COVID-19 Acute Respiratory Distress Syndrome
Conditions
Brief summary
COVID-19 is an infectious disease caused by SARS-CoV2 virus. COVID-19 patients can develop a severe disease that can lead to hypoxic respiratory failure and acute respiratory distress syndrome (ARDS). Severe patients can require access to intensive care unit (ICU). Early rehabilitation is known to be effective in critically ill patients and in ARDS. Early rehabilitation is known to be effective in critically ill subjects. The role of physiotherapy in severe COVID-19 patients is still unclear and few guidelines have been proposed so far. Aim of this study is to assess efficacy of early rehabilitation for severe ICU-admitted COVID-19 patients as compared to a group that did not received physiotherapy treatment in ICU.
Detailed description
COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in China in December 2019 and in Italy in February 2020. A large proportion of infected people have mild clinical manifestations, whereas \>10% develop a severe disease, which could evolve into acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) admission. A high proportion of ICU patients need invasive mechanical ventilation (IMV) and about 50% of the ICU-admitted patients die. The median age of ICU COVID-19 patients was \<65 years and the mortality in patients aged \<63 years ranges from 15 to 20%. Early rehabilitation is safe and effective in critically ill patients and, in patients with ARDS, it helps to reduce the functional impairment due to the prolonged stay in ICU. Preliminary data suggest the implementation of early and active mobilization programs, as well as airway clearance, for patients with severe forms of COVID-19. To date, the role of respiratory physiotherapy in severe COVID-19 patients is still unclear. Aim of this study is to assess efficacy of early rehabilitation for severe ICU-admitted COVID-19 patients as compared to a group that did not recevied physiotherapy treatment in ICU. Physiotherapy efficacy is evaluated in terms of ventilator free days (VFD) during the first 30 days after neuromuscular blockade stop. Moreover, duration of ICU stay and patient functional status at ICU discharge will be evaluated.
Interventions
PROCEDUREEarly physiotherapy
Respiratory physiotherapy included: 1. early and functional mobilization: passive and active mobilization, muscle strengthening, improving independence in activities of daily living (ADL), sitting out of bed, standing, walking; 2. patient positioning to achieve better ventilation/perfusion ratio and gas exchange; 3. airway clearance; 4. aerosol administration; 5. invasive mechanical ventilation weaning; 6. use of non-invasive mechanical ventilation (NIMV) and continuous positive airway pressure (CPAP); 7. tracheostomy management and weaning; 8. swallowing assessment; 9. management of oxygen delivery; 10. lung expansion; 11. patient assessment and functional scale administration.
Sponsors
Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Having laboratory confirmed COVID-19 pneumonia * Developed hypoxemic acute respiratory failure (hARF) requiring access to ICU * Treated by physiotherapists during the ICU stay * Stopped the neuromuscular blokade treatment
Exclusion criteria
* Previuos cognitive deficit (Mini menatal state examination \<20)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ventilator-free days (VFD) and alive at day 28 | Up to 28 days after neuromuscular blokade stop | To determine if early physiotherapy, as compared to no physiotherapy treatment, increases the number of ventilator-free days (VFD) and alive at day 28 in severe COVID-19 ICU-admitted patients. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ICU stay duration | From ICU admission to ICU discharge; up to 60 days. | Mean days of ICU stay |
| PaO2/FiO2 | At ICU discharge; up to 60 days | Mean measure of PaO2/FiO2 |
| ICU survival rate | From ICU admission until date of death from any cause, during ICU stay; up to 100 days. | Number of patients that survived ICU stay |
| hospital survival rate | From ICU admission until date of death from any cause, during hospitalization | Number of patients that survived hospitalization |
| 90 days survival rate | From ICU admission until date of death from any cause, assessed up to 90 days after neuromuscular blokade removal | Number of patients that survived during 90 days after neuromuscular blokade stop |
Countries
Italy
Outcome results
None listed