Rehab on the edge: The heamodynamic response to the initial active mobilisation in critically ill adults with COVID-19

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.