Six-Week Hospital-Based Pulmonary Rehabilitation in Covid Pneumonia ICU Survivors: Experience from a Tertiary Care Center in Central India

Abstract

Objective: There is very limited data on the usefulness of pulmonary rehabilitation in patients with coronavirus pneumonia who have survived intensive care unit care. The primary aim was to explore the feasibility of conducting a pulmonary rehabilitation program in patients with coronavirus disease-19 pneumonia surviving intensive care. The secondary aim was to study the impact of a hospital-based 6-week pulmonary rehabilitation program on exercise capacity, quality of life, and psychological parameters in these patients. This study was conducted at the Center for Pulmonary Rehabilitation, Department of Pulmonary Medicine of the institute.

Material and methods: A total of 27 patients were enrolled. Among them, 14 patients who completed the desired 12 sessions over 6 weeks constituted the pulmonary rehabilitation group and 13 patients who either did not consent or defaulted within the first 2 weeks were considered as controls. Both groups had assessments at 0 and 6 weeks that included a 6-Minute Walk Test, Incremental Shuttle Walk Test, mMRC Dyspnea Scale, Baseline Dyspnea Index, and Transitional Dyspnea Index, Saint George's Respiratory Questionnaire score, and Depression, Anxiety, Stress Scale-21 score.

Results: Significant improvement in dyspnea by mMRC (P = .01) and exercise capacity as measured by 6-Minute Walk Test (P <.001) and Incremental Shuttle Walk Test (P = .025) was seen in the pulmonary rehabilitation group as compared to the control group. There was no significant improvement in quality of life and psychological parameters (Depression, Anxiety, Stress Scale 21 score) after 6 weeks of pulmonary rehabilitation program as measured in our study.

Conclusion: Pulmonary rehabilitation is feasible and appears promising in coronavirus disease acute respiratory distress syndrome survivors. However, data from other centers and a larger number of patients are required to imbibe conclusive results.

Figure 1.

(A) HRCT thorax scan of 46-year-old female after recovery from ICU showing bilateral patchy GGOs predominantly in lower and middle zones (before enrollment into a PR program). (B) HRCT thorax scan of the same patient described in (A) after completion of a 6-week PR program shows marked resolution of the opacities. (C) HRCT thorax scan of 36-year-old male after recovery from ICU showing bilateral patchy GGOs predominantly in lower, middle zones, and subpleural areas. (D) HRCT thorax scan of the same patient described in 2(A) after 6 weeks (without PR intervention) also shows marked resolution of the opacities. ICU, intensive care unit; PR, pulmonary rehabilitation; GGOs, ground glass opacities.

Figure 2.

(A) Box violin plot comparing the various parameters namely 6MWD, mMRC, ISWT, DASS-21 stress, DASS-21 anxiety, and DASS-21 depression scores in the control and PR group. The bold line depicts the change in mean values, and the dotted lines reflect the change in individual values in each graph. (B) Box violin plot comparing SGRQ symptom, SGRQ activity, SGRQ impact, and SGRQ total score in the control and PR group. The bold line depicts the change in mean values, and the dotted lines reflect the change in individual values in each graph. 6MWD, 6-Minute Walk Test; DASS, Depression, Anxiety, Stress Scale; ISWT, Incremental Shuttle Walk Test; SGRQ, significant improvement in quality of life.