Rehabilitation of Critically Ill COVID-19 Survivors

Although researchers are still learning about recovery after severe cases of COVID-19, literature about acute respiratory distress syndrome (ARDS) and severe acute respiratory syndrome (SARS) shows the benefits of rehabilitation after a long intensive care unit stay. A comprehensive rehabilitation program with a multidisciplinary approach can reduce ICU-acquired weakness, dysphagia, functional decline, psychological problems and cognitive impairment, and improve quality of life, according to Radha Korupolu, MD, MS, Gerard Francisco, MD, Harvey Levin, PhD, and Dale Needham, MD, PhD, in an article published in The Journal of The International Society of Physical and Rehabilitation Medicine.¹ Dr. Korupolu, the lead author, is an assistant professor in the department of Physical Medicine and Rehabilitation at McGovern Medical School at UTHealth and an attending physician at TIRR Memorial Hermann.

“Being bedbound in the ICU can be debilitating in itself. Survivors of critical respiratory illness may experience long-lasting physical, cognitive and psychological dysfunction,” Dr. Korupolu says. “Early rehabilitation of critically ill COVID-19 patients is crucial to improving quality of life and promoting timely transition of patients across different levels of care, but is challenging due to the severity of the illness, the need for strict infection control measures, staffing issues and scarcity of personal protective equipment in many areas.”

At the time of publication of the article in June, 2020, there was little data on outcomes of COVID-19 survivors, but the researchers had access to a wealth of data on the outcomes of ARDS survivors, as well as those from other pandemics, including SARS in Toronto and Hong Kong and Ebola virus disease in West Africa.

“Long-term sequelae of critically ill COVID-19 patients were unknown at this point, and they still are. We do know that survivors of critical illness experience a range of impairments known as post-intensive care syndrome, which may persist for years and result in poor quality of life,” Dr. Korupolu says.

The article, which discusses challenges and potential solutions for rehabilitation of critically ill COVID-19 patients throughout the continuum of care, came about through Dr. Korupolu, who was part of the early mobility and ICU rehabilitation research team at Johns Hopkins University under the leadership of Dr. Dale Needham.

“I wanted to help our rehabilitation community, and given my past experience at Johns Hopkins with Dr. Needham, I contacted him to ask if he could guide me in writing this paper,” she says. They put together a team that included Dr. Francisco, professor and chair of the department of Physical Medicine and Rehabilitation at McGovern Medical School and chief medical officer at TIRR Memorial Hermann, and Dr. Levin, professor of physical medicine and rehabilitation at Baylor College of Medicine.

“Dr. Needham and I had tons of experience with the rehabilitation needs of ICU patients,” she says. “We wrote this in early April, when we knew far less about COVID-19 than we know now. There was so much panic at the time, and our goal was to create a guide about providing care. In general we knew what happened to patients on prolonged mechanical ventilation. We broke that into domains of possible physical and psychological dysfunction and created an algorithm to predict what to expect. At the time we had limited personal protective equipment, and many patients in the ICU were suffering pressure injuries that caused a decline in function. We knew that nurses had to position patients correctly on the ventilator and prevent joint contractures and pressure injuries, but once patients were COVID-19 negative, what then? We outlined what you should do for the patient from ICU to home, and provided guidance on health care needs after discharge.”

¹Korupolu R, Francisco GE, Levin H, Needham DM. Rehabilitation of critically ill COVID-19 Survivors. Journal of the International Society of Physical and Rehabilitation Medicine. 2020;3(2):45-52.