Functional Outcomes and Their Association With Physical Performance in Mechanically Ventilated Coronavirus Disease 2019 Survivors at 3 Months Following Hospital Discharge: A Cohort Study

doi:10.1097/CCM.0000000000005089

Observational Study

. 2021 Oct 1;49(10):1726-1738.

doi: 10.1097/CCM.0000000000005089.

Functional Outcomes and Their Association With Physical Performance in Mechanically Ventilated Coronavirus Disease 2019 Survivors at 3 Months Following Hospital Discharge: A Cohort Study

Rob J J van Gassel^{1

2

3

4

5

6

7

8

9

10

11}, Julia Bels^{1

3}, Loes Remij¹, Bas C T van Bussel^{1

4}, Rein Posthuma^{1

2

3

4

5

6

7

8

9

10

11}, Hester A Gietema^{7

8}, Jeanine Verbunt⁹, Iwan C C van der Horst^{1

10}, Steven W M Olde Damink^{2

3

11}, Susanne van Santen¹, Marcel C G van de Poll^{1

2

3

4

5

6

7

8

9

10

11}

Affiliations

¹ Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
² Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
³ NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
⁴ CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
⁵ Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
⁶ CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
⁷ Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
⁸ GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
⁹ Department of rehabilitation, Maastricht University, Maastricht, The Netherlands.
¹⁰ CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
¹¹ Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany.

PMID: 33967204
PMCID: PMC8439632
DOI: 10.1097/CCM.0000000000005089

Observational Study

Functional Outcomes and Their Association With Physical Performance in Mechanically Ventilated Coronavirus Disease 2019 Survivors at 3 Months Following Hospital Discharge: A Cohort Study

Rob J J van Gassel et al. Crit Care Med. 2021.

. 2021 Oct 1;49(10):1726-1738.

doi: 10.1097/CCM.0000000000005089.

Authors

Affiliations

¹ Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
² Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
³ NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
⁴ CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
⁵ Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
⁶ CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
⁷ Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
⁸ GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
⁹ Department of rehabilitation, Maastricht University, Maastricht, The Netherlands.
¹⁰ CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
¹¹ Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany.

PMID: 33967204
PMCID: PMC8439632
DOI: 10.1097/CCM.0000000000005089

Abstract

Objectives: We performed a comprehensive health assessment in mechanically ventilated coronavirus disease 2019 survivors to assess the impact of respiratory and skeletal muscle injury sustained during ICU stay on physical performance at 3 months following hospital discharge.

Design: Preregistered prospective observational cohort study.

Setting: University hospital ICU.

Patients: All mechanically ventilated coronavirus disease 2019 patients admitted to our ICU during the first European pandemic wave.

Measurements and main results: At 3 months after hospital discharge, 46 survivors underwent a comprehensive physical assessment (6-min walking distance, Medical Research Council sum score and handgrip strength), a full pulmonary function test, and a chest CT scan which was used to analyze skeletal muscle architecture. In addition, patient-reported outcomes measures were collected. Physical performance assessed by 6-minute walking distance was below 80% of predicted in 48% of patients. Patients with impaired physical performance had more muscle weakness (Medical Research Council sum score 53 [51-56] vs 59 [56-60]; p < 0.001), lower lung diffusing capacity (54% [44-66%] vs 68% of predicted [61-72% of predicted]; p = 0.002), and higher intermuscular adipose tissue area (p = 0.037). Reduced lung diffusing capacity and increased intermuscular adipose tissue were independently associated with physical performance.

Conclusions: Physical disability is common at 3 months in severe coronavirus disease 2019 survivors. Lung diffusing capacity and intermuscular adipose tissue assessed on CT were independently associated with walking distance, suggesting a key role for pulmonary function and muscle quality in functional disability.

PubMed Disclaimer

Conflict of interest statement

Dr. Posthuma received funding from Medtalk Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

**Figure 1.**
CT-derived skeletal muscle analysis at the 12th thoracic vertebrae level, showing skeletal muscle area and intermuscular adipose tissue surrounding erector spinae muscle. *Top row* shows high-resolution CT slices of three patients without tissue marking and *bottom row* shows the same slices with tissue marking in order of increasing intermuscular adipose tissue area.

See this image and copyright information in PMC

Cited by

Instruments to assess post-intensive care syndrome assessment: a scoping review and modified Delphi method study.
Nakanishi N, Liu K, Kawauchi A, Okamura M, Tanaka K, Katayama S, Mitani Y, Ota K, Taito S, Fudeyasu K, Masuka Y, Yoshihiro S, Utsumi S, Nishikimi M, Masuda M, Iida Y, Kawai Y, Hatakeyama J, Hifumi T, Unoki T, Kawakami D, Obata K, Katsukawa H, Sumita H, Morisawa T, Takahashi M, Tsuboi N, Kozu R, Takaki S, Haruna J, Fujinami Y, Nosaka N, Miyamoto K, Nakamura K, Kondo Y, Inoue S, Nishida O. Nakanishi N, et al. Crit Care. 2023 Nov 7;27(1):430. doi: 10.1186/s13054-023-04681-6. Crit Care. 2023. PMID: 37936249 Free PMC article.
Association between muscle quality index and pulmonary function in post-COVID-19 subjects.
González-Islas D, Robles-Hernández R, Flores-Cisneros L, Orea-Tejeda A, Galicia-Amor S, Hernández-López N, Valdés-Moreno MI, Sánchez-Santillán R, García-Hernández JC, Castorena-Maldonado A. González-Islas D, et al. BMC Pulm Med. 2023 Nov 15;23(1):442. doi: 10.1186/s12890-023-02745-5. BMC Pulm Med. 2023. PMID: 37968677 Free PMC article.
Critical COVID-19 disease: Clinical course and rehabilitation of neurological deficits.
Wimmer C, Egger M, Bergmann J, Huge V, Müller F, Jahn K. Wimmer C, et al. Front Neurol. 2022 Oct 28;13:1012685. doi: 10.3389/fneur.2022.1012685. eCollection 2022. Front Neurol. 2022. PMID: 36388208 Free PMC article.
Rehabilitation and COVID-19: update of the rapid living systematic review by Cochrane Rehabilitation Field as of October 31st, 2021.
Andrenelli E, Negrini F, de Sire A, Lazzarini SG, Patrini M, Ceravolo MG; International Multiprofessional Steering Committee of Cochrane Rehabilitation REH-COVER action. Andrenelli E, et al. Eur J Phys Rehabil Med. 2022 Feb;58(1):153-156. doi: 10.23736/S1973-9087.22.07434-2. Epub 2022 Mar 1. Eur J Phys Rehabil Med. 2022. PMID: 35229570 Free PMC article. No abstract available.
Radiological appearance and lung function six months after invasive ventilation in ICU for COVID-19 pneumonia: An observational follow-up study.
Konsberg Y, Szaro P, Aneman A, Kjellberg S, Solidakis N, Svedlund S, Nellgård B, Dalla K. Konsberg Y, et al. PLoS One. 2023 Sep 1;18(9):e0289603. doi: 10.1371/journal.pone.0289603. eCollection 2023. PLoS One. 2023. PMID: 37656699 Free PMC article.

See all "Cited by" articles

References

1. Iwashyna TJ: Survivorship will be the defining challenge of critical care in the 21st century. Ann Intern Med. 2010; 153:204–205 - PubMed
1. Kress JP, Hall JB: ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014; 370:1626–1635 - PubMed
1. Herridge MS, Tansey CM, Matté A, et al. ; Canadian Critical Care Trials Group: Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011; 364:1293–1304 - PubMed
1. Hermans G, Van Aerde N, Meersseman P, et al. : Five-year mortality and morbidity impact of prolonged versus brief ICU stay: A propensity score matched cohort study. Thorax. 2019; 74:1037–1045 - PubMed
1. Ferrando C, Suarez-Sipmann F, Mellado-Artigas R, et al. ; COVID-19 Spanish ICU Network: Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med. 2020; 46:2200–2211 - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information

[1] Iwashyna TJ: Survivorship will be the defining challenge of critical care in the 21st century. Ann Intern Med. 2010; 153:204–205 - PubMed

[2] Iwashyna TJ: Survivorship will be the defining challenge of critical care in the 21st century. Ann Intern Med. 2010; 153:204–205 - PubMed

[3] Kress JP, Hall JB: ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014; 370:1626–1635 - PubMed

[4] Kress JP, Hall JB: ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014; 370:1626–1635 - PubMed

[5] Herridge MS, Tansey CM, Matté A, et al. ; Canadian Critical Care Trials Group: Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011; 364:1293–1304 - PubMed

[6] Herridge MS, Tansey CM, Matté A, et al. ; Canadian Critical Care Trials Group: Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011; 364:1293–1304 - PubMed

[7] Hermans G, Van Aerde N, Meersseman P, et al. : Five-year mortality and morbidity impact of prolonged versus brief ICU stay: A propensity score matched cohort study. Thorax. 2019; 74:1037–1045 - PubMed

[8] Hermans G, Van Aerde N, Meersseman P, et al. : Five-year mortality and morbidity impact of prolonged versus brief ICU stay: A propensity score matched cohort study. Thorax. 2019; 74:1037–1045 - PubMed

[9] Ferrando C, Suarez-Sipmann F, Mellado-Artigas R, et al. ; COVID-19 Spanish ICU Network: Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med. 2020; 46:2200–2211 - PMC - PubMed

[10] Ferrando C, Suarez-Sipmann F, Mellado-Artigas R, et al. ; COVID-19 Spanish ICU Network: Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med. 2020; 46:2200–2211 - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Functional Outcomes and Their Association With Physical Performance in Mechanically Ventilated Coronavirus Disease 2019 Survivors at 3 Months Following Hospital Discharge: A Cohort Study

Affiliations

Functional Outcomes and Their Association With Physical Performance in Mechanically Ventilated Coronavirus Disease 2019 Survivors at 3 Months Following Hospital Discharge: A Cohort Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical