1. Instituto de Investigación Biomedica de Malaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Malaga, Spain
2. Intensive Medicine Service, Hospital Universitario Virgen de la Victoria, Malaga, Spain
3. Physical Medicine and Rehabilitation Service, Hospital Clínico Universitario Virgen de la Victoria, Malaga, Spain
4. Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
5. Cardiology and Cardiac Surgery Service, Hospital Universitario Virgen de la Victoria, Malaga, Spain
6. Family and Community Medicine Service, Hospital Universitario Virgen de la Victoria, Malaga, Spain
7. Cardiology Service, Hospital Universitario Virgen de la Victoria, Malaga, Spain
8. Mental Health Service, Hospital Universitario Virgen de la Victoria, Malaga, Spain
9. Pneumology Service, Hospital Universitario Virgen de la Victoria, Malaga, Spain
10. Servicio de Cardiología, Hospital Universitario de Salamanca, Universidad de Salamanca, IBSAL, Salamanca, Spain
Background: Short and long-term sequelae after admission to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) are to be expected, which makes multidisciplinary care key in the support of physical and cognitive recovery.
Objective: To describe, from a multidisciplinary perspective, the sequelae one month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia.
Design: Prospective cohort study.
Environment: Multidisciplinary outpatient clinic.
Population: Patients with severe COVID-19 pneumonia, post- ICU admission.
Methods: A total of 104 patients completed the study in the multidisciplinary outpatient clinic. The tests performed included spirometry, measurement of respiratory muscle pressure, loss of body cell mass (BCM) and BCM index (BCMI), general joint and muscular mobility, the short physical performance battery (SPPB or Guralnik test), grip strength with hand dynamometer, the six-minute walk test (6-MWT), the functional assessment of chronic illness therapy-fatigue scale (FACIT-F), the European quality of life-5 dimensions (EQ-5D), the Barthel index and the Montreal cognitive assessment test (MoCA). While rehabilitation was not necessary for 23 patients, 38 patients attended group rehabilitation sessions and other 43 patients received home rehabilitation.
Endpoints: The main sequelae detected in patients were fatigue (75.96%), dyspnoea (64.42%) and oxygen therapy on discharge (37.5%). The MoCA showed a mean score compatible with mild cognitive decline. The main impairment of joint mobility was limited shoulder (11.54%) and shoulder girdle (2.88%) mobility; whereas for muscle mobility, lower limb limitations (16.35%) were the main dysfunction. Distal neuropathy was present in 23.08% of patients, most frequently located in lower limbs (15.38%). Finally, 50% of patients reported moderate limitation in the EQ-5D, with a mean score of 60.62 points (SD 20.15) in perceived quality of life.
Conclusions: Our findings support the need for a multidisciplinary and comprehensive evaluation of patients after ICU admission for COVID-19 because of the wide range of sequelae, which also mean that these patients need a long-term follow-up.
Impact on clinical rehabilitation: This study provides data supporting the key role of rehabilitation during the follow-up of severe patients, thus facilitating their reintegration in society and a suitable adaptation to daily living.
Keywords: COVID-19, respiratory failure, sequela, multidisciplinary