Abstract
Background: Survivors of COVID-19 pneumonia often suffer from chronic critical illness (CCI) and require long-term hospitalization. Long-term acute care (LTAC) hospitals are vital in the care of CCI patients, but their role for patients post COVID-19 infection is not known. Barlow Respiratory Hospital (BRH) is a 105-bed, LTAC hospital network serving ventilator-dependent and medically-complex patients transferred from the ICUs of hospitals in southern California. We report patient characteristics of our first series of COVID-19 survivors admitted to the post-acute venue of an LTAC hospital. Methods: Single-center observational descriptive report of patients recovering from acute infectious complications of COVID-19 pneumonia requiring long-term respiratory support. Results: From 28 April to 7 September 2020, 41 patients were admitted to BRH for continued recovery from COVID-19 pneumonia. Median age: 68 [44-94] years, 25/41 (61%) male, 33/41 (80.5%) with tracheostomy, 21/41 (51.2%) on invasive mechanical ventilation, 9/41 (22%) receiving hemodialysis. All mechanical ventilation and hemodialysis interventions were initiated at the transferring hospital. Conclusions: To our knowledge, this is the first report to characterize CCI and medically complex COVID-19 patients transferred to the post-acute venue of an LTAC hospital. Patients on average spent over six weeks in the transferring hospital mostly in the ICU, are largely elderly, carry the known risk factors for COVID-19 infection, and experienced respiratory failure necessitating prolonged mechanical ventilation via tracheostomy. Our findings suggest that these patients will continue to require considerable medical interventions and treatments, including weaning from mechanical ventilation, owing to the numerous sequelae of the infection and the burden of acute-on-chronic diseases. As ICU survival rates improve, this research further emphasizes the important role of the LTAC hospital in responding to the COVID-19 crisis.
Highlights
Survivors of COVID-19 pneumonia often suffer from chronic critical illness (CCI) and require long-term hospitalization
The length of stay (LOS) for non-COVID patients admitted during the same time period was median 16 [1–96] days with median 15 [0–89] days spent in the intensive care unit (ICU)
Of 194 patients transferred to Barlow Respiratory Hospital (BRH) from 28 April 2020 to 7 September 2020, 41 (21%) were admitted for continued recovery from confirmed COVID-19 pneumonia
Summary
Any reports and responses or comments on the article can be found at the end of the article. We have included the accompanying ICU LOS data: The length of stay (LOS) at the transferring acute care hospital was median 42 [8–78] days for the post-COVID pneumonia cohort, with median 38 [8–77] days spent in the ICU. Any further responses from the reviewers can be found at the end of the article Introduction Advances in technology, research, and adoption of evidence-based practices have significantly improved intensive care unit (ICU) survivorship, creating the population of patients recognized as chronically critically ill (CCI). Any further responses from the reviewers can be found at the end of the article Introduction Advances in technology, research, and adoption of evidence-based practices have significantly improved intensive care unit (ICU) survivorship, creating the population of patients recognized as chronically critically ill (CCI)1 This improved survival, is often accompanied by a prolonged and challenging course of recovery. We report patient characteristics of our first series of COVID-19 survivors admitted to the post-acute venue of an LTAC, as an essential step in the continuum of care for treatment, rehabilitation, and recovery
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