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Intensive Care Admission and Early Neuro-Rehabilitation. Lessons for COVID-19?
Alessandro Pincherle1,2,3, Jane Jöhr1, Lisa Pancini3
1Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland.
Insights
Early rehabilitation is crucial for COVID-19 survivors to mitigate long-term neurological and physical impairments. Multidisciplinary interventions after intensive care unit (ICU) stays can improve respiratory function and reduce the overall burden of the disease.
Area of Science:
- Neurology
- Pulmonology
- Rehabilitation Medicine
Background:
- Coronavirus disease 2019 (COVID-19) can cause significant neurological and systemic complications, including acute respiratory distress syndrome requiring intensive care unit (ICU) admission.
- Evidence suggests potential direct effects of COVID-19 on the central and peripheral nervous systems, leading to persistent physical, cognitive, and functional deficits.
- Pulmonary fibrosis is a potential long-term consequence affecting lung function, exacerbated by respiratory muscle atrophy.
Purpose of the Study:
- To review the multifaceted burden of COVID-19 on neurological and systemic health.
- To address the importance and potential benefits of early rehabilitative interventions for COVID-19 patients, particularly those with ICU exposure.
- To highlight the generalizability of early multidisciplinary rehabilitation across various medical specialties.
Main Methods:
- This is a review article.
- It synthesizes existing evidence on the neurological and systemic impact of COVID-19.
- It discusses the role of early multidisciplinary rehabilitation strategies.
Main Results:
- COVID-19 is associated with complex and long-lasting physical, cognitive, and functional impairments.
- Early rehabilitation is fundamental in reducing the neurological burden and improving neuromuscular weakness.
- Ameliorating respiratory muscle atrophy through rehabilitation can enhance respiratory function and lung capacity.
Conclusions:
- Early multidisciplinary rehabilitation is essential for COVID-19 survivors to minimize neurological and systemic sequelae.
- The benefits of early rehabilitation are well-established in other critical illnesses, supporting its application in post-COVID-19 care.
- An early rehabilitative approach is desirable for physicians across specialties to manage the diverse impacts of COVID-19.
Abstract:
Coronavirus disease 2019 (COVID-19) requires admission to intensive care (ICU) for the management of acute respiratory distress syndrome in about 5% of cases. Although our understanding of COVID-19 is still incomplete, a growing body of evidence is indicating potential direct deleterious effects on the central and peripheral nervous systems. Indeed, complex and long-lasting physical, cognitive, and functional impairments have often been observed after COVID-19. Early (defined as during and immediately after ICU discharge) rehabilitative interventions are fundamental for reducing the neurological burden of a disease that already heavily affects lung function with pulmonary fibrosis as a possible long-term consequence. In addition, ameliorating neuromuscular weakness with early rehabilitation would improve the efficiency of respiratory function as respiratory muscle atrophy worsens lung capacity. This review briefly summarizes the polymorphic burden of COVID-19 and addresses possible early interventions that could minimize the neurological and systemic impact. In fact, the benefits of early multidisciplinary rehabilitation after an ICU stay have been shown to be advantageous in several clinical conditions making an early rehabilitative approach generalizable and desirable to physicians from a wide range of different specialties.
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