Physical Therapy Service, Hospital de Clínicas de Porto Alegre (HCPA), Santa Cecília, Porto Alegre, Rio Grande do Sul, Brazil.
Graduate Program in Human Movement Science (PPGCMH), Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre, Rio Grande do Sul, Brazil.
Phys Ther. 2023 Dec 6;103(12). doi: 10.1093/ptj/pzad117.
The objective of this study was to evaluate the impact of intensive care unit (ICU)-acquired weakness (ICUAW) on the functional independence of patients hospitalized for coronavirus disease 2019 (COVID-19) over 6 months after ICU discharge.
This was a prospective cohort study that included patients who were admitted to the ICU because of COVID-19 and who were monitored for 6 months after discharge from the ICU via telephone. Patients were evaluated at 3 times (30 days, 3 months, and 6 months after discharge from the ICU) for functional independence for personal care and mobility activities (Barthel Scale), independence for self-care (Katz Index), impact of COVID-19 on functional status (post-COVID-19 Functional Status Scale [PCFS]), and mobility level (ICU Mobility Scale). The existence of some degree of dependence was considered when the Barthel Scale score was <100 points, the Katz Index was ≥1, and the PCFS score was ≥1. A PCFS score of ≥3 indicated moderate or severe dependence. Patients with a Medical Research Council score of <48 at discharge from the ICU were diagnosed with ICUAW.
Sixty-eight patients were included, with a mean age of 51 (SD = 13) years. The ICUAW rate at ICU discharge was 35%. In the evaluation with the PCFS, the values for the presence of any functional limitation at 30 days, 3 months, and 6 months after ICU discharge were 89.7%, 57.4%, and 38.2%, respectively. The rate of persistence of functional limitations after 6 months was higher in patients with ICUAW than in those without ICUAW (66.7% vs 22.8%; P = .000); the same was true for moderate or severe limitations (20.8% vs 4.5%; P = .035). Likewise, functional independence for personal care, mobility, and self-care activities was poorer in patients with ICUAW.
In patients surviving an ICU stay due to COVID-19, decreased functional independence persists even 6 months after discharge, and patients with ICUAW have worse outcomes.
Patients who survive ICU stays due to COVID-19 continue to have greater functional dependence even 6 months after ICU discharge.
本研究旨在评估重症监护病房（ICU）获得性肌无力（ICUAW）对因 2019 年冠状病毒病（COVID-19）住院患者在 ICU 出院后 6 个月时的日常生活活动独立性的影响。
这是一项前瞻性队列研究，纳入了因 COVID-19 入住 ICU 并在 ICU 出院后通过电话监测 6 个月的患者。患者在 ICU 出院后 30 天、3 个月和 6 个月时 3 次评估日常生活活动独立性（巴氏量表）、自理能力（Katz 指数）、COVID-19 对功能状态的影响（COVID-19 后功能状态量表[PCFS]）和移动水平（ICU 移动量表）。当巴氏量表评分<100 分、Katz 指数≥1 和 PCFS 评分≥1 时，认为存在一定程度的依赖。PCFS 评分≥3 表示中度或重度依赖。当 ICU 出院时的医疗研究委员会评分<48 分，诊断为 ICUAW。
共纳入 68 例患者，平均年龄 51（SD=13）岁。ICU 出院时 ICUAW 发生率为 35%。在 PCFS 评估中，ICU 出院后 30 天、3 个月和 6 个月时存在任何功能障碍的比例分别为 89.7%、57.4%和 38.2%。6 个月后功能障碍持续存在的比例在 ICUAW 患者中高于无 ICUAW 患者（66.7% vs. 22.8%；P=.000）；中度或重度限制也是如此（20.8% vs. 4.5%；P=.035）。同样，ICUAW 患者的个人护理、移动和自理活动的独立功能也较差。
在因 COVID-19 入住 ICU 后存活的患者中，即使在 ICU 出院后 6 个月，功能独立性仍持续下降，且 ICUAW 患者的预后更差。
因 COVID-19 入住 ICU 后存活的患者，即使在 ICU 出院后 6 个月，仍有更大的功能依赖性。
