Analysis of mobility level of COVID-19 patients undergoing mechanical ventilation support: A single center, retrospective cohort study.

Autor: Nawa RK; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Serpa Neto A; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; Australian and New Zealand Intensive Care-Research Centre (ANZIC-RC), Monash University, Melbourne, Australia.; Data Analytics Research & Evaluation (DARE) Centre, Austin Hospital and University of Melbourne, Melbourne, Victoria, Australia., Lazarin AC; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., da Silva AK; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Nascimento C; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Midega TD; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Caserta Eid RA; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Corrêa TD; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil., Timenetsky KT; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Aug 01; Vol. 17 (8), pp. e0272373. Date of Electronic Publication: 2022 Aug 01 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0272373
Abstrakt: Background: Severe coronavirus disease 2019 (COVID-19) patients frequently require mechanical ventilation (MV) and undergo prolonged periods of bed rest with restriction of activities during the intensive care unit (ICU) stay. Our aim was to address the degree of mobilization in critically ill patients with COVID-19 undergoing to MV support.
Methods: Retrospective single-center cohort study. We analyzed patients' mobility level, through the Perme ICU Mobility Score (Perme Score) of COVID-19 patients admitted to the ICU. The Perme Mobility Index (PMI) was calculated [PMI = ΔPerme Score (ICU discharge-ICU admission)/ICU length of stay], and patients were categorized as "improved" (PMI > 0) or "not improved" (PMI ≤ 0). Comparisons were performed with stratification according to the use of MV support.
Results: From February 2020, to February 2021, 1,297 patients with COVID-19 were admitted to the ICU and assessed for eligibility. Out of those, 949 patients were included in the study [524 (55.2%) were classified as "improved" and 425 (44.8%) as "not improved"], and 396 (41.7%) received MV during ICU stay. The overall rate of patients out of bed and able to walk ≥ 30 meters at ICU discharge were, respectively, 526 (63.3%) and 170 (20.5%). After adjusting for confounders, independent predictors of improvement of mobility level were frailty (OR: 0.52; 95% CI: 0.29-0.94; p = 0.03); SAPS III Score (OR: 0.75; 95% CI: 0.57-0.99; p = 0.04); SOFA Score (OR: 0.58; 95% CI: 0.43-0.78; p < 0.001); use of MV after the first hour of ICU admission (OR: 0.41; 95% CI: 0.17-0.99; p = 0.04); tracheostomy (OR: 0.54; 95% CI: 0.30-0.95; p = 0.03); use of extracorporeal membrane oxygenation (OR: 0.21; 95% CI: 0.05-0.8; p = 0.03); neuromuscular blockade (OR: 0.53; 95% CI: 0.3-0.95; p = 0.03); a higher Perme Score at admission (OR: 0.35; 95% CI: 0.28-0.43; p < 0.001); palliative care (OR: 0.05; 95% CI: 0.01-0.16; p < 0.001); and a longer ICU stay (OR: 0.79; 95% CI: 0.61-0.97; p = 0.04) were associated with a lower chance of mobility improvement, while non-invasive ventilation within the first hour of ICU admission and after the first hour of ICU admission (OR: 2.45; 95% CI: 1.59-3.81; p < 0.001) and (OR: 2.25; 95% CI: 1.56-3.26; p < 0.001), respectively; and vasopressor use (OR: 2.39; 95% CI: 1.07-5.5; p = 0.03) were associated with a higher chance of mobility improvement.
Conclusion: The use of MV reduced mobility status in less than half of critically ill COVID-19 patients.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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