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

• Published in: Heart & lung Vol. 60; pp. 139 - 145
• Main Authors: Yamada, Kanji, Kitai, Takeshi, Iwata, Kentaro, Nishihara, Hiromasa, Ito, Tsubasa, Yokoyama, Rina, Inagaki, Yuta, Shimogai, Takayuki, Honda, Akihiro, Takahashi, Tetsuya, Tachikawa, Ryo, Shirakawa, Chigusa, Ito, Jiro, Seo, Ryutaro, Kuroda, Hirokazu, Doi, Asako, Tomii, Keisuke, Kohara, Nobuo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2023
• Subjects: Aged; Coronavirus disease 2019; COVID-19 - epidemiology; Functional decline; Humans; Intensive care unit; Intensive Care Units; Male; Muscle weakness; Muscle Weakness - epidemiology; Muscle Weakness - etiology; Prospective Studies; Rehabilitation; Respiration, Artificial; Respiratory distress syndrome; ICU-AW; Coronavirus disease 2019; VAP; Functional decline; CCI; APACHE II; PICS; Intensive care unit; CRRT; IMS; COVID-19; CFS; SOFA; Muscle weakness; HFNC; IMV; Respiratory distress syndrome; ADLs; ICU; NMBAs; Rehabilitation; ARDS; MRC
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2023.03.008

•Approximately half of the COVID-19 patients developed ICU-AW.•Older age, NMBAs, pulse steroid therapy, and sepsis were associated with ICU-AW.•ICU-AW delayed functional independence during hospitalization. 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. This study aimed to examine the causes of ICU-AW and functional outcomes in critically ill patients with COVID-19 who required IMV. 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. 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). Approximately half of the patients with COVID-19 requiring IMV developed ICU-AW, which was associated with delayed functional independence during hospitalization.