Northwell Opens Acute Ventilator Recovery Units for Coronavirus Patients

For seriously ill coronavirus patients, acute ventilator recovery units serve as a bridge between ICU care and acute rehabilitation facilities.

Northwell Health has opened two acute ventilator recovery units (AVRUs) to care for coronavirus patients who have been on ventilators for extended durations.

Many coronavirus disease 2019 (COVID-19) patients with acute respiratory distress require at least a week on a ventilator to support lung function while they recover from the illness. With immobilization required for mechanical ventilation, these patients need physical therapy once they are well enough to move and respond to commands.

AVRUs feature physical therapy while COVID-19 patients are being weaned off ventilators, says Mangala Narasimhan, DO, regional director for critical care at the New Hyde Park, New York-based health system.

"These patients are so behind the curve with long sedative times and long ventilator times that they need aggressive physical therapy to get back on their feet. To do that in ventilated patients is very difficult because most of the PT units that exist are for patients who are not on ventilators. Most acute rehab units want patients to be off a ventilator," she says.

On May 27, Northwell opened two AVRUs at Glen Cove Hospital in Glen Cove, New York, and Northern Westchester Hospital in Mount Kisco, New York. The AVRUs have a total of 27 beds and cost about $1 million each to equip. Most of the expense was associated with equipment such as monitors and oxygen systems.

"It took about three weeks from the thought process to actually opening, and that time was needed mostly for getting equipment installed and staffing in place," Narasimhan says.

The staffing includes hospitalists, pulmonary clinicians, respiratory therapists, physical therapists, and nursing. "Both units have a pulmonary team that is rounding on all of the ventilated patients," she says.

Acute ventilator recovery unit care

For most severely ill COVID-19 patients, Northwell expects its AVRUs will serve as a bridge between ICU care and discharge to an acute rehabilitation facility, Narasimhan says. "In the ICU setting, the focus is not necessarily on physical therapy and ventilator weaning—the focus is on survival and getting patients to a point where we are not hurting them with the ventilator such as reducing the oxygen. In the AVRUs, the goal is to get patients off ventilators."

Ventilated COVID-19 patients must meet three primary criteria for transfer from an ICU to an AVRU, she says.

• Patients must have a tracheostomy for airway stability.
   
• Patients must be hemodynamically stable. For example, they cannot be on vasopressors.
   
• Patients must be able to participate in physical therapy—they must be awake and able to follow commands.

Each AVRU coronavirus patient has a tailored physical therapy regimen, Narasimhan says. "Some patients are just doing passive range of motion and trying to get their muscles strong. Some patients are doing active PT, where they are sitting up and standing. It really depends on where the patients are in that spectrum and how much muscle loss they have experienced."

The pair of AVRUs are expected to meet service demand at Northwell, for now, she says. "Whether we expand the program depends on whether we have a second wave of COVID."