ABSTRACT
OBJECTIVE: To investigate the changes in activities of daily living (ADLs) and the conditions of rehabilitation for acute COVID-19 patients in Japan. DESIGN: Retrospective, observational survey. SETTING: Four tertiary hospitals with intensive care units and one secondary hospital in Japan. PARTICIPANTS: COVID-19 patients (N=478) admitted to 5 hospitals INTERVENTIONS: : Not applicable. MAIN OUTCOME MEASURES: Walking ability and swallowing status were assessed using the FIM locomotion item and Food Intake Scale at admission and discharge. The physiatrists of each hospital were also surveyed regarding the factors that influenced decisions to provide rehabilitation. RESULTS: Excluding patients who died, the proportion of critical patients who could walk independently at discharge was 63%, and the proportion of those who were able to take 3 meals orally at discharge was 90%. Rehabilitation was provided to 13.4% of all patients and to 58.3% of patients with critical symptoms. CONCLUSIONS: After COVID-19 treatment, patients, especially those with critical symptoms, still have functional disabilities related to walking and swallowing. It is possible that sufficient rehabilitation could not be provided during the period studied.
Subject(s)
Activities of Daily Living , COVID-19 Drug Treatment , Humans , Japan , Recovery of Function , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Post-extubation dysphagia reportedly occurs in 3%-60% of patients and is independently associated with poor patient outcomes. AIM: The aim of this study was to investigate the frequency of post-extubation dysphagia, as diagnosed using our novel nurse-performed swallowing screening protocol, and to evaluate patient outcomes, including the frequency of discharge home, the length of the intensive care unit and hospital stays, the frequency of hospital-acquired pneumonia and death in the intensive care unit and hospital. DESIGN: This was a prospective cohort study. METHODS: This study was conducted in a mixed intensive care unit in a critical care hospital in Japan. Between October 2016 and September 2017, the swallowing functions of 216 patients were assessed using our novel screening protocol. To investigate the correlation between dysphagia and patient outcomes, we compared a dysphagia group with a no dysphagia group. RESULTS: Twenty-five patients (11·6%) were diagnosed with dysphagia. The frequency of discharge home, which was the primary outcome, was significantly lower in the patients with dysphagia (60% versus 87·4%, P = 0·002). Dysphagia was also correlated with longer hospital stay and higher mortality. A binomial logistic regression analysis, including the variables of dysphagia, Acute Physiology and Chronic Health Evaluation II score and duration of ventilator use, showed that dysphagia was an independent risk factor for a lower incidence of discharge home. CONCLUSION: Among patients admitted to a mixed intensive care unit, post-extubation dysphagia was correlated with a poor prognosis. RELEVANCE TO CLINICAL PRACTICE: The current study emphasizes the poor prognosis of patients with dysphagia after extubation. Dysphagia developed in more than 1 in 10 patients post-extubation; therefore, monitoring for a swallowing disorder is crucial in daily nursing in the intensive care unit.
