Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, São Paulo, Brazil.
Serviço de Fisioterapia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Respir Care. 2024 Nov 18;69(12):1508-1516. doi: 10.4187/respcare.12032.
COVID-19 is associated with prolonged disability, particularly after critical illness. This study aimed to assess and compare disability post-hospital discharge of subjects who were invasively ventilated versus those who were not, following ICU admission due to COVID-19. This study also explored variables associated with long-term disability.
In this prospective cohort study, subjects with COVID-19 who received invasive ventilation, noninvasive ventilation, or high-flow nasal cannula during ICU stay were assessed with the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 at 3 and 6 months post-hospital discharge. Data were analyzed collectively and stratified as subjects with and without invasive mechanical ventilation. Analysis of variance and multiple regression analyses were applied.
The subjects ( = 43) were mainly male, middle age, and overweight. Subjects who were invasively ventilated ( = 21) had decreased physical function compared to those who were not during hospital assessments. From 3-6 months after discharge, all WHODAS domains and the overall score decreased in both groups ( < .001), indicating disability recovery. The participation domain, which assesses joining in society, was the only domain that remained worse in the ventilation group compared to the no ventilation group ( = .01). No interaction was found between time and the study groups, suggesting that the recovery trajectory was similar. At 6 months, considering the entire cohort, 70% and 56% had no disability in self-care and getting along domains, respectively, while 42% exhibited moderate to severe disability in the participation domain. According to the overall WHODAS score, 86% of subjects still had some level of disability at 6 months. In multivariate analyses, the overall WHODAS score along with the household and participation domains showed significant positive correlations, indicating higher disability, with corticosteroid use.
Disability persisted at 6 month post-hospital discharge for ICU survivors of COVID-19, regardless of the need for invasive mechanical ventilation. Participation was the only domain that showed higher disability among those who received invasive ventilation.
COVID-19 与长期残疾有关，尤其是在重症后。本研究旨在评估和比较因 COVID-19 入住 ICU 后接受有创通气和未接受有创通气的患者出院后的残疾情况。本研究还探讨了与长期残疾相关的变量。
在这项前瞻性队列研究中，对接受有创通气、无创通气或高流量鼻导管通气的 COVID-19 患者，在出院后 3 个月和 6 个月时使用世界卫生组织残疾评估表（WHODAS）2.0 进行评估。对所有数据进行了综合分析，并按照有无有创机械通气进行了分层分析。应用方差分析和多元回归分析。
患者（n=43）主要为男性、中年和超重。与未接受有创机械通气的患者相比，接受有创机械通气的患者（n=21）在住院评估时的身体功能下降。出院后 3-6 个月，两组患者的所有 WHODAS 领域和总体评分均下降（<0.001），表明残疾得到恢复。参与领域，即评估参与社会活动的能力，是通气组与无通气组相比唯一仍较差的领域（=0.01）。未发现时间与研究组之间存在交互作用，表明恢复轨迹相似。在 6 个月时，考虑整个队列，分别有 70%和 56%的患者在自我护理和相处领域无残疾，而 42%的患者在参与领域有中度至重度残疾。根据总体 WHODAS 评分，86%的患者在 6 个月时仍有一定程度的残疾。多元分析显示，WHODAS 总体评分以及家庭和参与领域与皮质类固醇的使用呈显著正相关，表明残疾程度更高。
COVID-19 ICU 幸存者无论是否需要有创机械通气，在出院后 6 个月仍存在残疾。接受有创通气的患者中，只有参与领域显示出更高的残疾。
