Long-Term Sequelae of severe COVID-19: Outpatient assessment of radiological and pulmonary function tests

Objective: Identify lung sequelae of COVID-19 through radiological and pulmonary function assessment. Design(s): Prospective, longitudinal, cohort study from March 2020 to March 2021. Setting(s): Intensive Care Units (ICU) in a tertiary hospital in Portugal. Patient(s): 254 patients with COVID-19 admitted to ICU due to respiratory illness. Intervention(s): A chest computed tomography (CT) scan and pulmonary function tests (PFT) were performed at 3 to 6 months. Main variables of interest: CT-scan;PFT;decreased diffusion capacity of carbon monoxide (DLCO). Result(s): All CT scans revealed improvement in the follow-up, with 72% of patients still showing abnormalities, 58% with ground glass opacities and 62% with evidence of fibrosis. PFT had abnormalities in 94 patients (46%): thirteen patients (7%) had an obstructive pattern, 35 (18%) had a restrictive pattern, and 58 (30%) had decreased DLCO. There was a statistically significant association between abnormalities in the follow-up CT scan and older age, more extended hospital and ICU stay, higher SAPS II and APACHE scores and invasive ventilation. Mechanical ventilation, especially with no lung protective parameters, was associated with abnormalities in PFT. Multivariate regression showed more abnormalities in lung function with more extended ICU hospitalization, chronic obstructive pulmonary disease (COPD), chronic kidney disease, invasive mechanical ventilation, and ventilation with higher plateau pressure, and more abnormalities in CT-scan with older age, more extended ICU stay, organ solid transplants and ventilation with higher positive end-expiratory pressure (PEEP). Conclusion(s): Most patients with severe COVID-19 still exhibit abnormalities in CT scans or lung function tests three to six months after discharge.Copyright © 2023

Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study.

BACKGROUND: We aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19. METHODS: International, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections. RESULTS: 684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa. Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections. CONCLUSIONS: Infectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized.

Delirium in COVID-19 patients admitted to an infectious diseases intensive care unit

Background and aims: COVID-19 is a respiratory disease caused by SARS-CoV-2. Nevertheless, neurological complications have been described. Delirium, seems frequent, prolonged, and difficult to control. Methods: To evaluate the prevalence and characteristics of delirium in a cohort of critically ill patients with COVID- 19, compared to a historical cohort of critically ill patients with other respiratory infections. Retrospective comparative analysis of demographic, clinical and laboratory data from two cohorts: patients admitted to an Infectious Diseases Intensive Care Unit (IDICU) with COVID-19 and for other respiratory infections in 2018-2019. Olanzapine equivalent dosages of antipsychotics necessary to control delirium was used as a severity marker. Results: We included 114 patients (74 COVID-19 and 40 non-COVID-19). The COVID-19 cohort presented with a statistically significant higher median age of 67 years old and a slight male predominance (56.8%). Previous neurological disease was present in 12.2%. Delirium developed in 45.9% of which, lasted a median of four days and needed a median of 10mg/day of olanzapine equivalents to control. Samples were matched to sex, previous neurological disease and use of benzodiazepines/ antipsychotics. There was no difference in prevalence of delirium or its duration between cohorts (p>0.05). In patients with delirium the univariate analysis demonstrated a difference in the severity of delirium (p=0.045). In a model of multiple logistic regression, COVID-19 was associated with increased severity of delirium (p≤0.001) adjusted for confounding factors. Conclusion: COVID-19 is not associated with higher prevalence or duration of delirium. However, it seems to be associated with severe forms with increasing doses of antipsychotics needed its control.

Clinical characteristics and outcomes of critically ill covid-19 patients admitted to an infectious diseases intensive care unit in Portugal

Objective: We aimed to describe the characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) admitted to an intensive care unit (ICU) in Portugal. Design: This is an observational retrospective study. Demographic and clinical data were col-lected. Respiratory failure treated with invasive mechanical ventilation (IMV) and death during ICU stay were the main outcomes evaluated. Setting: This study was conducted in the Infectious Diseases ICU of Centro Hospitalar e Uni-versitário de São João, in Porto, Portugal, be-tween March 11 and August 17, 2020. Patients and participants: All consecutive patients with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infec-tion, admitted to the ICU during the study peri-od were enrolled, and 62 patients were included. Measurements and results: The median age was 71 years (IQR, 54-78) and 39 (62.9%) were male. Thirty-four (54.8%) patients received. IMV in contrast to 28 (45.2%) who were not intubated and the median lowest PaO2/FiO2 was 86 (IQR, 70-113) in IMV and 150 (94-257) in non-IMV patients. Several patients with severe hypoxemic COVID-19 were treated without IMV, especially with high flow nasal cannu-la (HFNC). Overall mortality was 21.8% and older age, male sex, active cancer, lower lym-phocyte count, higher aspartate aminotransfer-ase (AST) level, and higher creatinine level at admission, hematologic dysfunction, and renal dysfunction during ICU stay were all associated with fatal outcome. Mortality was lower than observed in other series of critically ill patients, although comparisons are limited by different ICU admission criteria, management practices, and duration of follow-up. Conclusions: This study provides data regard-ing the characteristics and outcomes of COVID-19 critically ill patients that can be used to op-timize ICU preparedness in the future. © 2021, The Indonesian Foundation of Critical Care Medicine. All rights reserved.