Mayer Kirby P, Parry Selina M, Kalema Anna G, Joshi Rajan R, Soper Melissa K, Steele Angela K, Lusby Megan L, Dupont-Versteegden Esther E, Montgomery-Yates Ashley A, Morris Peter E
Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY.
Kentucky Research Alliance for Lung Disease, College of Medicine, University of Kentucky, Lexington, KY.
Crit Care Explor. 2021 Aug 19;3(8):e0516. doi: 10.1097/CCE.0000000000000516. eCollection 2021 Aug.
Examine the safety and feasibility of a multimodal in-person or telehealth treatment program, administered in acute recovery phase for patients surviving critical coronavirus disease 2019.
Pragmatic, pre-post, nonrandomized controlled trial with patients electing enrollment into one of the two recovery pathways.
ICU Recovery Clinic in an academic medical center.
Adult patients surviving acute respiratory failure due to critical coronavirus disease 2019.
Patients participated in combined ICU Recovery clinic and 8 weeks of physical rehabilitation delivered: 1) in-person or 2) telehealth. Patients received medical care by an ICU Recovery Clinic interdisciplinary team and physical rehabilitation focused on aerobic, resistance, and respiratory muscle training.
Thirty-two patients enrolled with mean age 57 ± 12, 62% were male, and the median Sequential Organ Failure Assessment score was 9.5. There were no differences between the two groups except patients in telehealth pathway ( = 10) lived further from clinic than face-to-face patients (162 ± 60 vs 31 ± 47 kilometers, = 6.06, < 0.001). Four safety events occurred: one minor adverse event in the telehealth group, two minor adverse events, and one major adverse event in the in-person group. Three patients did not complete the study (two in-person and one telehealth). Six-minute walk distance increased to 101 ± 91 meters from pre to post ( = 29, = 6.93, < 0.0001), which was similar between the two groups (110 vs 80 meters, = 1.34, = 0.19). Self-reported levels of anxiety, depression, and distress were high in both groups with similar self-report quality of life.
A multimodal treatment program combining care from an interdisciplinary team in an ICU Recovery Clinic with physical rehabilitation is safe and feasible in patients surviving the ICU for coronavirus disease 2019 acute respiratory failure.
研究针对2019冠状病毒病重症康复期患者的多模式面对面或远程医疗治疗方案的安全性和可行性。
实用、前后对照、非随机对照试验，患者可选择加入两种康复途径之一。
一家学术医疗中心的重症监护病房康复诊所。
因2019冠状病毒病导致急性呼吸衰竭后存活的成年患者。
患者参加重症监护病房康复诊所联合治疗，并接受为期8周的物理康复治疗，治疗方式为：1）面对面治疗；2）远程医疗。患者接受重症监护病房康复诊所跨学科团队的医疗护理，物理康复治疗侧重于有氧运动、抗阻运动和呼吸肌训练。
32名患者入组，平均年龄57±12岁，62%为男性，序贯器官衰竭评估评分中位数为9.5。两组之间无差异，只是远程医疗组的患者（n = 10）居住地距离诊所比面对面治疗组的患者更远（162±60 vs 31±47公里，t = 6.06，p < 0.001）。发生了4起安全事件：远程医疗组1起轻微不良事件，面对面治疗组2起轻微不良事件和1起严重不良事件。3名患者未完成研究（2名面对面治疗患者和1名远程医疗患者）。6分钟步行距离从治疗前的增加到治疗后的101±91米（n = 29，t = 6.93，p < 0.0001），两组之间相似（110 vs 80米，t = 1.34，p = 0.19）。两组患者自我报告的焦虑、抑郁和痛苦水平都很高，自我报告的生活质量相似。
对于因2019冠状病毒病急性呼吸衰竭入住重症监护病房后存活的患者，将重症监护病房康复诊所跨学科团队的护理与物理康复相结合的多模式治疗方案是安全可行的。
