Exploring the evolving picture of physical outcomes for patients admitted to ICU with COVID-19: A single centre observational study from a London teaching Trust

ABSTRACT

Introduction: Prolonged Intensive Care Unit (ICU) admission is frequently accompanied by ICU acquired weakness, impaired mobility and reduced health related quality of life.1,2,3 The COVID-19 pandemic caused a sudden and unprecedented surge in ICU admissions for severe acute respiratory failure in the UK in two distinct waves between March-April 2020 and Jan-Feb 2021. Whilst knowledge surrounding medical management of COVID-19 evolved throughout the pandemic, the impact of this on physical recovery and outcomes is less clear. Objective: To explore the impact of ICU admission on physical function in COVID-19 survivors across two distinct UK waves. Methods: A retrospective clinical review of patients admitted to ICU with a primary diagnosis of COVID-19 between March-April 2020 and January-February 2021 was conducted at a large London NHS Foundation Trust. Electronic clinical notes were reviewed, and the following data extracted age, ethnicity, sex, BMI, duration of sedation, duration of mechanical ventilation, ICU length of stay (LOS) and hospital LOS. Physical impairment was based on the Intensive Care Unit Mobility Score (ICUMS) and defined as significant (≤3), moderate (≤6), mild (≥7) or none (score of 10). Data was analysed using descriptive statistics, reported as absolute numbers, percentages (%) and median (range). Comparisons were made between data sets from each wave to examine whether greater understanding surrounding the management of COVID-19 translated into improved physical outcomes for those surviving ICU admission. Results: 444 clinical notes were identified, 287 were excluded as 149 died, 14 were incidental findings of COVID-19, 115 had missing data due to paper notes or transfers in/ out of the Trust and 9 were duplicate records. 157 patients were included in the final analysis;66 from wave 1 and 91 from wave 2. Baseline patient demographics were equally matched across both waves (table 1). Wave 1 patients were sedated longer (13(0-39) v's 11(0-83) days), ventilated longer (25(0-277) vs 13(0-175) days) with longer ICU (27(2-67) vs 17(0-189) days) and hospital LOS (49(5-277) vs 32(4-182) days) than those in wave 2 (Table 1). The median ICUMS at ICU discharge was lower for wave 1 than wave 2 (3 (0-10) V's 4 (0-9)). A higher percentage of patients in wave 1 were discharged from ICU with severe physical impairment compared to Wave 2 (52% vs 40%). Moderate physical impairment was the most frequent presentation category at ICU discharge for wave 2 patients (Table 2). At hospital discharge 66% of patients in wave 1 and 76% in wave 2 had ongoing rehab needs, although the majority of these were mild (ICUMS ≥7) in both cohorts. Conclusions: These preliminary data comparisons between the first two waves of the COVID-19 pandemic suggest evolving knowledge and experience of the condition resulted in reduced sedation duration, ventilation days, ICU and hospital LOS. There were also improved physical outcomes for patients at ICU discharge, but long-term rehabilitation needs persisted. Ongoing exploration of the acute and longer-term needs of individuals surviving ICU admission for COVID-19 is required to inform future rehabilitation provision and health care policy.