU discharge. Physical functioning was evaluated using the MOS Short-Form General Health Survey, Clinical Frailty Scale and spirometry tests. Social functioning was determined using the McMaster Family Assessment Device and return to work. Psychological functioning was assessed using the Hospital Anxiety and Depression Scale. RESULTS: Sixty COVID-19 ICU-survivors and 78 family members participated in this study. Physical functioning was impaired in ICU-survivors as reflected by a score of 33.3 (IQR 16.7-66.7) and 50 (IQR 16.7-83.3) out of 100 at 3- and 6-month follow-ups, respectively. Ninety percent of ICU-survivors reported persistent symptoms after 6 months. Social functioning was impaired since 90% of COVID-19 ICU-survivors had not reached their pre-ICU work level 6 months after ICU-discharge. Psychological functioning was unaffected in COVID-19 ICU-survivors. Family members experienced worse work status in 35% and 34% of cases, including a decrease in work rate among 18.3% and 7.4% of cases at 3- and 6-months post ICU-discharge, respectively. Psychologically, 63% of family members reported ongoing impaired well-being due to the COVID-19-related mandatory physical distance from their relatives. CONCLUSION: COVID-19 ICU-survivors suffer from a prolonged disease burden, which is prominent in physical and social functioning, work status and persisting symptoms among 90% of patients. Family members reported a reduction in return to work and impaired well-being. Further research is needed to extend the follow-up period and study the effects of standardized rehabilitation in COVID-19 patients and their family members.

Pelvic Floor Considerations in COVID-19.

BACKGROUND: Much of the research and clinical commentary on COVID-19 have been focused on respiratory function. Pelvic floor therapists understand that both respiratory dysfunction and hospitalization can have an impact on pelvic floor function. This clinical commentary provides context as to how the long-term effects of COVID-19 could affect the pelvic floor as well as some generalized treatment considerations. DISCUSSION: The respiratory diaphragm has an impact on the ability of the pelvic floor to contract and relax in a manner that will allow for both continence and elimination. COVID-19 survivors often have disability in this muscle of respiration that can lead to implications for both overactive and underactive pelvic floor. Commonly, this population is hospitalized for long periods of time, which can have long-term consequences on both bladder and bowel functioning including, but not limited to, incontinence, urinary retention, and constipation. Pelvic floor therapists must be prepared to adjust both their evaluation and treatment methods in consideration of this novel treatment population. CONCLUSIONS: Because of the pervasive nature of this virus, pelvic floor physical therapists should be a part of the rehabilitation team treating these patients once they have become medically stable.Video abstract with sound available at http://links.lww.com/JWHPT/A36.

COVID-19 Patient Returned to Work after Long Hospitalization and Follow-up: A Case Report.

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes severe respiratory dysfunction and post-intensive care syndrome (PICS), which can significantly affect the return to work after discharge from the hospital. This report describes the first case of a patient with severe COVID-19 at our institution during the first wave of the COVID-19 pandemic (February to June 2020) who returned to work following rehabilitation management. CASE: A 48-year-old female nurse was admitted with COVID-19 and underwent mechanical ventilation (MV). Respiratory and anti-gravity training was conducted as physical therapy; however, the patient developed PICS, muscle weakness, delirium, and psychological problems. After the withdrawal of MV, muscle strengthening activities, activities of daily living (ADL) training, family visits, and occupational and speech therapy were started. On day 60 post-admission, the patient was able to perform ADL independently and was discharged; however, she continued to experience shortness of breath during exertion. Post-discharge, follow-up assessments for symptoms, respiratory function, and exercise capacity were continued. On day 130, she returned to work as a nurse. DISCUSSION: The PICS noted during hospitalization in this patient improved, but at discharge, the patient had difficulty completing the practical tasks involved in a nurse's workload. Follow-up assessments of symptoms, respiratory function, and exercise capacity after discharge helped to determine whether the patient could return to work.