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Outcomes Research
Houston Methodist-Developed Algorithm May Improve Management and Outcomes in Critically Ill COVID-19 Patients
Houston Methodist-Developed Algorithm May Improve Management and Outcomes in Critically Ill COVID-19 Patients
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In the United States, physical therapy (PT) is commonly administered to patients in the intensive care unit (ICU) since these patients suffer from weakness, fatigue and poor functional status. Physical therapists play a fundamental role in improving the quality of life of ICU patients during their recovery from critical illnesses. The COVID-19 surge between March and May 2020 in Houston caused several cardiovascular, neurological and musculoskeletal symptoms in patients. Patients with COVID-19 in the ICU suffered from these symptoms and were at risk for reduced functional mobility, reduced quality of life, increased mortality and increased risk for developing post-intensive care syndrome and ICU-acquired weakness.
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Catherine Stolboushkin PT, DPT, CCS
At the beginning of the pandemic, PT intervention appeared to be limited in the ICU and primarily focused on proning, range of motion and bed exercises. After discussions with clinicians in other hospitals, review of the literature and patient observation, Catherine Stolboushkin, PT, DPT, CCS, at the Houston Methodist Rehabilitation Services noticed that the ICU patients with COVID-19 could endure more intensive PT intervention than anticipated. However, some of these patients were outside the normal parameters for initiating PT intervention and continuing mobility exercises, which presented a unique clinical challenge. This suggested the need for better clinical decision-making processes to provide safe and effective PT intervention at the bedside to ICU patients.
To describe the PT practice in critically ill patients with COVID-19 at a tertiary care hospital such as Houston Methodist and to outline a novel clinical decision-making algorithm (nCDM) and its applications in improving clinical practice for this patient population, Stolboushkin performed a retrospective chart review, the results of which were published in the Cardiopulmonary Physical Therapy Journal in 2021. This study entailed selection and evaluation of PT and demographic data and clinical records of patients with COVID-19 admitted to Houston Methodist Hospital ICUs with a PT consultation between March and May 2020.

According to Stolboushkin, “Physical therapy intervention is an integral component of a patient’s course for recovery during and after critical illness due to COVID-19. This algorithm allowed us to provide PT intervention for patients who may not have been seen or for whom intervention may have been delayed based on our previous guidelines. Further research needs to be done on the safety and feasibility of using this clinical decision-making algorithm for patients with COVID-19 or other similar respiratory impairments.”

The COVID-19 surge challenged health care professionals to adjust best practices and become creative. This retrospective chart review was the first to describe PT practice for critically ill patients with COVID-19 in the ICU, with or without mechanical ventilation. The clinical decision-making algorithm described here can be applied to diseases other than COVID-19, such as acute respiratory distress syndrome being treated in ICU settings. Moreover, this study pushed the envelope with the patient tolerance and mobility of PT intervention.

Taken together, the novel algorithm developed by Stolboushkin can help clinicians identify patient populations suitable for PT intervention as well as the optimum time of PT intervention to maximize the safety and quality of life of ICU patients with COVID-19.
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