ICU Physiotherapy Did Not Prevent Prolonged Weakness Among COVID ICU Survivors

A recent addition to this knowledge comes from the work of Clément Medrinal (France Institute for Research and Innovation in Biomedicine) and colleagues.1 They found that while muscle weakness was high and persistent among COVID patients discharged from the intensive care unit (ICU), the amount of physiotherapy received in the ICU was not associated with muscle strength. Severe functional limitations persisted among discharged patients, prompting the researchers to call for patient monitoring and anticipation of the need for rehabilitation after the ICU. Researchers studied 23 patients from two hospitals.

At the time of extubation, 69% had limb muscle weakness and nearly a quarter of those patients additionally had respiratory muscle weakness. The prevalence of weakness was higher than previously reported for other diagnoses.2 A meta-analysis published in the European Respiratory Journal in 2020 evaluated muscle weakness among patients undergoing mechanical ventilation. Their analysis included all reported causes. COVID was not among them at the time. Muscle weakness occurred in 50% of those patients. In the current study, researchers also telephoned the COVID patients 30 days after extubation.

Forty-four percent of patients with limb weakness were still unable to walk 100m. This prolonged and severe functional limitation persisted despite the fact that all patients received physiotherapy in the ICU during mechanical ventilation. Researchers found that the amount of physiotherapy in the ICU was not associated with muscle strength. The findings of the current study are congruent with three other studies following patients hospitalised for COVID-19 with varying degrees of severity.3-5

This is true in that the current study found persistent functional limitations after patients returned to the community and that limb muscle weakness was the greatest cause. Researchers state that the prevalence of physical deconditioning underscores the importance of outpatient physiotherapy for COVID-19 survivors.3 At Advanced Physiotherapy, patients can receive supervised and/or independent programs to restore conditioning following an injury or illness. These programs are complimented by access to titled physiotherapists, exercise physiology, and to Advanced’s patient-only gym.  

References

1. Medrinal C, Prieur G, Bonnevie T, Gravier FE, Mayard D, Desmalles E, Smondack P, Lamia B, Combret Y, Fossat G. Muscle weakness, functional capacities and recovery for COVID-19 ICU survivors. BMC Anesthesiology. 2021 Dec;21(1):1-5.

2. Medrinal C, Combret Y, Hilfiker R, Prieur G, Aroichane N, Gravier FE, Bonnevie T, Contal O, Lamia B. ICU outcomes can be predicted by noninvasive muscle evaluation: a meta-analysis. European Respiratory Journal. 2020 Oct 1;56(4).

3. Jahn K, Sava M, Sommer G, Schumann DM, Bassetti S, Siegemund M, Battegay M, Stolz D, Tamm M, Khanna N, Hostettler KE. Exercise capacity impairment after COVID-19 pneumonia is mainly caused by deconditioning. European Respiratory Journal. 2022 Jan 1;59(1).

4. Rinaldo RF, Mondoni M, Parazzini EM, Pitari F, Brambilla E, Luraschi S, Balbi M, Papa GF, Sotgiu G, Guazzi M, Di Marco F. Deconditioning as main mechanism of impaired exercise response in COVID-19 survivors. European Respiratory Journal. 2021 Jan 1.

5. Skjørten I, Ankerstjerne OA, Trebinjac D, Brønstad E, Rasch-Halvorsen Ø, Einvik G, Lerum TV, Stavem K, Edvardsen A, Ingul CB. Cardiopulmonary exercise capacity and limitations 3 months after COVID-19 hospitalisation. European Respiratory Journal. 2021 Aug 1;58(2)