• Rob J J van Gassel, Julia Bels, Loes Remij, Bas C T van Bussel, Rein Posthuma, Hester A Gietema, Jeanine Verbunt, van der HorstIwan C CICCDepartment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands., Olde DaminkSteven W MSWMDepartment of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.Department of General, Susanne van Santen, and van de PollMarcel C GMCGDepartment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.NUTRIM School for Nutrition and Trans.
• Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
• Crit. Care Med. 2021 Oct 1; 49 (10): 172617381726-1738.

ObjectivesWe performed a comprehensive health assessment in mechanically ventilated coronavirus disease 2019 survivors to assess the impact of respiratory and skeletal muscle injury sustained during ICU stay on physical performance at 3 months following hospital discharge.DesignPreregistered prospective observational cohort study.SettingUniversity hospital ICU.PatientsAll mechanically ventilated coronavirus disease 2019 patients admitted to our ICU during the first European pandemic wave.Measurements And Main ResultsAt 3 months after hospital discharge, 46 survivors underwent a comprehensive physical assessment (6-min walking distance, Medical Research Council sum score and handgrip strength), a full pulmonary function test, and a chest CT scan which was used to analyze skeletal muscle architecture. In addition, patient-reported outcomes measures were collected. Physical performance assessed by 6-minute walking distance was below 80% of predicted in 48% of patients. Patients with impaired physical performance had more muscle weakness (Medical Research Council sum score 53 [51-56] vs 59 [56-60]; p < 0.001), lower lung diffusing capacity (54% [44-66%] vs 68% of predicted [61-72% of predicted]; p = 0.002), and higher intermuscular adipose tissue area (p = 0.037). Reduced lung diffusing capacity and increased intermuscular adipose tissue were independently associated with physical performance.ConclusionsPhysical disability is common at 3 months in severe coronavirus disease 2019 survivors. Lung diffusing capacity and intermuscular adipose tissue assessed on CT were independently associated with walking distance, suggesting a key role for pulmonary function and muscle quality in functional disability.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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