ABSTRACT
AIM: To determine whether the duration of respiratory distress symptoms in severe COVID-19 pneumonia affects the need for invasive mechanical ventilation and clinical outcomes. MATERIALS AND METHODS: An observational multicentre cohort study of patients hospitalised in five COVID-19-designated ICUs of the University Hospitals of Emilia-Romagna Region. Patients included were adults with pneumonia due to SARS-CoV-2 with PaO2/FiO2 ratio <300 mmHg, respiratory distress symptoms, and need for mechanical ventilation (invasive or non-invasive). Exclusion criteria were an uncertain time of respiratory distress, end-of-life decision, and mechanical respiratory support before hospital admission. MEASUREMENTS AND MAIN RESULTS: We analysed 171 patients stratified into tertiles according to respiratory distress duration (distress time, DT) before application of mechanical ventilation support. The rate of patients requiring invasive mechanical ventilation was significantly different (p < 0.001) among the tertiles: 17/57 patients in the shortest duration, 29/57 in the intermediate duration, and 40/57 in the longest duration. The respiratory distress time significantly increased the risk of invasive ventilation in the univariate analysis (OR 5.5 [CI 2.48-12.35], p = 0.003). Multivariable regression analysis confirmed this association (OR 10.7 [CI 2.89-39.41], p < 0.001). Clinical outcomes (mortality and hospital stay) did not show significant differences between DT tertiles. DISCUSSION: Albeit preliminary and retrospective, our data raised the hypothesis that the duration of respiratory distress symptoms may play a role in COVID-19 patients' need for invasive mechanical ventilation. Furthermore, our observations suggested that specific strategies may be directed towards identifying and managing early symptoms of respiratory distress, regardless of the levels of hypoxemia and the severity of the dyspnoea itself.
ABSTRACT
Background and aims: We investigated cognitive and affective disorders in patients with SARS-CoV-2 hospitalized in Intensive Care Unit (ICU). Care givers quality of life, psychological distress and satisfaction with the information received by health-care professionals were assessed. Methods: From March 1 to April 30, 2020, 22 consecutive patients with SARS-CoV-2 infection, confirmed by PCR on oronasopharyngeal swab, requiring ICU admission were recruited together with a caregiver. Patients with previous cognitive disorders were excluded. Three months after ICU discharge, patients underwent a comprehensive neuropsychological evaluation and filled out validated questionnaires. Results: Seven of 22 resulted mildly cognitively impaired. Memory was the most impaired domain, followed by attention and verbal fluency. Three out of 22 patients reported an average high level of anxiety but no depression. Quality of life was mild impaired for 19 patients. Lower performances at MoCA were related to higher APACHE score at T0 (r = −.44;p <.04). Lower performances in working memory, short- and long-term memory and verbal fluency were correlated to longer ICU stay, duration of mechanical ventilation and longer treatment with opioid and antipsychotics drugs (rs > −.48;ps <.04). Long term memory performances were related to higher Sequential Organ Failure assessment (SOFA) score and longer treatment with propofol and benzodiazepines (rs > −.53;ps <.02). Higher patient’s anxiety was correlated to higher psychological distress of the caregiver (r = −.64;p <.001). Higher SOFA score is related to lower caregiver quality of life and lower satisfaction with information received (rs > −.53;ps <.02). Conclusions: At 3 months from ICU admission, cognitive and psychological distress sequelae can be observed in SARS-CoV2 ICU patients.