ABSTRACT
Introduction/Aim: Medium and long-term impacts of COVID-19 pneumonitis are being increasingly recognised. Our study aimed to evaluate outcomes of hospitalised COVID-19 patients with moderate-to-severe respiratory compromise. Method(s): Patients admitted to a tertiary centre with COVID-19 pneumonitis (March 2020-October 2022) were followed in the Post-COVID Respiratory Clinic at 6-24 weeks. Baseline demographics, admission details, pulmonary function tests (PFTs), and clinic data were collected. Univariable and multivariable logistic regression were performed to investigate for predictors of persisting respiratory symptoms (dyspnoea, cough, chest pain) and functional limitation (self-reported). Result(s): 125 patients (64.8%male, 63.2+/-16.7years, 42.5% former/current smokers, BMI 31.0+/-8.0kg/m2, 49.6% fully vaccinated) with median follow-up time of 85 [interquartile range (IQR) 64-131] days were included. Pre-existing conditions included lung disease (29.6%), immunocompromise (15.2%), diabetes (24.8%) and hypertension (43.6%). 35.2% required ICU care (14.4% mechanical ventilated, 4% ECMO), 44.8% received high flow nasal prong oxygen and/or continuous positive airway pressure (CPAP). At initial clinic follow up, 65.4% had persisting X-ray changes. Mean predicted FEV1, FVC, DLCO were 86.8+/-20.7%, 85.3+/-20.3%, 82.2+/-19.8% respectively. Symptoms included dyspnoea (63.2%), fatigue (24.2%), cognitive dysfunction (12.9%) and musculoskeletal complaints (10.5%). Univariate predictors of continued respiratory and/or functional disability included age [odds ratio (OR) 1.03, 95%confidence interval (CI) 1.01-1.06, p = 0.01), prior lung disease (OR2.98, 95%CI 1.05-8.48, p = 0.04), hypertension OR2.61, 95%CI 1.09-6.22, p = 0.03) and length of hospital stay (LOHS) (OR1.03, 95%CI 1.00-1.07, p = 0.04). On multivariable analysis, only LOHS was independently predictive of continued respiratory and functional limitations (OR1.03, 95%CI 1.00-1.07, p = 0.02). Conclusion(s): Patients recovering from COVID-19 pneumonitis have a large burden of disability at follow-up. Older age, hypertension, lung disease and LOHS are risk factors for delayed recovery.
ABSTRACT
Introduction/Aim: The use of veno-venous Extracorporeal Membrane Oxygenation (V-V ECMO) in the management of refractory respiratory failure due to viral illnesses has increased with recent pandemics. The aim of this study is to describe the clinical characteristics and outcomes of hospitalized patients with COVID-19 requiring ECMO and compare this population to that observed during the H1N1-influenza pandemic at Royal Prince Alfred Hospital (RPAH). Methods: Between March to October 2021, medical records of inpatients diagnosed with COVID-19 at RPAH requiring v-v ECMO were analysed. The clinical characteristics and outcomes of these patients were compared to data from patients with H1N1 influenza requiring ECMO at RPAH between July 2009 and August 2017. The primary outcome was analysed using Cox Regression Model, categorical variables were analysed using Fisher's exact test and continuous variables were analysed using two-sample T-test. Results: ECMO was used for 18 patients with COVID-19 and 32 patients for H1N1 at RPAH. The COVID-19 group was older. Both groups were obese with low rates of comorbidities prior to admission. The in-hospital mortality rate was significantly higher for the COVID-19 group with an odds ratio of 6.31 (95%CI 1.3-30.0;p = 0.01). Days on ECMO were longer in the COVID-19 group, with similar rates of ECMO related complications. There was a trend to higher rates of secondary infection in the COVID group, with a significant increase in blood stream infections compared to the H1N1 group. Conclusion: Our single centre experience demonstrates the significant in-hospital morbidity and mortality of severe COVID-19 requiring ECMO above and beyond that experienced during the H1N1 pandemic. (Figure Presented).