key: cord-0759918-ter86ba5
authors: Van Aerde, Nathalie; Van den Berghe, Greet; Wilmer, Alexander; Gosselink, Rik; Hermans, Greet
title: Intensive care unit acquired muscle weakness in COVID-19 patients
date: 2020-09-28
journal: Intensive Care Med
DOI: 10.1007/s00134-020-06244-7
sha: 693033d50b5798e7d303007f71f389b12bee736e
doc_id: 759918
cord_uid: ter86ba5

nan

requiring invasive mechanical ventilation (IMV). In addition, we evaluated factors and short-term outcomes associated with weakness at ICU discharge. To assess bias, we compared characteristics and outcomes for patients with and without MRC-sum score, and studied patients without IMV.

Of 486 hospitalized COVID-19 patients, 114 required intensive care of whom 74 (64.9%) needed IMV (Supplemental Fig. 1 ). Admission and ICU characteristics are provided in the Online Supplement. Total hospital mortality was 60/486 (12.3%), ICU mortality was 11/114 (9.6%). All deaths occurred in IMV patients [11/74 (14.9%)]. In 50/74 (67.6%) assessed IMV patients, the incidences of ICUAW at awakening, ICU, and hospital discharge were 72%, 52% and 27% (Fig. 1) . Those without MRC-sum-score were older as compared to those with MRC-sum-score [67 (60-76) versus 60 (53-67), p = 0.044] and comprised nine patients who died before awakening, possibly introducing selection bias. Admission characteristics were similar between patients with and without ICUAW, but weak patients had prolonged ventilation ( (Fig. 1) . 15/26 (57.7%) weak versus 6/24 (25%) not-weak patients were referred for in-patient rehabilitation. In 6/40 (15%) assessed non-IMV patients, one patient was weak at ICU discharge and none at hospital discharge (see Online Supplement).

In conclusion, in this cohort of critically ill COVID-19 patients, survival was high, but those needing prolonged sedation frequently presented with ICUAW. Although strength improved throughout hospitalization, impact on functional status remained substantial. These data indicate that there may be a price to pay for allowing rigorous lung-protective ventilation and underscore the need for follow-up of post-ICU COVID-19 patients, to offer tailored rehabilitation, hopefully reducing long-term impact.

Functional disability 5 years after acute respiratory distress syndrome

Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis

Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region

Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)

The use of analgesia and sedation in mechanically ventilated patients with COVID-19 ARDS

The authors declare that they have no conflict of interest.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Accepted: 7 September 2020