Intensive Care Unit-Acquired Weakness in Patients With COVID-19: Occurrence and Associated Factors.

Abstract

ObjectiveThe primary objective of this study was to identify the occurrence and factors associated with intensive care unit (ICU)–acquired weakness (ICUAW) in patients with COVID-19. Secondarily, we monitored the evolution of muscle strength and mobility among patients with ICUAW and patients without ICUAW and the association of these variables with length of stay, mechanical ventilation (MV), and other clinical variables.MethodsIn this prospective observational study, patients admitted to the ICU for >72 h with COVID-19 were evaluated for muscle strength and mobility at 3 times: when being weaned from ventilatory support, discharged from the ICU, and discharged from the hospital. Risk factors for ICUAW were monitored.ResultsThe occurrences of ICUAW at the 3 times evaluated among the 75 patients included were 52%, 38%, and 13%. The length of the ICU stay (29.5 [16.3–42.5] versus 11 [6.5–16] days; P ≤ .001), the length of the hospital stay (43.5 [22.8–55.3] versus 16 [12.5–24] days; P ≤ .001) and time on MV (25.5 [13.8–41.3] versus 10 [5–22.5] days; P ≤ .001) were greater in patients with ICUAW. Muscle strength and mobility were lower at all times assessed in patients with ICUAW (P < .05). Bed rest time for all patients (relative risk = 1.14; 95% CI = 1.02–1.28; P = .03 per week) and use of corticosteroids (relative risk = 1.01; 95% CI = 1.00–1.03; P = .01 per day) for those who required MV were factors independently associated with ICUAW. Muscle strength was found to have a positive correlation with mobility and a negative correlation with lengths of stay in the ICU and hospital and time on MV.ConclusionsThe occurrence of ICUAW was high upon patients’ awakening in the ICU but decreases throughout hospitalization; however, strength and mobility remained compromised at hospital discharge. Bed rest time and use of corticosteroids (for those who needed MV) were factors independently associated with ICUAW in patients with COVID-19.