Functional Outcomes and Their Association With Physical Performance in Mechanically Ventilated Coronavirus Disease 2019 Survivors at 3 Months Following Hospital Discharge: A Cohort Study
Critical Care Medicine, vol. 49, pp. 1726–1738
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.
Authors 11
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Maastricht University Medical Centre · Maastricht University · Universitätsklinikum Aachen · Ciro · Care and Public Health Research Institute · RWTH Aachen University
Affiliation as printed
CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Maastricht University Medical Centre
Affiliation as printed
Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Maastricht University Medical Centre · Maastricht University · Care and Public Health Research Institute
Affiliation as printed
CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Maastricht University Medical Centre · Maastricht University · Universitätsklinikum Aachen · Ciro · Care and Public Health Research Institute · RWTH Aachen University
Affiliation as printed
CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
-
Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
-
Affiliation as printed
Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
-
Maastricht University Medical Centre · Maastricht University
Affiliation as printed
CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
-
Maastricht University Medical Centre · Maastricht University · Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
-
Maastricht University Medical Centre
Affiliation as printed
Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
-
Maastricht University Medical Centre · Maastricht University · Universitätsklinikum Aachen · Ciro · Care and Public Health Research Institute · RWTH Aachen University
Affiliation as printed
CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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