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. 2022 Apr:69:103160.
doi: 10.1016/j.iccn.2021.103160. Epub 2021 Oct 28.

Muscle strength and functional outcome after prone positioning in COVID-19 ICU survivors

Filippo Binda  1 , Veronica Rossi  2 , Simone Gambazza  3 , Emilia Privitera  4 , Alessandro Galazzi  5 , Federica Marelli  6 , Martina Santambrogio  7 , Ileana Adamini  8 , Giacomo Grasselli  9 , Dario Laquintana  10
Affiliations

Muscle strength and functional outcome after prone positioning in COVID-19 ICU survivors

Filippo Binda et al. Intensive Crit Care Nurs. 2022 Apr.

Abstract

Objective: To evaluate the muscle strength and functional level of patients discharged from intensive care unit (ICU) in relation to the swimmer position as a nurse intervention during pronation.

Methods: Prospective study conducted in the hub COVID-19 center in Milan (Italy), between March and June 2020. All patients with COVID-19 discharged alive from ICU who received invasive mechanical ventilation were included. Forward continuation ratio model was fitted to explore the statistical association between muscle strength grades and body positioning during ICU stay.

Results: Over the 128 patients admitted to ICU, 87 patients were discharged alive from ICU, with available follow-up measures at hospital discharge. Thirty-four patients (39.1%) were treated with prone positioning as rescue therapy, for a total of 106 pronation cycles with a median duration of 72 (IQR 60-83) hours. Prone positioning did not influence the odds of showing particular level of muscle strength, in any of the evaluated districts, namely shoulder (OR 1.34, 95%CI:0.61-2.97), elbow (OR 1.10, 95%CI:0.45-2.68) and wrist (OR 0.97, 95%CI:0.58-1.63). Only in the shoulder district, age showed evidence of association with strength (OR 1.06, 95%CI:1.02-1.10), affecting people as they get older. No significant sequalae related to swimmer position were reported by physiotherapists or nurses.

Conclusion: Swimmer position adopted during prone ventilation is not associated with worse upper limb strength or poor mobility level in COVID-19 survivors after hospital discharge.

Keywords: COVID-19; Intensive Care Units; Nursing; Physiotherapy; Prone position.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Prone patient in swimmer position. The position involves raising one arm on the same side to which the head is facing whilst placing the other arm by the patient side. The figure was created with permission of BioRender.com.
Fig. 2
Fig. 2
Correlation plot in patients treated with supine or prone position. Correlations not surviving correction for multiplicity are crossed. Direction and strength of correlation is displayed both by colors and circles areas.
Fig. 3
Fig. 3
Forward continuation ratio model for shoulder strength. Lines depict marginal probabilities for each strength level. For example, when discharged from ICU, a patient aged 60 years shows greater probability of having strength equal to 3 rather than 4 or 5. Before leaving the hospital, the probability of one patient of the same age to show strength equal to 4 is higher than showing a normal muscle strength (i.e., 5).
See this image and copyright information in PMC

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