Safety and Feasibility of an Interdisciplinary Treatment Approach to Optimize Recovery From Critical Coronavirus Disease 2019

Kirby P Mayer; Selina M Parry; Anna G Kalema; Rajan R Joshi; Melissa K Soper; Angela K Steele; Megan L Lusby; Esther E Dupont-Versteegden; Ashley A Montgomery-Yates; Peter E Morris

doi:10.1097/CCE.0000000000000516

Safety and Feasibility of an Interdisciplinary Treatment Approach to Optimize Recovery From Critical Coronavirus Disease 2019

Crit Care Explor. 2021 Aug 19;3(8):e0516. doi: 10.1097/CCE.0000000000000516. eCollection 2021 Aug.

Authors

Kirby P Mayer^{1

2

3}, Selina M Parry⁴, Anna G Kalema⁵, Rajan R Joshi^{5

6}, Melissa K Soper⁵, Angela K Steele⁶, Megan L Lusby⁶, Esther E Dupont-Versteegden^{1

3}, Ashley A Montgomery-Yates^{2

5}, Peter E Morris^{2

5}

Affiliations

¹ Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY.
² Kentucky Research Alliance for Lung Disease, College of Medicine, University of Kentucky, Lexington, KY.
³ Center for Muscle Biology, College of Health Sciences, University of Kentucky, Lexington, KY.
⁴ Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville VIC, Australia.
⁵ Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Kentucky, Lexington, KY.
⁶ Pulmonary Rehabilitation, Medicine Specialties Clinic, Therapeutic Services, University of Kentucky Healthcare, Lexington, KY.

Abstract

Objectives: Examine the safety and feasibility of a multimodal in-person or telehealth treatment program, administered in acute recovery phase for patients surviving critical coronavirus disease 2019.

Design: Pragmatic, pre-post, nonrandomized controlled trial with patients electing enrollment into one of the two recovery pathways.

Setting: ICU Recovery Clinic in an academic medical center.

Patients: Adult patients surviving acute respiratory failure due to critical coronavirus disease 2019.

Interventions: Patients participated in combined ICU Recovery clinic and 8 weeks of physical rehabilitation delivered: 1) in-person or 2) telehealth. Patients received medical care by an ICU Recovery Clinic interdisciplinary team and physical rehabilitation focused on aerobic, resistance, and respiratory muscle training.

Measurements and main results: Thirty-two patients enrolled with mean age 57 ± 12, 62% were male, and the median Sequential Organ Failure Assessment score was 9.5. There were no differences between the two groups except patients in telehealth pathway (n = 10) lived further from clinic than face-to-face patients (162 ± 60 vs 31 ± 47 kilometers, t = 6.06, p < 0.001). Four safety events occurred: one minor adverse event in the telehealth group, two minor adverse events, and one major adverse event in the in-person group. Three patients did not complete the study (two in-person and one telehealth). Six-minute walk distance increased to 101 ± 91 meters from pre to post (n = 29, t = 6.93, p < 0.0001), which was similar between the two groups (110 vs 80 meters, t = 1.34, p = 0.19). Self-reported levels of anxiety, depression, and distress were high in both groups with similar self-report quality of life.

Conclusions: A multimodal treatment program combining care from an interdisciplinary team in an ICU Recovery Clinic with physical rehabilitation is safe and feasible in patients surviving the ICU for coronavirus disease 2019 acute respiratory failure.

Keywords: cognitive dysfunction; coronavirus disease 2019; implementation; intensive care unit recovery; physical rehabilitation; postintensive care syndrome; posttraumatic stress disorder; safety.