Association between functional admission characteristics and physiotherapy interventions with COVID-19 mortality in patients with cardiovascular diseases admitted to the intensive care unit

Abstract

Introduction: A higher incidence of new coronavirus disease (COVID-19) is observed in patients with cardiovascular diseases. Whether admission functional outcomes and physiotherapy interventions are associated with functional status at hospitalization and risk of death in this population is uncertain. Objective: To estimate whether admission functional outcomes and exposure to physiotherapy interventions are associated with mortality rate in intensive care unit (ICU) inpatients with cardiovascular diseases and COVID-19. Setting: Intensive care unit of a primary-totertiary private hospital located in Curitiba, Paraná, Brazil. Population: Patients with cardiovascular disease hospitalized in ICU from February to November 2020. Methods: This retrospective cohort analyzed 100 ICU inpatients age (mean [SD] 75 [16] years; female/male 49/51; COVID-19 positive/negative: 58/42) that underwent
routine physiotherapy interventions—mainly ventilatory support, kinesiotherapy, and mobility—until ICU discharge or death. Patients were split into COVID-19+ or COVID-19– to investigate the association of their clinical status with exposure to routine
physiotherapy interventions. The association of in-ICU death with admission functional outcomes and physiotherapy interventions was investigated using univariable and multivariable regression models and decision trees. Results: In-ICU mortality rate
was 37%, being higher for the COVID-19+ group (odds ratio, OR [95%CI]: 3.2 [1.37-7.47], p=0.008). In-ICU death was associated with lower admission IMS score (0.81 [0.71-0.91], p=0.001). In-ICU mortality was more likely in patients exposed to invasive mechanical ventilation in either supine (22.71 [8.28-70.76], p<0.001) or prone position (4.74 [1.42-18.74], p=0.016), oxygen therapy (8.75 [2.34-57.11], p=0.005) or alveolar recruitment (10.06 [3.25-38.35], p<0.001). Restricted mobility (24.90 [6.77-161.94], p<0.001) and passive kinesiotherapy (30.67 [9.49-139.52], p<0.001) were associated with in-ICU death, whereas active kinesiotherapy (0.13 [0.05-0.32], p<0.001), standing (0.12 [0.05-0.30], p<0.001), or walking (0.10 [0.03-0.27], p<0.001) were associated with in-ICU discharge. Conclusion: Admission functional outcomes and exposure to routine physiotherapy interventions are associated with the mortality rate in ICU inpatients with cardiovascular diseases. The protective effects of routine physiotherapy interventions were highest when patients can progress from passive to active kinesiotherapy activities. Patients who further progress with standing and walking
activities appear to experience a higher survival effect. Clinical rehabilitation impact: Planning of physiotherapy interventions aimed at reducing in-ICU fatality among patients with cardiovascular diseases and COVID-19 should focus on progressing from passive to active kinesiotherapy activities and mobility activities.