This dissertation is devoted to the problem of long-term consequences of coronavirus disease and staying in the Intensive Care Unit (ICU), which may manifest as significant impairments in the physical, mental, and cognitive health of patients. An important aspect of treating these patients is the use of physical rehabilitation during the acute phase of the disease.
The aim of this work is to improve approaches to physical rehabilitation in the ICU, specifically by determining the optimal number of daily exercise sessions and analyzing their impact on physical, mental, and cognitive indicators, the length of hospital stay, as well as the overall manifestations of post-COVID syndrome in patients who require ICU treatment.
The objectives of the study are:
1. To investigate the trends in applying and the impact of early physical rehabilitation in the ICU on the development of post-COVID syndrome in patients who had severe COVID-19.
2. To determine and compare the effects of standard and extended modes of early physical rehabilitation in the ICU on patients’ physical functional status (ability for self-care, basic mobility, and highest level of mobility).
3. To compare the impact of standard and extended rehabilitation modes in the ICU on the mental and cognitive status of patients.
4. To assess the effects of standard and extended rehabilitation modes on the severity of post-COVID syndrome (according to the PCFS scale) in the first week after discharge and 4–6 weeks after discharge from the hospital.
5. To assess the influence of the rehabilitation mode in the ICU on the duration of ICU stay and the overall length of hospitalization.
6. Based on the obtained results, to develop practical recommendations for the use of early physical rehabilitation in the ICU to prevent and alleviate the manifestations of post-COVID syndrome.
This was a prospective cohort study. It involved patients treated in the ICU for respiratory failure caused by ARDS against the background of coronavirus infection. The following criteria were used to include patients in the study: Age ≥ 18 years; COVID-19 diagnosis confirmed by polymerase chain reaction (PCR); ICU hospitalization for respiratory failure against the background of ARDS.
Exclusion criteria: Pre-existing musculoskeletal disorders limiting mobility; Neurological disorders limiting mobility; Presence of oncological diseases; Death of the patient or transfer to another health care facility; Patient’s refusal to participate.
A total of 102 patients were selected to participate in the study. The mean age was 56.82±13.19 years. By gender, the distribution was 33 women (32%) and 69 men (68%). The most common comorbidities were: arterial hypertension (64 patients, 63%), diabetes mellitus (37 patients, 36%), and chronic kidney disease (21 patients, 21%). All patients included in the study had a pronounced oxygen dependence (SpO2<90%) and required non-invasive mechanical ventilation.
Patients were divided into two groups of 51 persons each, depending on the number of rehabilitation sessions per day. Group 1 had one rehabilitation session per day (standard rehabilitation mode), whereas Group 2 had two sessions per day (extended rehabilitation mode). According to anthropometric data, severity of condition, and physical functional status at the time of ICU admission, there were no significant differences between the groups. It should be noted that an untreated control group was not formed due to ethical considerations.
The study design was approved by the Commission on Bioethics and Research Ethics at the O.O. Bohomolets National Medical University.
The following methods were used in the research: general clinical (analysis of medical history data, objective examinations, assessment of complaints and identification of post-COVID-19 symptoms); instrumental (CT scan of the lungs, dynamic monitoring of blood pressure, SpO2, ECG); laboratory (complete blood count, biochemical tests, coagulation parameters, inflammatory markers, etc.); questionnaires (AM-PAC, JH-HLM, HADS, MMSE, PCFS scales); statistical methods (descriptive and inferential statistics [tests of normality, comparison of means, nonparametric tests, correlation analysis]) using software package EZR.
