ABSTRACT
Introduction: Long-term clinical management and evolution of a cohort of critical COVID-19 survivors has not been well described. Method(s): We report a prospective observational study of COVID-19 patients admitted to ICU between March to August 2020. The follow-up comprised symptoms, pulmonary function test, 6-minute walking test (6MWT, and chest computed tomography (CT). Additionally, questionnaires to evaluate the prevalence of post-covid19 syndrome was performed at 1-year. Result(s) and Conclusion(s): A total of 181 patients were admitted at the ICU during the study period. They were predominantly middle-aged (median [IQR] of 61 [52;67] years old) male (66.9%) with a median of ICU stay of 9 (5- 24.2) days. Twenty percent of them died in the hospital and 39 were not able to be included, a final cohort of 105 patients initiated the follow-up. At one year, 32.2% persist with respiratory alterations and needed to continue the follow-up. 10% still had severe lung diffusing (DLCO) involvement (<60%) and 53.7% had a fibrotic pattern on CT. Moreover, patients had a mean (SD) of symptoms of 5.77 (4.66) and 61.3% meet criteria for post-covid syndrome at one-year. During the follow-up 46 patients were discharge and 16 were transfer to others consultations. Other conditions such as emphysema (21.6%), COPD (8.2%), severe neurocognitive disorders (4.1%) and lung cancer (1%) have been identified. A high use of healthcare resources is observed in the first year of these critical survivors after hospital discharge.
ABSTRACT
Background More than 20% of hospitalized patients with coronavirus disease 2019 (COVID-19) develop acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) admission. The long-term respiratory sequelae in ICU survivors remain unclear. Aim: To perform a detailed characterization of the long-term pulmonary sequelae in critical COVID-19 survivors. Study Design and Methods Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-minute walking test (6MWT)) and chest computed tomography (CT). Results 125 ICU patients with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%), and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The mean distance in the 6MWT was 401±93 mts. CT scans were abnormal in 70.2% of patients, showing reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT had worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT were age and prone position during the ICU stay. Interpretation Pulmonary structural abnormalities and functional impairment are highly prevalent in surviving ICU patients with ARDS secondary to COVID-19 3 months after hospital discharge. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months post discharge.