Predictive factors and clinical impact of ICU-acquired weakness on functional disability in mechanically ventilated patients with COVID-19

Kanji Yamada; Takeshi Kitai; Kentaro Iwata; Hiromasa Nishihara; Tsubasa Ito; Rina Yokoyama; Yuta Inagaki; Takayuki Shimogai; Akihiro Honda; Tetsuya Takahashi; Ryo Tachikawa; Chigusa Shirakawa; Jiro Ito; Ryutaro Seo; Hirokazu Kuroda; Asako Doi; Keisuke Tomii; Nobuo Kohara

doi:10.1016/j.hrtlng.2023.03.008

Predictive factors and clinical impact of ICU-acquired weakness on functional disability in mechanically ventilated patients with COVID-19

Heart Lung. 2023 Jul-Aug:60:139-145. doi: 10.1016/j.hrtlng.2023.03.008. Epub 2023 Mar 24.

Authors

Kanji Yamada¹, Takeshi Kitai², Kentaro Iwata¹, Hiromasa Nishihara³, Tsubasa Ito³, Rina Yokoyama³, Yuta Inagaki³, Takayuki Shimogai³, Akihiro Honda³, Tetsuya Takahashi⁴, Ryo Tachikawa⁵, Chigusa Shirakawa⁵, Jiro Ito⁶, Ryutaro Seo⁷, Hirokazu Kuroda⁸, Asako Doi⁸, Keisuke Tomii⁵, Nobuo Kohara³

Affiliations

¹ Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.
² Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: t-kitai@kcho.jp.
³ Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan.
⁴ Department of Physical Therapy, Juntendo University, Tokyo, Japan.
⁵ Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
⁶ Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Japan.
⁷ Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
⁸ Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Japan.

Abstract

Background: Patients with critical COVID-19 often require invasive mechanical ventilation (IMV) and admission to the intensive care unit (ICU), resulting in a higher incidence of ICU-acquired weakness (ICU-AW) and functional decline.

Objective: This study aimed to examine the causes of ICU-AW and functional outcomes in critically ill patients with COVID-19 who required IMV.

Methods: This prospective, single-center, observational study included COVID-19 patients who required IMV for ≥48 h in the ICU between July 2020 and July 2021. ICU-AW was defined as a Medical Research Council sum score <48 points. The primary outcome was functional independence during hospitalization, defined as an ICU mobility score ≥9 points.

Results: A total of 157 patients (age: 68 [59-73] years, men: 72.6%) were divided into two groups (ICU-AW group; n = 80 versus non-ICU-AW; n = 77). Older age (adjusted odds ratio [95% confidence interval]: 1.05 [1.01-1.11], p = 0.036), administration of neuromuscular blocking agents (7.79 [2.87-23.3], p < 0.001), pulse steroid therapy (3.78 [1.49-10.1], p = 0.006), and sepsis (7.79 [2.87-24.0], p < 0.001) were significantly associated with ICU-AW development. In addition, patients with ICU-AW had significantly longer time to functional independence than those without ICU-AW (41 [30-54] vs 19 [17-23] days, p < 0.001). The development of ICU-AW was associated with delayed time to functional independence (adjusted hazard ratio: 6.08; 95% CI: 3.05-12.1; p < 0.001).

Conclusions: Approximately half of the patients with COVID-19 requiring IMV developed ICU-AW, which was associated with delayed functional independence during hospitalization.

Keywords: Coronavirus disease 2019; Functional decline; Intensive care unit; Muscle weakness; Rehabilitation; Respiratory distress syndrome.

Publication types

Observational Study

MeSH terms

Aged
COVID-19* / epidemiology
Humans
Intensive Care Units
Male
Muscle Weakness / epidemiology
Muscle Weakness / etiology
Prospective Studies
Respiration, Artificial*