1
|
Serpa Neto A, Higgins AM, Bailey MJ, Anderson S, Bernard S, Fulcher BJ, Jones A, Linke NJ, Board JV, Brodie D, Buhr H, Burrell AJC, Cooper DJ, Fan E, Fraser JF, Gattas DJ, Hopper IK, Huckson S, Litton E, McGuinness SP, Nair P, Orford N, Parke RL, Pellegrino VA, Pilcher DV, Dicker C, Reddi BAJ, Stub D, Trapani TV, Udy AA, Hodgson CL. Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter Study. Circ Heart Fail 2025:e012476. [PMID: 40298907 DOI: 10.1161/circheartfailure.124.012476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 04/15/2025] [Indexed: 04/30/2025]
Abstract
BACKGROUND Long-term outcomes and quality of life have been identified as core patient-centered outcomes for venoarterial extracorporeal membrane oxygenation (VA-ECMO) research. The aim of this study is to investigate the incidence of death or new disability at 12 months after the initiation of VA-ECMO. METHODS Prospective, multicenter, registry-embedded cohort study in 26 hospitals in Australia and New Zealand from February 2019 through April 2023. Adult patients admitted to a participating ICU and who underwent VA-ECMO were included. The primary outcome was death or new disability at 6 and 12 months. All results were adjusted for patient characteristics at the time of ECMO initiation. RESULTS Among 389 patients who received VA-ECMO (median age, 57 [44-65] years; 35% female), the incidence of death or new disability at 12 months was 70.6% compared with 70.8% at 6 months (adjusted odds ratio for 12 versus 6 months, 0.61 [95% CI, 0.25-1.49]; P=0.27). Compared with 6 months, at 12 months after VA-ECMO more patients were independent in activities of daily living (62.1% versus 48.2%; adjusted odds ratio, 2.84 [95% CI, 1.50-5.36]; P=0.001), and fewer patients were unemployed due to health reasons (32.7% versus 47.4%; adjusted odds ratio, 0.29 [95% CI, 0.13-0.65]; P<0.001). Differences in outcomes were found according to the reason for VA-ECMO initiation. CONCLUSIONS At 12 months after VA-ECMO, 30% of patients are alive and without disability, with differences in outcome associated with the reason for VA-ECMO initiation. The major burden of disability appears to develop in the first 6 months after VA-ECMO initiation and is sustained between 6 and 12 months. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03793257.
Collapse
Affiliation(s)
- Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia (A.S.N., M.J.B., C.L.H.)
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil (A.S.N.)
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
| | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia (A.S.N., M.J.B., C.L.H.)
| | - Shannah Anderson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
| | - Stephen Bernard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. (S.B., I.K.H., D.S.)
- Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.)
| | - Bentley J Fulcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
| | - Annalie Jones
- Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.)
| | - Natalie J Linke
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
| | - Jasmin V Board
- Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.)
| | - Daniel Brodie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.B.)
| | - Heidi Buhr
- Intensive Care Service, Royal Prince Alfred Hospital, Melbourne, Victoria, Australia (H.B., D.J.G.)
| | - Aidan J C Burrell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
- Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.)
| | - D James Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
- Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.)
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Ontario, Canada (E.F.)
| | - John F Fraser
- University of Queensland, Brisbane, Australia (J.F.F.)
- Critical Care Research Group, Adult Intensive Care Society, Prince Charles Hospital, Brisbane, Queensland, Australia (J.F.F.)
| | - David J Gattas
- Intensive Care Service, Royal Prince Alfred Hospital, Melbourne, Victoria, Australia (H.B., D.J.G.)
| | - Ingrid K Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. (S.B., I.K.H., D.S.)
| | - Sue Huckson
- Australian and New Zealand Intensive Care Society, Melbourne, Victoria, Australia (S.H.)
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Melbourne, Victoria, Australia (E.L.)
| | - Shay P McGuinness
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
- Medical Research Institute of New Zealand, Wellington (S.P.M.G., R.L.P.)
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, New Zealand (S.P.M.G., R.L.P.)
| | - Priya Nair
- Intensive Care Unit, St Vincent's Hospital, Melbourne, Victoria, Australia (P.N.)
| | - Neil Orford
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
- Intensive Care Unit, University Hospital Geelong, Melbourne, Victoria, Australia (N.O.)
- School of Medicine, Deakin University, Melbourne, Victoria, Australia (N.O.)
| | - Rachael L Parke
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
- Medical Research Institute of New Zealand, Wellington (S.P.M.G., R.L.P.)
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, New Zealand (S.P.M.G., R.L.P.)
| | - Vincent A Pellegrino
- Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.)
| | - David V Pilcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
- Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.)
| | - Craig Dicker
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
| | - Benjamin A J Reddi
- Intensive Care Unit, Royal Adelaide Hospital, Melbourne, Victoria, Australia (B.A.J.R.)
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. (S.B., I.K.H., D.S.)
- Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.)
| | - Tony V Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
- Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.)
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia. (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.)
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Victoria, Australia (A.S.N., M.J.B., C.L.H.)
- Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia (S.B., A.J., J.V.B., A.J.C.B., D.J.C., V.A.P., D.V.P., D.S., A.A.U., C.L.H.)
| |
Collapse
|
2
|
Taniguchi LU, Gonçalves NG, Ferreira NV, Bertola L, Avelino-Silva TJ, Dias MB, Hajjar LA, Jacob-Filho W, Suemoto CK, Aliberti MJR. Discordance between physical and cognitive health problems over one year after critical care: Insights from severe COVID-19 patients. J Nutr Health Aging 2025; 29:100547. [PMID: 40147062 DOI: 10.1016/j.jnha.2025.100547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 03/04/2025] [Accepted: 03/19/2025] [Indexed: 03/29/2025]
Abstract
OBJECTIVES To investigate the longitudinal evolution of physical and cognitive problems after hospital discharge in survivors of severe COVID-19; to describe the co-occurrence of these health problems domains in the following year after discharge; and evaluate if results are different taking into account the use of invasive mechanical ventilation. DESIGN Prospective cohort study. SETTING A large academic medical center in Brazil. PARTICIPANTS Patients aged ≥50 years who survived hospitalization for COVID-19 requiring critical care. MEASUREMENTS We evaluated participants' status before hospital admission and one, three, six, nine, and twelve months after hospital discharge using validated questionnaires to measure frailty, persistent physical symptoms, and cognitive function. Clusters of physical and cognitive problems were defined using sequential analysis. Concordance was studied between different problems and trajectories, and after stratifying for use of invasive mechanical ventilation during ICU stay. RESULTS We included 428 participants (median age was 63 years, 57% were male, 14% were frail before COVID-19, and 61% required mechanical ventilation). Physical and/or cognitive problems were experienced in 83% of responders at least once during follow-up, and half reported any problem even after one year. Most participants experienced health problems in a single health domain, with co-occurrence less than 9% in every assessment (Cramer's V bias-corrected less than 0.1 in any assessment). Sequential analysis identified three clusters each of cognitive and physical trajectories, with different evolution and no concordance. Stratifying the sample based on the use of mechanical ventilation did not change the results. CONCLUSIONS Severe COVID-19 survivors frequently experience physical and/or cognitive problems, yet these conditions and their trajectories are discordant. Multidimensional evaluations post-ICU discharge can aid in delivering tailored rehabilitation programs.
Collapse
Affiliation(s)
- Leandro U Taniguchi
- Intensive Care and Emergency Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio Libanês, São Paulo, Brazil; Brazilian Research in Intensive Care Network (BRICnet), São Paulo, Brazil.
| | - Natalia G Gonçalves
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Naomi V Ferreira
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Laiss Bertola
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil; Faculdade Israelita de Ciencias da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Murilo B Dias
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Ludhmila A Hajjar
- Intensive Care and Emergency Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Claudia K Suemoto
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Márlon J R Aliberti
- Hospital Sírio Libanês, São Paulo, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| |
Collapse
|
3
|
Paulo MF, Lago AF, Bellíssimo-Rodrigues F, da Silva JM, Basile-Filho A. Comparative analysis of demographic, clinical, biochemical, and predictors of mortality in COVID-19 and NON-COVID-19 ARDS patients: A retrospective cohort study. Medicine (Baltimore) 2025; 104:e41851. [PMID: 40128087 PMCID: PMC11936669 DOI: 10.1097/md.0000000000041851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 02/24/2025] [Indexed: 03/26/2025] Open
Abstract
The COVID-19 pandemic has brought a significant increase in the incidence of acute respiratory distress syndrome (ARDS). This retrospective study aims to compare the differences in demographic, clinical, and biochemical variables and predictive factors in 2 situations of ARDS cause (COVID-19 vs NON-COVID-19) in patients admitted to the intensive care unit. The Mann-Whitney rank-sum test was performed for quantitative variables, and Fisher exact test for qualitative variables. 115 patients with ARDS were enrolled (53 patients with COVID-19 ARDS and 62 NON-COVID-19 ARDS). The COVID-19 ARDS group consisted of 33 male patients (66.2%), whereas the NON-COVID-19 ARDS group had 25 male patients (40.3%) (P = .0248). The median and interquartile age difference of the COVID-19 ARDS group was 64.0 [52.0-69.5], and non-COVID-19 ARDS was 49.0 [34.0-63.0] (P = .0011). Body mass index, simplified acute physiology score, sequential organ failure assessment, and intensive care unit length of stay, with P-values of .0061, .0002, .0003, and <.0001, respectively (COVID-19 vs NON-COVID-19 ARDS). Diabetes, arterial hypertension, venous thrombosis, and chronic obstructive pulmonary disease had values of <.0001, .0234, .0358, and .0001, respectively. On the other hand, the NON-COVID-19 ARDS group had a greater need for dialysis (P = .0109). The stepwise logistic regression showed that relevant clinical, and demographic characteristics associated with ARDS due to COVID-19, such as male gender, diabetes, chronic obstructive pulmonary disease, and body mass index, were independent prognostic factors of severity in patients with COVID-19 ARDS, compared to NON-COVID-19 ARDS. The overall mortality rate was 62.9% for COVID-19 ARDS and 77.4% for the non-COVID-19 ARDS group (P = .2950). Ventilatory parameters of COVID-19 ARDS and NON-COVID-19 ARDS were similar.
Collapse
Affiliation(s)
- Matheus Furlan Paulo
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil
| | | | - Fernando Bellíssimo-Rodrigues
- Department of Social Medicine – Biostatistics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - João Manoel da Silva
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Anibal Basile-Filho
- Division of Intensive Care Medicine, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
4
|
Taher MK, Salzman T, Banal A, Morissette K, Domingo FR, Cheung AM, Cooper CL, Boland L, Zuckermann AM, Mullah MA, Laprise C, Colonna R, Hashi A, Rahman P, Collins E, Corrin T, Waddell LA, Pagaduan JE, Ahmad R, Jaramillo Garcia AP. Global prevalence of post-COVID-19 condition: a systematic review and meta-analysis of prospective evidence. Health Promot Chronic Dis Prev Can 2025; 45:112-138. [PMID: 40073162 PMCID: PMC12039764 DOI: 10.24095/hpcdp.45.3.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2025]
Abstract
INTRODUCTION We investigated the prevalence of new or persistent manifestations experienced by COVID-19 survivors at 3 or more months after their initial infection, collectively known as post-COVID-19 condition (PCC). METHODS We searched four electronic databases and major grey literature resources for prospective studies, systematic reviews, authoritative reports and population surveys. A random-effects meta-analysis pooled the prevalence data of 22 symptoms and outcomes. The GRADE approach was used to assess the certainty of evidence. PROSPERO CRD42021231476. RESULTS Of 20 731 identified references, 194 met our inclusion criteria. These studies followed 483 531 individuals with confirmed COVID-19 diagnosis over periods of up to 2 years. Most focused on adults, nearly two-thirds were conducted in Europe and 63% were of high or moderate quality. The supplementary search identified 17 systematic reviews, five authoritative reports and four population surveys that reported on PCC prevalence. Our analysis revealed that more than half of COVID-19 survivors experienced one or more symptoms more than a year after their initial infection. The most common symptoms were fatiguedyspneamemory, sleep or concentration disturbances; depressionand pain. Limitation in returning to work was the most common outcome. Prevalence tended to be higher among females, individuals hospitalized during their initial infection and those who experienced severe COVID-19 illness. CONCLUSION PCC presents a significant health burden, affecting some groups more than others. This information will help inform health care system policies and services for people living with PCC and those caring for them.
Collapse
Affiliation(s)
- Mohamed Kadry Taher
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Talia Salzman
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Allyson Banal
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Kate Morissette
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Francesca R Domingo
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Angela M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute and Schroeder Arthritis Institute, Toronto, Ontario, Canada
| | - Curtis L Cooper
- Department of Medicine, University of OttawaOttawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Laura Boland
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Alexandra M Zuckermann
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Muhammad A Mullah
- Infectious Disease and Vaccination Programs Branch, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Claudie Laprise
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Quebec, Canada
| | - Roberto Colonna
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Ayan Hashi
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Prinon Rahman
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Erin Collins
- Population Health Modelling Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario,Canada
| | - Tricia Corrin
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Lisa A Waddell
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Jason E Pagaduan
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Rukshanda Ahmad
- Risk Assessment Division, Centre for Surveillance, Integrated Insights and Risk Assessment, Data, Surveillance and Foresight Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Alejandra P Jaramillo Garcia
- Evidence Synthesis and Knowledge Translation Unit, Centre for Surveillance and Applied Research, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| |
Collapse
|
5
|
Fernando SM, Qureshi D, Ante Z, Talarico R, McIsaac DI, Urner M, Munshi L, Rochwerg B, Needham DM, Hodgson CL, Brodie D, Fowler RA, Slutsky AS, Scales DC, Herridge MS, Tanuseputro P, Fan E. One-Year Mortality and Hospital Readmission in Survivors of COVID-19 Critical Illness-A Population-Based Cohort Study. Crit Care Med 2025:00003246-990000000-00476. [PMID: 40013851 DOI: 10.1097/ccm.0000000000006603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2025]
Abstract
OBJECTIVES To evaluate 1-year outcomes (mortality, and recurrent hospital and ICU readmission) in adult survivors of COVID-19 critical illness compared with survivors of critical illness from non-COVID-19 pneumonia. DESIGN Population-based retrospective observational cohort study. SETTING Province of Ontario, Canada. PATIENTS Six thousand ninety-eight consecutive adult patients (≥ 18 yr old) from 102 centers, admitted to ICU with COVID-19 (from January 1, 2020, to March 31, 2022), and surviving to hospital discharge. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was 1-year mortality. We also evaluated the number of emergency department (ED) visits, hospital readmissions, and ICU readmissions over this same time period. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. Mean age was 59.6 years and 38.5% were female. Of these patients, 1610 (26.4%) and 375 (6.1%) were readmitted to hospital and ICU, respectively, and 917 (15.0%) died within 1 year. Compared with survivors of critical illness from non-COVID-19 pneumonia (n = 2568), those who survived COVID-19 critical illness had a lower risk of ED visit (hazard ratio [HR], 0.65 [95% CI, 0.60-0.71]), hospital readmission (HR, 0.56 [95% CI, 0.51-0.62]), ICU readmission (HR, 0.44 [95% CI, 0.37-0.53]), and mortality (HR, 0.67 [95% CI, 0.58-0.78]) within 1 year. CONCLUSIONS Risk of ED visit, hospital readmission, ICU readmission, and mortality within 1 year of discharge among survivors of COVID-19 critical illness was lower than survivors of critical illness from non-COVID-19 pneumonia.
Collapse
Affiliation(s)
- Shannon M Fernando
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Critical Care, Lakeridge Health, Oshawa, ON, Canada
| | - Danial Qureshi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- ICES, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | | | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Martin Urner
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dale M Needham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, VIC, Australia
| | - Daniel Brodie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert A Fowler
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Damon C Scales
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Muto Y, Hosozawa M, Hori M, Iba A, Maruyama S, Morioka S, Teruya K, Nishida T, Harada T, Yoshida H, Miike S, Kawauchi A, Kato H, Hatakeyama J, Fujitani S, Asahi T, Nakamura K, Sato Y, Oshima T, Nagashima F, Ota K, Fuchigami T, Nosaka N, Kamijo H, Hattori T, Taniguchi H, Iso H. Post COVID-19 condition in hospitalized survivors after one year of infection during the Alpha- and Delta-variant dominant waves in Japan: COVID-19 Recovery Study II. J Epidemiol 2025:JE20240179. [PMID: 39924249 DOI: 10.2188/jea.je20240179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2025] Open
Abstract
BackgroundEvidence of post-COVID-19 condition (PCC) in the Alpha- and Delta-variant dominant waves is limited.MethodsIn a nationwide multicentre cohort study in collaboration with 20 hospitals, we collected data using self-administered questionnaires and electronic medical records of participants aged 20 or more diagnosed with COVID-19, hospitalized between Apr 1 2021 and Sept 30 2021, and discharged alive. Descriptive statistics were analyzed for PCC and mental health (HADS anxiety and depression scores), comparing Alpa and Delta-dominant waves.ResultsWe analyzed 1,040 patients (median age, 57 [IQR 49-66] years; men, 66.2%). Of the respondents, 45.4% had at least one PCC symptom one year after infection. The common symptoms included dyspnea (20.7%), fatigue/malaise (17.6%), muscle weakness (15.4%), decrease in concentration (13.4%), and sleep disorder (13.3%), followed by brain fog (8.4%). Among patients with PCC, 14.0% had anxiety (HADS-Anxiety ≥11), and 18.6% had depression (HADS-Depression ≥11), with four times higher proportions than those without PCC; only small variations by age, sex, and waves were observed. Associated factors for PCC were age 40 years or over, women, severity of COVID-19 during hospitalization, ex-smokers who quit smoking before COVID-19 infection and being infected during the Delta-variant dominant wave.ConclusionThe study described the prevalence of PCC, associated factors, and mental health of COVID-19 survivors hospitalized during the Alpha and Delta-variant dominant waves in Japan. Further follow-up will be conducted to examine the longer-term impact of COVID-19 on PCC, complications, daily life, and socioeconomic status.
Collapse
Affiliation(s)
- Yoko Muto
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation, National Center for Global Health and Medicine
| | - Mariko Hosozawa
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation, National Center for Global Health and Medicine
| | - Miyuki Hori
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation, National Center for Global Health and Medicine
| | - Arisa Iba
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation, National Center for Global Health and Medicine
| | - Shuhei Maruyama
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center
| | - Shinichiro Morioka
- Disease Control and Prevention Center, National Center for Global Health and Medicine
| | - Katsuji Teruya
- AIDS Clinical Center, National Center for Global Health and Medicine
| | - Takeshi Nishida
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center
- Department of Acute Medicine and Intensive Care Medicine, Osaka University Hospital
| | - Toshiyuki Harada
- Center for Respiratory Disease, Department of Respiratory Medicine, Japan Community Healthcare Organization Hokkaido Hospital
| | - Hideki Yoshida
- Department of Emergency and Critical Care Medicine, St. Marianna University Yokohama Seibu Hospital
| | - Satoshi Miike
- Department of Emergency and Critical Care Medicine, St. Marianna University Yokohama Seibu Hospital
| | - Akira Kawauchi
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine
| | | | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital
- Department of Critical Care Medicine, Yokohama City University Hospital
| | - Yuichi Sato
- Department of Emergency and Critical Care, Tokyo Metropolitan Tama Medical Center
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine
| | - Futoshi Nagashima
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Tatsuya Fuchigami
- Department of Anesthesiology and Intensive Care Medicine, University of the Ryukyus Hospital
| | - Nobuyuki Nosaka
- Department of Intensive Care Medicine, Tokyo Medical and Dental University
| | - Hiroshi Kamijo
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine
| | - Takeshi Hattori
- Department of Respiratory Medicine, National Hospital Organization, Hokkaido Medical Center
| | - Hayato Taniguchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center
| | - Hiroyasu Iso
- Institute for Global Health Policy Research (iGHP), Bureau of International Health Cooperation, National Center for Global Health and Medicine
| |
Collapse
|
7
|
Fernando SM, Qureshi D, Talarico R, Fan E, McIsaac DI, Vigod SN, Sood MM, Myran DT, Hodgson CL, Rochwerg B, Munshi L, Fiest KM, Bienvenu OJ, Needham DM, Brodie D, Ferguson ND, Fowler RA, Cook DJ, Slutsky AS, Scales DC, Herridge MS, Tanuseputro P, Kyeremanteng K. Long-Term Mental Health Morbidity in Adult Survivors of COVID-19 Critical Illness: A Population-Based Cohort Study. Chest 2025:S0012-3692(25)00105-9. [PMID: 39848569 DOI: 10.1016/j.chest.2025.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 12/15/2024] [Accepted: 01/06/2025] [Indexed: 01/25/2025] Open
Abstract
BACKGROUND Surviving COVID-19 critical illness may be associated with important long-term sequelae, but little is known regarding mental health outcomes. RESEARCH QUESTION What is the association between COVID-19 critical illness and new mental health diagnoses after discharge? STUDY DESIGN AND METHODS We conducted a population-based cohort study in Ontario, Canada (January 1, 2020-March 31, 2022). We included consecutive adult survivors (age ≥ 18 years) of COVID-19 critical illness and compared them with consecutive adult survivors of critical illness from non-COVID-19 pneumonia. The primary outcome was a new mental health diagnosis (a composite of mood, anxiety, or related disorders; schizophrenia or psychotic disorders; and other mental health disorders) after hospital discharge. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. RESULTS We included 6,098 survivors of COVID-19 critical illness and 2,568 adult survivors of critical illness from non-COVID-19 pneumonia at 102 centers. Incidence of new mental health diagnosis among survivors of COVID-19 critical illness was 25.3 diagnoses per 100 person-years (95% CI, 24.0-26.6 diagnoses), and 25.9 diagnoses per 100 person-years (95% CI, 24.0-27.8 diagnoses) among survivors of non-COVID-19 pneumonia. After propensity weighting, COVID-19 critical illness was not associated with increased risk of new mental health diagnosis overall (hazard ratio [HR], 1.08; 95% CI, 0.96-1.23), but was associated with increased risk in the category of new mood, anxiety, or related disorders (HR, 1.21; 95% CI, 1.05-1.40). No difference was seen in psychotic disorders, other mental health diagnoses, social problems, or deliberate self-harm. INTERPRETATION As compared with survival after critical illness resulting from non-COVID-19 pneumonia, survival after COVID-19 critical illness was not associated with increased risk of the composite outcome of new mental health diagnosis, but was associated with elevated risk of new mood, anxiety, or related disorders. CLINICAL TRIAL REGISTRY Center for Open Science; URL: www.archive.org/details/osf-registrations-pfn6q-v1.
Collapse
Affiliation(s)
- Shannon M Fernando
- Department of Critical Care, Lakeridge Health, Oshawa; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Division of Critical Care, Ottawa.
| | - Danial Qureshi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Bruyère Research Institute, Ottawa; Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; ICES, Toronto
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, Toronto; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto; Toronto General Hospital Research Institute, University Health Network, Toronto; Department of Medicine, Sinai Health System and University Health Network, Toronto
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; School of Epidemiology and Public Health, Ottawa; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa; ICES, Toronto
| | - Simone N Vigod
- ICES, Toronto; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto; Department of Psychiatry, University of Toronto, Toronto; Women's College Hospital and Research Institute, Toronto
| | - Manish M Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Division of Nephrology, Department of Medicine, Ottawa; School of Epidemiology and Public Health, Ottawa; ICES, Toronto
| | | | - Carol L Hodgson
- Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, VIC, Australia
| | - Bram Rochwerg
- Division of Critical Care, Department of Medicine, Hamilton, ON; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Toronto; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto; Department of Medicine, Sinai Health System and University Health Network, Toronto
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Calgary, AB, Canada; Department of Psychiatry and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | | | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Baltimore, MD
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, Toronto; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto; Toronto General Hospital Research Institute, University Health Network, Toronto; Department of Medicine, Sinai Health System and University Health Network, Toronto
| | - Robert A Fowler
- ICES, Toronto; Interdepartmental Division of Critical Care Medicine, Toronto; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto
| | - Deborah J Cook
- Division of Critical Care, Department of Medicine, Hamilton, ON; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, Toronto; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
| | - Damon C Scales
- ICES, Toronto; Interdepartmental Division of Critical Care Medicine, Toronto; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, Toronto; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto; Toronto General Hospital Research Institute, University Health Network, Toronto; Department of Medicine, Sinai Health System and University Health Network, Toronto
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Bruyère Research Institute, Ottawa; ICES, Toronto; Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Kwadwo Kyeremanteng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa; Division of Critical Care, Ottawa; Institut du Savoir Montfort, Hôpital Montfort, Ottawa
| |
Collapse
|
8
|
De Silva S, Neto AS, Sathe A, Higgins AM, Hodgson CL. The Psychometric Properties of the EuroQol 5D Five Level in Survivors of Critical Illness. Crit Care Med 2025; 53:e151-e160. [PMID: 39774206 DOI: 10.1097/ccm.0000000000006516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
OBJECTIVES The EuroQol 5D five level (EQ-5D-5L) instrument is a standardized measure of health-related quality of life and is routinely used in survivors of critical illness. However, information on its psychometric properties and minimal clinically important difference (MCID) in this patient group is lacking. DESIGN Secondary analysis of data from the previously published PREDICT (a registry in critically ill patients to determine predictors of disability-free survival) study, a prospective, multicenter cohort study. SETTING Six ICUs in the state of Victoria, Australia. PATIENTS Four hundred fifty adult patients admitted to the ICU and ventilated for over 24 hours. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The EQ-5D-5L was administered by telephone at 6 months following ICU admission. Internal consistency (inter-item correlations, Cronbach's α, and split-half reliability coefficients), construct validity (against age, body mass index, and other outcome measures), responsiveness (observing change over time and effect sizes), percentage of participants presenting no change, and MCID (triangulation of distribution-based and anchor-based estimates) were evaluated. The EQ-5D-5L showed high internal consistency, Cronbach α coefficients of 0.82 (between dimensions) and 0.79 (between the EuroQol-Visual Analogue Scale [EQ-VAS] and utility score), and average split-half coefficients of 0.79 each (between dimensions and between EQ-VAS and utility score). Construct validity was confirmed with a strong correlation between the EQ-5D-5L and the World Health Organization Disability Assessment Schedule 2.0 (EQ-VAS: r = 0.72; p < 0.001 and utility score: r = 0.81; p < 0.001). Effect sizes for change over time for EQ-VAS and utility score were low. The final MCID estimates were 10 (EQ-VAS) and 0.11 (utility score). CONCLUSIONS The EQ-5D-5L, using the Australian value set, demonstrated evidence of good internal consistency and validity, but poor responsiveness in a critically ill population.
Collapse
Affiliation(s)
- Sheraya De Silva
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paolo, Brazil
| | - Aditya Sathe
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Medicine, Eastern Health, Melbourne, VIC, Australia
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
- Physiotherapy Department, Alfred Health, Melbourne, VIC, Australia
- Intensive Care Department, Alfred Health, Melbourne, VIC, Australia
| |
Collapse
|
9
|
Vrettou CS, Jolley SE, Mantziou V, Dimopoulou I. Clinical Comparison of Post-intensive Care Syndrome and Long Coronavirus Disease. Crit Care Clin 2025; 41:89-102. [PMID: 39547729 DOI: 10.1016/j.ccc.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2024]
Abstract
Post-intensive care syndrome (PICS) encompasses persistent physical, psychological, and cognitive impairments. The coronavirus disease of 2019 (COVID-19) pandemic highlighted parallels between PICS and "long COVID". There is an overlap between the 2 in risk factors, symptoms, and pathophysiology. Physical impairments in both include weakness and fatigue. Cognitive impairments include executive dysfunction in PICS and "brain fog" in long COVID. Mental health issues consist of depression, anxiety, and posttraumatic stress disorder in both disease states. Long COVID and PICS impact families, with multifaceted effects on physical health, mental well-being, and socioeconomic stability. Understanding these syndromes is crucial for comprehensive patient care and family support.
Collapse
Affiliation(s)
- Charikleia S Vrettou
- First Department of Critical Care Medicine, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 45-47, Ipsilantou street, 106 76, Athens, Greece.
| | - Sarah E Jolley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Colorado, 1635 Aurora Court, Anschutz Outpatient Pavilion, 7th Floor, Aurora, CO 80045, USA
| | - Vassiliki Mantziou
- First Department of Critical Care Medicine, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 45-47, Ipsilantou street, 106 76, Athens, Greece
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, 45-47, Ipsilantou street, 106 76, Athens, Greece
| |
Collapse
|
10
|
Sun C, Xie Y, Zhu C, Guo L, Xu B, Qin H, Li X. Prognostic value of serum Mrp 8/14 in sepsis-induced acute respiratory distress syndrome patients: a retrospective cohort study. PeerJ 2024; 12:e18718. [PMID: 39686985 PMCID: PMC11648679 DOI: 10.7717/peerj.18718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 11/25/2024] [Indexed: 12/18/2024] Open
Abstract
Background Mrp 8/14 is abundantly secreted by activated neutrophils during infection and inflammation. However, its prognostic value in acute respiratory distress dyndrome (ARDS) induced by sepsis is poorly understood. Our aim was to investigate the relationship between serum Mrp 8/14 and the prognosis in sepsis-induced ARDS patients admitted to the intensive care unit (ICU). Methods Serum Mrp 8/14 concentrations were analyzed in 118 ARDS patients induced by sepsis included in the analytical study. Patients were enrolled upon admission to the ICU of Nanjing Hospital affiliated to Nanjing Medical University. The baseline information and clinical outcomes were obtained. Patients were divided into survivor group and non-survivor group according to whether they died during ICU hospitalization. Results The serum Mrp 8/14 levels were significantly increased in the non-survivor group compared to the survivor group (P < 0.05). Logistic regression analysis showed that serum Mrp 8/14, albumin and APACHE II were the independent factors for predicting the prognosis of sepsis-induced ARDS during ICU hospitalization after adjustment. Additionally, the area under the receiver operating characteristic curve for Mrp 8/14 combined with albumin was associated with ICU mortality and was higher than that of Mrp 8/14, albumin, APACHE II and Mrp 8/14 combined with APACHE II (all P < 0.05). A nomogram was constructed to predict ICU mortality and the c-indexes of predictive accuracy was 0.830 in the cohort (P < 0.05). Conclusions The serum Mrp 8/14 upon ICU admission in septic patients may be useful for predicting mortality in sepsis-induced ARDS patients during ICU hospitalization.
Collapse
Affiliation(s)
- Caizhi Sun
- Department of Emergency Medicine, Lianyungang Clinical College, Nanjing Medical University, Lianyungang, Jiangsu, China
- Department of Emergency Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yongpeng Xie
- Department of Emergency Medicine, Lianyungang Clinical College, Nanjing Medical University, Lianyungang, Jiangsu, China
| | - Chenchen Zhu
- Department of Emergency Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Guo
- Department of Emergency Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bowen Xu
- Department of Emergency Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haidong Qin
- Department of Emergency Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaomin Li
- Department of Emergency Medicine, Lianyungang Clinical College, Nanjing Medical University, Lianyungang, Jiangsu, China
| |
Collapse
|
11
|
Heesakkers H, van der Hoeven JG, Corsten S, Janssen I, Ewalds E, Simons KS, de Blauw M, Rettig TCD, Jacobs C, van Santen S, Slooter AJC, van der Woude MCE, Zegers M, van den Boogaard M. One-year outcomes in COVID-19 and non-COVID-19 intensive care unit survivors. J Crit Care 2024; 84:154858. [PMID: 39003923 DOI: 10.1016/j.jcrc.2024.154858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To determine differences in one-year multi-domain health outcomes in COVID-19 and non-COVID-19 intensive care unit (ICU) survivors. MATERIALS AND METHODS Adult ICU survivors treated for COVID-19 were compared to a control group consisting of survivors admitted for respiratory distress due to other causes, i.e. non-COVID-19 ARDS or pneumonia. Occurrence of physical (frailty, fatigue, physical symptoms), mental (anxiety, depression, post-traumatic stress) and cognitive symptoms, and quality of life (QoL) scores were measured, using validated questionnaires, before and one year after ICU treatment. RESULTS In total, 506 COVID-19 survivors could be compared to 228 non-COVID-19 survivors. At one-year follow-up, COVID-19 ICU survivors had less physical (76.2% vs. 86.9%, p = 0.001) and mental symptoms (32.0% vs. 47.1%, p < 0.001) than the control group. Cognitive symptoms were comparable (22.5% vs. 17.2%, p = 0.12). However, compared to pre-ICU health symptoms and scores, COVID-19 survivors experienced an increase in symptom occurrence rates in all domains and a decrease in QoL, whereas the control group only experienced an increase in mental and cognitive symptoms, with a similar QoL at one-year follow-up. CONCLUSIONS COVID-19 ICU survivors experience equal or less health problems but a greater decline in QoL one year after ICU admission compared to non-COVID-19 ARDS or pneumonia survivors.
Collapse
Affiliation(s)
- Hidde Heesakkers
- Radboud university medical center, Department Intensive Care, Nijmegen, the Netherlands.
| | | | - Stijn Corsten
- Department of Intensive Care, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Inge Janssen
- Department of Intensive Care, Maasziekenhuis Pantein, Beugen, the Netherlands
| | - Esther Ewalds
- Department of Intensive Care, Bernhoven Hospital, Uden, the Netherlands
| | - Koen S Simons
- Department of Intensive Care, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Maaike de Blauw
- Department of Intensive Care, Rijnstate Hospital, Arnhem, the Netherlands
| | - Thijs C D Rettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Hospital, Breda, the Netherlands
| | - Crétien Jacobs
- Department of Intensive Care, Elkerliek Hospital, Helmond, the Netherlands
| | - Susanne van Santen
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Arjen J C Slooter
- Departments of Psychiatry and Intensive Care and UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | - Margaretha C E van der Woude
- Department of Intensive Care and department of quality and safety, Heerlen Medical Center, Heerlen, the Netherlands; Department of Intensive Care, Amsterdam UMC, location AC, Amsterdam, the Netherlands
| | - Marieke Zegers
- Radboud university medical center, Department Intensive Care, Nijmegen, the Netherlands
| | - Mark van den Boogaard
- Radboud university medical center, Department Intensive Care, Nijmegen, the Netherlands
| |
Collapse
|
12
|
Eklund R, Hjelmfors L, Nyquist S, Sveen J, Hultström M, Lipcsey M, Frithiof R, Wallin E, Larsson IM, Arnberg FK, Orwelius L. Surviving COVID-19: patients' experiences of care and path to recovery. Int J Qual Stud Health Well-being 2024; 19:2301953. [PMID: 38184794 PMCID: PMC10773674 DOI: 10.1080/17482631.2024.2301953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024] Open
Abstract
PURPOSE To examine patients' experiences of receiving care on an ICU for COVID-19 and the subsequent rehabilitation process. METHODS An explorative and inductive design was used. Participants were recruited from two university hospitals in Sweden. Patients admitted to the ICU due to COVID-19 from March 2020 to April 2021, who enrolled in the ICU follow-up, and understood and spoke Swedish were invited to participate. In total, 20 participants completed a semi-structured interview, of whom 18 were included in the thematic analysis. RESULTS The analysis resulted in two themes: "An isolated world with silver linings" and "Recovery in the wake of the pandemic". Findings show that patients cared for on an ICU for COVID-19 during the pandemic felt safe but experienced a sense of vulnerability. After discharge, physical rehabilitation was a slow process with frustrating day-to-day fluctuations. Mentally, participants felt isolated, fatigued, and emotionally sensitive. Patients reported that love and support from family and friends were crucial for the recovery process. CONCLUSIONS This study highlights the challenges of recovering from COVID-19, emphasizing the importance of continued support from health care, public services, family and friends. It provides important insights into patients' experiences and can inform future healthcare strategies and policies.
Collapse
Affiliation(s)
- Rakel Eklund
- National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Lisa Hjelmfors
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
| | - Sophia Nyquist
- Department of Addiction Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Josefin Sveen
- National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
- Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Michael Hultström
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
- Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Ewa Wallin
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Ing-Marie Larsson
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Filip K. Arnberg
- National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lotti Orwelius
- Department of Intensive Care, Linköping University Hospital, Linköping, Sweden
- Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
13
|
da Silva KRS, Prazeres DC, Gaspar S, de Souza FG, Chiavegato LD, Leite CF, de Castro SS, Carvalho CR, Volpe MS. Long-Term Disabilities in ICU Survivors of COVID-19. Respir Care 2024; 69:1508-1516. [PMID: 39438066 PMCID: PMC11573000 DOI: 10.4187/respcare.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
BACKGROUND COVID-19 is associated with prolonged disability, particularly after critical illness. This study aimed to assess and compare disability post-hospital discharge of subjects who were invasively ventilated versus those who were not, following ICU admission due to COVID-19. This study also explored variables associated with long-term disability. METHODS In this prospective cohort study, subjects with COVID-19 who received invasive ventilation, noninvasive ventilation, or high-flow nasal cannula during ICU stay were assessed with the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 at 3 and 6 months post-hospital discharge. Data were analyzed collectively and stratified as subjects with and without invasive mechanical ventilation. Analysis of variance and multiple regression analyses were applied. RESULTS The subjects (N = 43) were mainly male, middle age, and overweight. Subjects who were invasively ventilated (n = 21) had decreased physical function compared to those who were not during hospital assessments. From 3-6 months after discharge, all WHODAS domains and the overall score decreased in both groups (P < .001), indicating disability recovery. The participation domain, which assesses joining in society, was the only domain that remained worse in the ventilation group compared to the no ventilation group (P = .01). No interaction was found between time and the study groups, suggesting that the recovery trajectory was similar. At 6 months, considering the entire cohort, 70% and 56% had no disability in self-care and getting along domains, respectively, while 42% exhibited moderate to severe disability in the participation domain. According to the overall WHODAS score, 86% of subjects still had some level of disability at 6 months. In multivariate analyses, the overall WHODAS score along with the household and participation domains showed significant positive correlations, indicating higher disability, with corticosteroid use. CONCLUSIONS Disability persisted at 6 month post-hospital discharge for ICU survivors of COVID-19, regardless of the need for invasive mechanical ventilation. Participation was the only domain that showed higher disability among those who received invasive ventilation.
Collapse
Affiliation(s)
| | - Dimas Cavalheiro Prazeres
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, São Paulo, Brazil
| | - Silvia Gaspar
- Serviço de Fisioterapia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Luciana D Chiavegato
- Disciplina de Pneumologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil; and Programa de Mestrado e Doutorado, Universidade Cidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Camila Ferreira Leite
- Programa de Pós-graduação em Fisioterapia e Funcionalidade, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Shamyr Sulyvan de Castro
- Programa de Pós-graduação em Fisioterapia e Funcionalidade, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Carlos Rr Carvalho
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Marcia S Volpe
- Departamento de Ciências do Movimento Humano, Universidade Federal de São Paulo, Santos, São Paulo, Brazil.
| |
Collapse
|
14
|
Gorsler A, Franke C, Quitschau A, Külzow N. Cognitive recovery of post critical care patients with and without COVID-19: differences and similarities, an observational study. Neurol Res Pract 2024; 6:50. [PMID: 39438985 PMCID: PMC11495021 DOI: 10.1186/s42466-024-00349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 10/02/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) patients treated in an intensive care unit (ICU) are at high risk of developing cognitive impairments of a "post-intensive care syndrome" (PICS). We explored whether critically ill COVID-19 and non-COVID-19 survivors differ in their post-ICU recovery course in terms of severity and affected cognitive domains. METHODS An observational prospective study was conducted in a German post-acute neurological early rehabilitation clinic. Critically ill patients with or without SARS-CoV-2 infection (at least mechanically ventilated for one week) underwent repeated standardized assessments during their subsequent inpatient rehabilitation stay. Cognitive functions (information processing speed, learning, recognition, short-term and working-memory, word fluency, flexibility) assigned to different domains (attention, memory, executive functions) were assessed as primary outcome. Secondary outcomes included mental (depression, anxiety) and physical (Barthel index, modified ranking scale) state. RESULTS Out of 92 eligible patients (screened between June 2021 and August 2023), 34 were examined, and 30 were available for analysis (15 per group). Both groups were ventilated for a similar period (COVID-19 vs. Non-COVID-19: median: 48 vs. 53 days). Patients of COVID-19 group spend on average 10 days longer at ICU and developed slightly more complications, but subsequent inpatient rehabilitation was of comparable duration (median: 36.5 vs. 37 days). On the group-level both groups showed similar cognitive dysfunctions with striking impairments (normative T-scores < 41) in information processing speed, word fluency, flexibility, and recognition memory on admission. Significant gains until discharge were only revealed for information processing speed in both groups (main effect visit, mean difference [95%CI] - 7.5 [- 13.1, - 2.0]). Physical and mental state were also similarly affected in both groups on admission, but improved over time, indicating that overall recovery for higher-order cognitive functions is slowest. Interestingly, majority of patients stated correctly being still physically disabled, while a discrepancy was found between subjective and objective evaluation of cognitive health. CONCLUSIONS Results suggest a substantial overlap of cognitive, mental and physical dysfunction in post-acute recovery of ICU survivors independent of SARS-CoV-2 infection which warrants further monitoring to reduce the risk of long-term burden and enable a return to previous functionality. TRIAL REGISTRATION Retrospectively registered at https://drks.de/search/de/trial/DRKS00025523 , 21.06.2021.
Collapse
Affiliation(s)
- Anna Gorsler
- Clinic for Neurological Rehabilitation, Fachklinik Für Neurologische Frührehabilitation, Kliniken Beelitz GmbH, Paracelsusring 6a, Beelitz-Heilstätten, 14547, Brandenburg, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany.
| | - Christiana Franke
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anneke Quitschau
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nadine Külzow
- Clinic for Neurological Rehabilitation, Fachklinik Für Neurologische Frührehabilitation, Kliniken Beelitz GmbH, Paracelsusring 6a, Beelitz-Heilstätten, 14547, Brandenburg, Germany.
| |
Collapse
|
15
|
Montgomery CL, Davenport A, Milovanovic L, Bagshaw SM, Rolfson DB, Rewa OG. COVID-19-Associated Outcomes of Critical Illness in Patients with Frailty: a Cohort Study. Can Geriatr J 2024; 27:307-316. [PMID: 39234285 PMCID: PMC11346629 DOI: 10.5770/cgj.27.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
Background Pre-admission frailty has been associated with higher hospital mortality in patients with critical illness. We aimed to measure the prevalence of frailty and its associated outcomes in patients with COVID-19 critical illness. Methods A historical cohort study of all adults admitted to ICU with a pneumonia diagnosis in Alberta, Canada between May 1, 2020, and October 31, 2020. At ICU admission patients were routinely assessed for frailty using the Clinical Frailty Scale (CFS). Frailty was defined as a CFS score ≥5. Primary outcomes were pre-admission frailty prevalence and hospital mortality. Results The cohort (n=521) prevalence of frailty was 34.2% (n=178), mean (SD) age was 58.8 (14.9) years, APACHE II 22.8 (8.0), and 39.5% (n=206) were female. COVID-19 pneumonia was diagnosed in (19.0%; n=99) admissions; pre-admission frailty was present in 20.2% (n=20) vs. 79.8% (n=79) non-frail (p<.001). Among ICU patients admitted with COVID-19, hospital mortality in frail patients was 35.4% (n=63) vs. 14.0% (n=48) in non-frail (p<.001). Conclusion Pre-admission frailty was present in 20.2% of COVID-19 ICU admissions and was associated with higher risk of hospital mortality. Frailty assessment may yield valuable prognostic information when considering COVID-19 ICU admission; however, further study is needed to identify effect on patient-centred outcomes in this heterogeneous population.
Collapse
Affiliation(s)
- Carmel L Montgomery
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton
| | - Andrea Davenport
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta and Alberta Health Services, Edmonton
| | - Lazar Milovanovic
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta and Alberta Health Services, Edmonton
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta and Alberta Health Services, Edmonton
| | - Darryl B Rolfson
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta and Alberta Health Services, Edmonton
| |
Collapse
|
16
|
Koulenti D, Almyroudi MP, Andrianopoulos I, Mantzarlis K, Papathanakos G, Fragkou PC. Management of severe COVID-19 in the ICU. COVID-19: AN UPDATE 2024. [DOI: 10.1183/2312508x.10020523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
|
17
|
Brown A, Udy A, Kirk M, Bennett S, Chavan S, Huckson S, Pilcher D. Outcomes for people admitted to Australian and New Zealand intensive care units with primary, exacerbating, or incidental SARS-CoV-2 infections, 2022-23: a retrospective analysis of ANZICS data. Med J Aust 2024; 221:209-216. [PMID: 39019483 DOI: 10.5694/mja2.52390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 01/15/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVES To compare in-hospital mortality and intensive care unit (ICU) length of stay for people admitted to Australian and New Zealand ICUs during 2022-23 with coronavirus disease 2019 (COVID-19) pneumonitis, incidental or exacerbating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, or without SAR-CoV-2 infections. STUDY DESIGN Retrospective cohort study; analysis of Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database data. SETTING, PARTICIPANTS Adults (16 years or older) admitted to participating ICUs in Australia or New Zealand, 1 January 2022 - 30 June 2023. MAJOR OUTCOME MEASURES The primary outcome was in-hospital mortality, the secondary outcome ICU length of stay, each by SARS-CoV-2 infection attribution classification: primary COVID-19; exacerbating SARS-CoV-2 infection (SARS-CoV-2 infection was a contributing factor to the primary cause of ICU admission); incidental SARS-CoV-2 infections (SARS-CoV-2 infection detected during ICU admission but did not contribute to admission diagnosis); no SARS-CoV-2 infection. RESULTS A total of 207 684 adults were admitted to 195 Australian and New Zealand ICUs during 2022-23; 2674 people (1.3%) had incidental SARS-CoV-2 infections, 4923 (2.4%) exacerbating infections, and 3620 (1.7%) primary COVID-19. Unadjusted in-hospital mortality for people with incidental SARS-CoV-2 infections (288 deaths, 10.8%) was lower than for those with exacerbating infections (928 deaths, 18.8%) or primary COVID-19 (830 deaths, 22.9%), but higher than for patients without SARS-CoV-2 infections (15 486 deaths, 7.9%). After adjusting for illness severity, frailty, geographic region, and type of hospital, mortality was higher for patients with incidental SARS-CoV-2 infections (adjusted odds ratio [aOR], 1.28; 95% confidence interval [CI], 1.10-1.50), exacerbating infections (aOR, 1.35; 95% CI, 1.22-1.48), or primary COVID-19 (aOR, 2.54; 95% CI, 2.30-2.81) than for patients without SARS-CoV-2 infections. After adjusting for diagnosis and illness severity, ICU stays were longer for people with incidental (mean difference, 3.3 hours; 95% CI, 2.4-4.2 hours) or exacerbating infections (0.8 hours; 95% CI, 0.2-1.5 hours) than for those without SARS-CoV-2 infections. CONCLUSION Risk-adjusted in-hospital mortality and ICU length of stay are higher for people admitted to intensive care who have concomitant SARS-CoV-2 infections than for people who do not.
Collapse
Affiliation(s)
- Alastair Brown
- Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
- St Vincent's Hospital, Melbourne, VIC
| | - Andrew Udy
- Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
- The Alfred, Melbourne, VIC
| | - Martyn Kirk
- Australian Department of Health and Aged Care, Canberra, ACT
| | - Sonya Bennett
- Australian Department of Health and Aged Care, Canberra, ACT
| | - Shaila Chavan
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC
| | - Sue Huckson
- Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC
| | - David Pilcher
- St Vincent's Hospital, Melbourne, VIC
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC
| |
Collapse
|
18
|
Maher A, Bennett M, Huang HCC, Gaughwin P, Johnson M, Brady M, Patterson K, Buettikofer T, Morris J, Rainbird VM, Mitchell I, Bissett B. Personalized Exercise Prescription in Long COVID: A Practical Toolbox for a Multidisciplinary Approach. J Multidiscip Healthc 2024; 17:3981-3991. [PMID: 39161542 PMCID: PMC11330745 DOI: 10.2147/jmdh.s465946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024] Open
Abstract
Objective To describe our methodology and share the practical tools we have developed to operationalize a multidisciplinary Long COVID clinic that incorporates progressive, personalized exercise prescription as a cornerstone feature. Background There is a lack of evidence-based guidance regarding optimal rehabilitation strategies for people with Long COVID. Existing guidelines lack precision regarding exercise dosage. As one of Australia's few established multidisciplinary Long COVID clinics, we describe our novel approach to safely incorporating exercise of both peripheral and respiratory muscles, with essential monitoring and management of post-exertional symptom exacerbation. Methods Working closely with primary health-care providers, our multidisciplinary team screens referrals for people aged 16 and older with Long COVID. Staff apply a three tier model of triage, dependent on the consumer's presenting problems. Exercise-based interventions necessitate detailed monitoring for post-exertional symptom exacerbation both in the clinic and at home. Personalized exercise prescription includes resistance training at a submaximal threshold (4-6 exercises, 3 days/week); whole-body endurance exercise titrated to the individual's progress, at an intensity 4-6/10 (Rate of Perceived Exertion); and for those limited by dyspnoea, high-intensity inspiratory muscle training using a threshold-based handheld device (30 repetitions per day, ≥50% of their maximum inspiratory pressure). Discussion We have used these approaches for the past 2 years in 250 consumers with no serious adverse events and promising consumer feedback. Our exercise prescription is less conservative than the methods advocated in international guidelines for people with Long COVID, and these more progressive tools may be valuable in other contexts. Conclusion In our experience, a multidisciplinary clinic-based approach to safely prescribing progressive exercise in Long COVID is feasible. Both peripheral and inspiratory muscle exercise can be effectively titrated to each individual's symptoms, and careful monitoring for post-exertional symptom exacerbation is crucial.
Collapse
Affiliation(s)
- Allison Maher
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
| | - Michelle Bennett
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
| | - Hsin-Chia Carol Huang
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- College of Health and Medicine, Australian National University, Canberra ACT, Australia
| | - Philip Gaughwin
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- Faculty of Health, University of Canberra, Canberra ACT, Bruce, Australia
| | - Mary Johnson
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
| | - Madeleine Brady
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
| | - Kacie Patterson
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- Faculty of Health, University of Canberra, Canberra ACT, Bruce, Australia
| | - Tanya Buettikofer
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- Faculty of Health, University of Canberra, Canberra ACT, Bruce, Australia
| | - Jo Morris
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
| | | | - Imogen Mitchell
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- College of Health and Medicine, Australian National University, Canberra ACT, Australia
| | - Bernie Bissett
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- Faculty of Health, University of Canberra, Canberra ACT, Bruce, Australia
| |
Collapse
|
19
|
Carenzo L, Zini L, Mercalli C, Stomeo N, Milani A, Amato K, Gatti R, Costantini E, Aceto R, Protti A, Cecconi M. Health related quality of life, physical function, and cognitive performance in mechanically ventilated COVID-19 patients: A long term follow-up study. J Crit Care 2024; 82:154773. [PMID: 38479299 DOI: 10.1016/j.jcrc.2024.154773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Survivors of severe COVID-19 related respiratory failure may experience durable functional impairments. We aimed at investigating health-related quality of life (HR-QoL), physical functioning, fatigue, and cognitive outcomes in COVID-19 patients who received invasive mechanical ventilation (IMV). METHODS Case-series, prospective, observational cohort study at 18 months from hospital discharge. Patients referring to the Intensive Care Unit (ICU) of Humanitas Research Hospital (Milan, Italy) were recruited if they needed IMV due to COVID-19 related respiratory failure. After 18 months, these patients underwent the 6-min walking test (6MWT), the Italian version of the 5-level EQ-5D questionnaire (EQ-5D-5L), the Functional Assessment of Chronic Illness Therapy - Fatigue questionnaire (FACIT-F), the Trail Making Test-B (TMT-B) and the Montreal Cognitive Assessment-BLIND test (MoCA-BLIND). RESULTS 105 patients were studied. The population's age was 60 ± 10 years on average, with a median Frailty Scale of 2 (Hodgson et al., 2017; Carenzo et al., 2021a [2,3]). EQ-VAS was 80 [70-90] out of 100, walked distance was 406 [331-465] meters, corresponding to about 74 ± 19,1% of the predicted value. FACIT-F score was 43 [36-49] out of 52, and MoCa-BLIND score was 19 (DeSalvo et al., 2006; von Elm et al., 2008; Herdman et al., 2011; Scalone et al., 2015 [16-20]) out of 22. The median TMT-B time was 90 [62-120] seconds. We found a possible age and gender specific effect on HR-QoL and fatigue. CONCLUSIONS After 18 months from ICU discharge, survivors of severe COVID-19 respiratory failure experience a moderate reduction in HR-QoL, and a severe reduction in physical functioning. Fatigue prevalence is higher in younger patients and in females. Finally, cognitive impairment was present at a low frequency.
Collapse
Affiliation(s)
- Luca Carenzo
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (MI), Italy.
| | - Leonardo Zini
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | - Cesare Mercalli
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | - Niccolò Stomeo
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | - Angelo Milani
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | - Katia Amato
- Department of Physiotherapy, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (MI), Italy
| | - Roberto Gatti
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy; Department of Physiotherapy, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (MI), Italy
| | - Elena Costantini
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (MI), Italy
| | - Romina Aceto
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (MI), Italy
| | - Alessandro Protti
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (MI), Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano (MI), Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| |
Collapse
|
20
|
Giménez-Esparza Vich C, Oliver Hurtado B, Relucio Martinez MA, Sanchez Pino S, Portillo Requena C, Simón Simón JD, Pérez Gómez IM, Andrade Rodado FM, Laghzaoui Harbouli F, Sotos Solano FJ, Montenegro Moure CA, Carrillo Alcaraz A. Postintensive care syndrome in patients and family members. Analysis of COVID-19 and non-COVID-19 cohorts, with face-to-face follow-up at three months and one year. Med Intensiva 2024; 48:445-456. [PMID: 38734493 DOI: 10.1016/j.medine.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/12/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Compare prevalence and profile of post-intensive care patient (P-PICS) and family/caregiver (F-PICS) syndrome in two cohorts (COVID and non-COVID) and analyse risk factors for P-PICS. DESIGN Prospective, observational cohort (March 2018-2023), follow-up at three months and one year. SETTING 14-bed polyvalent Intensive Care Unit (ICU), Level II Hospital. PATIENTS OR PARTICIPANTS 265 patients and 209 relatives. Inclusion criteria patients: age > 18 years, mechanical ventilation > 48 h, ICU stay > 5 days, delirium, septic shock, acute respiratory distress syndrome, cardiac arrest. Inclusion criteria family: those who attended. INTERVENTIONS Follow-up 3 months and 1 year after hospital discharge. MAIN VARIABLES OF INTEREST Patients: sociodemographic, clinical, evolutive, physical, psychological and cognitive alterations, dependency degree and quality of life. Main caregivers: mental state and physical overload. RESULTS 64.9% PICS-P, no differences between groups. COVID patients more physical alterations than non-COVID (P = .028). These more functional deterioration (P = .005), poorer quality of life (P = .003), higher nutritional alterations (P = .004) and cognitive deterioration (P < .001). 19.1% PICS-F, more frequent in relatives of non-COVID patients (17.6% vs. 5.5%; P = .013). Independent predictors of PICS-P: first years of the study (OR: 0.484), higher comorbidity (OR: 1.158), delirium (OR: 2.935), several reasons for being included (OR: 3.171) and midazolam (OR: 4.265). CONCLUSIONS Prevalence PICS-P and PICS-F between both cohorts was similar. Main factors associated with the development of SPCI-P were: higher comorbidity, delirium, midazolan, inclusion for more than one reason and during the first years.
Collapse
Affiliation(s)
- Carola Giménez-Esparza Vich
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain.
| | - Beatriz Oliver Hurtado
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | - Salomé Sanchez Pino
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Cristina Portillo Requena
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - José David Simón Simón
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Isabel María Pérez Gómez
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | - Fadoua Laghzaoui Harbouli
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | | | - Andrés Carrillo Alcaraz
- Hospital Vega Baja Orihuela, Alicante, Spain; Hospital General Universitario Morales Meseguer, Murcia, Spain
| |
Collapse
|
21
|
Bradley J, Xu Q, Touloumes N, Lusciks E, Ali T, Huang EC, Chen J, Ghafghazi S, Arnold FW, Kong M, Huang J, Cavallazzi R, Center of Excellence for Research in Infectious Diseases (CERID) Post-COVID-19 Research Clinic Study Group. Association of pulmonary function test abnormalities and quality-of-life measures after COVID-19 infection. Am J Med Sci 2024; 368:112-121. [PMID: 38636655 PMCID: PMC11269026 DOI: 10.1016/j.amjms.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/29/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Long-COVID is a multisystem disease that can lead to significant impairments in health-related quality of life (HRQoL). Following COVID-19 infection, abnormalities on pulmonary function tests (PFT) are common. The primary aim of this study is to evaluate for any correlation between PFT abnormalities and impairment in HRQoL scores following COVID-19 infection. METHODS This is an analysis of a prospective cohort of patients in Louisville, KY who were infected with COVID-19. Data collected included demographics, past medical history, laboratory tests, PFTs, and several HRQoL questionnaires such as the EuroQol 5 Dimension HRQoL questionnaire (EQ-5D-5 L), Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire (PHQ-9), and Posttraumatic stress disorder checklist for DSM-5 (PCL-5). Descriptive statistics were performed, comparing PFTs (normal vs abnormal) and time since COVID-19 infection (3- vs 6- vs ≥ 12 months). RESULTS There were no significant differences in FEV1, FVC, or the percentage of patients with abnormal PFTs over time after COVID-19 infection. Following COVID-19, patients with normal PFTs had worse impairment in mobility HRQoL scores and change in GAD-7 scores over time. There were no differences over time in any of the HRQoL scores among patients with abnormal PFTs. CONCLUSIONS Among patients with an abnormal PFT, there was no temporal association with HRQoL scores as measured by EQ-5D-5 L, GAD-7, PHQ-9, and PCL-5. Among patients with a normal PFT, mobility impairment and anxiety may be associated with COVID-19 infection. Following COVID-19 infection, impairment in HRQoL scores is not completely explained by the presence of abnormalities on spirometry.
Collapse
Affiliation(s)
- James Bradley
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, Department of Medicine, University of Louisville, Louisville, KY
| | - Qian Xu
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
- Biometrics and Data Science, Fosun Pharma, Beijing 100026, PR China
| | - Nikolas Touloumes
- Division of General Internal Medicine, Department of Medicine, University of Louisville, Louisville, KY
| | - Eugene Lusciks
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - T’shura Ali
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Emma C. Huang
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | - James Chen
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - Shahab Ghafghazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, KY
| | - Forest W Arnold
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, Department of Medicine, University of Louisville, Louisville, KY
| | | |
Collapse
|
22
|
Mouli TC, Patnaik R, Samal S, Mishra SB. Assessment of quality of life in follow-up patients with COVID-19 pneumonia: A prospective, observational study from a tertiary care center. Int J Crit Illn Inj Sci 2024; 14:147-152. [PMID: 39512551 PMCID: PMC11540191 DOI: 10.4103/ijciis.ijciis_29_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/13/2024] [Accepted: 07/01/2024] [Indexed: 11/15/2024] Open
Abstract
Background This study intended to assess the quality of life (QOL) with telephonic interview using the Short Form 12 (SF-12) Scale in follow-up patients admitted to the intensive care unit (ICU) with COVID-19 pneumonia. Methods This prospective, noninterventional follow-up study was conducted at a tertiary care center. COVID-19 pneumonia patients discharged from ICU were recruited for telephonic interviews. Interviews were performed using SF-12 Scale to assess QOL 6 months after discharge. The SF-12 survey measures general health status in eight domains. A radar chart was used for the interpretation of health component scores. Results One hundred and fifty patients could complete the telephonic interview. The first-stage depression risk was 50%, which was 30% more than general position incidence (20%). As compared to the general population, physical component summary (PCS-12) was 60% below and mental component summary (MCS-12) was 67% below the general norm. Role emotional was the most affected followed by role physical. Conclusions QOL in follow-up ICU patients with COVID-19 pneumonia was worse in terms of physical and mental scores. By employing a comprehensive, longitudinal assessment of QOL in follow-up patients, using validated SF-12 Scale, this study captures a multifaceted view of their health status postrecovery.
Collapse
Affiliation(s)
| | - Rupali Patnaik
- Department of Critical Care Medicine, IMS and SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India
| | - Samir Samal
- Department of Critical Care Medicine, IMS and SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India
| | - Shakti Bedanta Mishra
- Department of Critical Care Medicine, IMS and SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India
| |
Collapse
|
23
|
Makam AN, Burnfield J, Prettyman E, Nguyen OK, Wu N, Espejo E, Blat C, Boscardin WJ, Ely EW, Jackson JC, Covinsky KE, Votto J, RAFT COVID Study. One-Year Recovery Among Survivors of Prolonged Severe COVID-19: A National Multicenter Cohort. Crit Care Med 2024; 52:e376-e389. [PMID: 38597793 PMCID: PMC11176028 DOI: 10.1097/ccm.0000000000006258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Understanding the long-term effects of severe COVID-19 illness on survivors is essential for effective pandemic recovery planning. Therefore, we investigated impairments among hospitalized adults discharged to long-term acute care hospitals (LTACHs) for prolonged severe COVID-19 illness who survived 1 year. DESIGN The Recovery After Transfer to an LTACH for COVID-19 (RAFT COVID) study was a national, multicenter, prospective longitudinal cohort study. SETTING AND PATIENTS We included hospitalized English-speaking adults transferred to one of nine LTACHs in the United States between March 2020 and February 2021 and completed a survey. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Validated instruments for impairments and free response questions about recovering. Among 282 potentially eligible participants who provided permission to be contacted, 156 (55.3%) participated (median age, 65; 38.5% female; 61.3% in good prior health; median length of stay of 57 d; 77% mechanically ventilated for a median of 26 d; 42% had a tracheostomy). Approximately two-thirds (64%) had a persistent impairment, including physical (57%), respiratory (49%; 19% on supplemental oxygen), psychiatric (24%), and cognitive impairments (15%). Nearly half (47%) had two or more impairment types. Participants also experienced persistent debility from hospital-acquired complications, including mononeuropathies and pressure ulcers. Participants described protracted recovery, attributing improvements to exercise/rehabilitation, support, and time. While considered life-altering with 78.7% not returning to their usual health, participants expressed gratitude for recovering; 99% returned home and 60% of previously employed individuals returned to work. CONCLUSIONS Nearly two-thirds of survivors of among the most prolonged severe COVID-19 illness had persistent impairments at 1 year that resembled post-intensive care syndrome after critical illness plus debility from hospital-acquired complications.
Collapse
Affiliation(s)
- Anil N. Makam
- Division of Hospital Medicine, UCSF at San Francisco General Hospital, San Francisco, CA
- UCSF Philip R. Lee Institute for Health Policy Studies, San Francisco, CA
- UCSF Center for Vulnerable Populations, San Francisco, CA
| | - Judith Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE
| | - Ed Prettyman
- Texas NeuroRehab Center, Austin, TX
- National Association of Long Term Hospitals, North Bethesda, MD
| | - Oanh Kieu Nguyen
- Division of Hospital Medicine, UCSF at San Francisco General Hospital, San Francisco, CA
- UCSF Philip R. Lee Institute for Health Policy Studies, San Francisco, CA
- UCSF Center for Vulnerable Populations, San Francisco, CA
| | - Nancy Wu
- Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Edie Espejo
- Division of Geriatrics, UCSF, San Francisco, CA
- Northern California Center for Research and Education, San Francisco, CA
| | - Cinthia Blat
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF, San Francisco, CA
| | - W John Boscardin
- Division of Geriatrics, UCSF, San Francisco, CA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction and Survivorship Center, Vanderbilt University, Medical Center, Nashville, TN
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Medical Center, Nashville, TN
- Veteran’s Affairs Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee
| | - James C. Jackson
- Critical Illness, Brain Dysfunction and Survivorship Center, Vanderbilt University, Medical Center, Nashville, TN
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Medical Center, Nashville, TN
- Veteran’s Affairs Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee
| | | | - John Votto
- National Association of Long Term Hospitals, North Bethesda, MD
- Hospital for Special Care, New Britain, Connecticut
| | | |
Collapse
|
24
|
Alfaro E, Díaz-García E, García-Tovar S, Galera R, Casitas R, Torres-Vargas M, López-Fernández C, Añón JM, García-Río F, Cubillos-Zapata C. Endothelial dysfunction and persistent inflammation in severe post-COVID-19 patients: implications for gas exchange. BMC Med 2024; 22:242. [PMID: 38867241 PMCID: PMC11170912 DOI: 10.1186/s12916-024-03461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Understanding the enduring respiratory consequences of severe COVID-19 is crucial for comprehensive patient care. This study aims to evaluate the impact of post-COVID conditions on respiratory sequelae of severe acute respiratory distress syndrome (ARDS). METHODS We examined 88 survivors of COVID-19-associated severe ARDS six months post-intensive care unit (ICU) discharge. Assessments included clinical and functional evaluation as well as plasma biomarkers of endothelial dysfunction, inflammation, and viral response. Additionally, an in vitro model using human umbilical vein endothelial cells (HUVECs) explored the direct impact of post-COVID plasma on endothelial function. RESULTS Post-COVID patients with impaired gas exchange demonstrated persistent endothelial inflammation marked by elevated ICAM-1, IL-8, CCL-2, and ET-1 plasma levels. Concurrently, systemic inflammation, evidenced by NLRP3 overexpression and elevated levels of IL-6, sCD40-L, and C-reactive protein, was associated with endothelial dysfunction biomarkers and increased in post-COVID patients with impaired gas exchange. T-cell activation, reflected in CD69 expression, and persistently elevated levels of interferon-β (IFN-β) further contributed to sustained inflammation. The in vitro model confirmed that patient plasma, with altered levels of sCD40-L and IFN-β proteins, has the capacity to alter endothelial function. CONCLUSIONS Six months post-ICU discharge, survivors of COVID-19-associated ARDS exhibited sustained elevation in endothelial dysfunction biomarkers, correlating with the severity of impaired gas exchange. NLRP3 inflammasome activity and persistent T-cell activation indicate on going inflammation contributing to persistent endothelial dysfunction, potentially intensified by sustained viral immune response.
Collapse
Affiliation(s)
- Enrique Alfaro
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Elena Díaz-García
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Sara García-Tovar
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Raúl Galera
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Raquel Casitas
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - María Torres-Vargas
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina López-Fernández
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - José M Añón
- Department of Intensive Medicine, La Paz University Hospital, Madrid, Spain
| | - Francisco García-Río
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain.
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain.
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.
| | - Carolina Cubillos-Zapata
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain.
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain.
| |
Collapse
|
25
|
Volpe MS, dos Santos ACC, Gaspar S, de Melo JL, Harada G, Ferreira PRA, da Silva KRS, Souza NTS, Toufen C, Chiavegato LD, Amato MBP, Feltrim MIZ, de Carvalho CRR. A comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19. CRITICAL CARE SCIENCE 2024; 36:e20240284en. [PMID: 38716961 PMCID: PMC11098067 DOI: 10.62675/2965-2774.20240284-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/22/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To examine the physical function and respiratory muscle strength of patients - who recovered from critical COVID-19 - after intensive care unit discharge to the ward on Days one (D1) and seven (D7), and to investigate variables associated with functional impairment. METHODS This was a prospective cohort study of adult patients with COVID-19 who needed invasive mechanical ventilation, non-invasive ventilation or high-flow nasal cannula and were discharged from the intensive care unit to the ward. Participants were submitted to Medical Research Council sum-score, handgrip strength, maximal inspiratory pressure, maximal expiratory pressure, and short physical performance battery tests. Participants were grouped into two groups according to their need for invasive ventilation: the Invasive Mechanical Ventilation Group (IMV Group) and the Non-Invasive Mechanical Ventilation Group (Non-IMV Group). RESULTS Patients in the IMV Group (n = 31) were younger and had higher Sequential Organ Failure Assessment scores than those in the Non-IMV Group (n = 33). The short physical performance battery scores (range 0 - 12) on D1 and D7 were 6.1 ± 4.3 and 7.3 ± 3.8, respectively for the Non-Invasive Mechanical Ventilation Group, and 1.3 ± 2.5 and 2.6 ± 3.7, respectively for the IMV Group. The prevalence of intensive care unit-acquired weakness on D7 was 13% for the Non-IMV Group and 72% for the IMV Group. The maximal inspiratory pressure, maximal expiratory pressure, and handgrip strength increased on D7 in both groups, but the maximal expiratory pressure and handgrip strength were still weak. Only maximal inspiratory pressure was recovered (i.e., > 80% of the predicted value) in the Non-IMV Group. Female sex, and the need and duration of invasive mechanical were independently and negatively associated with the short physical performance battery score and handgrip strength. CONCLUSION Patients who recovered from critical COVID-19 and who received invasive mechanical ventilation presented greater disability than those who were not invasively ventilated. However, they both showed marginal functional improvement during early recovery, regardless of the need for invasive mechanical ventilation. This might highlight the severity of disability caused by SARS-CoV-2.
Collapse
Affiliation(s)
- Marcia Souza Volpe
- Universidade Federal de São PauloDepartment of Human Movement SciencesSantosSPBrazilDepartment of Human Movement Sciences, Universidade Federal de São Paulo - Santos (SP), Brazil.
| | - Ana Carolina Cardoso dos Santos
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Sílvia Gaspar
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Jade Lara de Melo
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Gabriela Harada
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Patrícia Rocha Alves Ferreira
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Karina Ramiceli Soares da Silva
- Universidade Federal de São PauloDepartment of Human Movement SciencesSantosSPBrazilDepartment of Human Movement Sciences, Universidade Federal de São Paulo - Santos (SP), Brazil.
| | - Natália Tiemi Simokomaki Souza
- Universidade Federal de São PauloDiscipline of PneumologySão PauloSPBrazilDiscipline of Pneumology, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
| | - Carlos Toufen
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Luciana Dias Chiavegato
- Universidade Federal de São PauloDiscipline of PneumologySão PauloSPBrazilDiscipline of Pneumology, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
| | - Marcelo Britto Passos Amato
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Maria Ignez Zanetti Feltrim
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDepartment of Physiotherapy, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Carlos Roberto Ribeiro de Carvalho
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilDivision of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| |
Collapse
|
26
|
Cagino L, Seagly K, Noyes E, Prescott H, Valley T, Eaton T, McSparron JI. Outcomes and Management After COVID-19 Critical Illness. Chest 2024; 165:1149-1162. [PMID: 38104961 PMCID: PMC11214908 DOI: 10.1016/j.chest.2023.11.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023] Open
Abstract
TOPIC IMPORTANCE COVID-19 has caused > 7 million deaths worldwide since its onset in 2019. Although the severity of illness has varied throughout the pandemic, critical illness related to COVID-19 persists. Survivors of COVID-19 critical illness can be left with sequelae of both the SARS-CoV-2 virus and long-term effects of critical illness included within post-intensive care syndrome. Given the complexity and heterogeneity of COVID-19 critical illness, the biopsychosocial-ecological model can aid in evaluation and treatment of survivors, integrating interactions among physical, cognitive, and psychological domains, as well as social systems and environments. REVIEW FINDINGS Prolonged illness after COVID-19 critical illness generally can be classified into effects on physical, cognitive, and psychosocial function, with much interaction among the various effects, and includes a wide range of symptoms such as ICU-acquired weakness, prolonged respiratory symptoms, cognitive changes, post-traumatic stress disorder post-traumatic stress disorder, anxiety, and depression. Risk factors for COVID-19 critical illness developing are complex and include preexisting factors, disease course, and specifics of hospitalization in addition to psychological comorbidities and socioenvironmental factors. Recovery trajectories are not well defined, and management requires a comprehensive, interdisciplinary, and individualized approach to care. SUMMARY The onset of vaccinations, new therapeutics, and new strains of SARS-CoV-2 virus have decreased COVID-19 mortality; however, the number of survivors of COVID-19 critical illness remains high. A biopsychosocial-ecological approach is recommended to guide care of COVID-19 critical illness survivors.
Collapse
Affiliation(s)
- Leigh Cagino
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
| | - Katharine Seagly
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Emily Noyes
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Hallie Prescott
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Thomas Valley
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Tammy Eaton
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI; VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Ann Arbor, MI
| | - Jakob I McSparron
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| |
Collapse
|
27
|
Turgeon J, Venkatamaran V, Englesakis M, Fan E. Long-term outcomes of patients supported with extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Intensive Care Med 2024; 50:350-370. [PMID: 38197932 DOI: 10.1007/s00134-023-07301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is increasingly used to support patients with severe acute respiratory distress syndrome (ARDS). The impact of ECMO on long-term outcomes of patients with severe ARDS is unclear. METHODS We searched electronic databases from inception to January 17th 2023. We selected clinical trials and observational studies reporting on long-term outcomes of patients supported with ECMO for ARDS. Health-related quality of life (HRQoL) was the primary outcome. Secondary outcomes included cognitive function, mental health, functional status, respiratory symptoms, and return to work. RESULTS Of the 7126 screened citations, 1 randomized clinical trial and 31 observational studies were included, of which 7 compared conventional mechanical ventilation (CMV) and ECMO. Overall quality of studies of the included studies was limited, with the majority being either low (45%) or fair (32%) quality. There was no significant difference in HRQoL measured with the SF-36 score between ECMO and CMV patients (physical component score [PCS]: mean difference 3.91 (- 6.22 to 14.05), mental component score [MCS] mean difference 1.33 (- 3.93 to 6.60)). There was no difference between cognitive function, mental health, functional status, and respiratory symptoms between ECMO and CMV, but data available for comparison were limited. There were high rates of disability for ECMO survivors with 49% of patients returning to work and 23% needing assistance at home on follow-up. CONCLUSION Survivors of ECMO for ARDS experience significant disability in multiple domains. Further studies are needed to examine the effect of ECMO on long-term outcomes of patients compared to CMV.
Collapse
Affiliation(s)
- Julien Turgeon
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, Qc, G1V 4G5, Canada.
| | - Varsha Venkatamaran
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, University Health Network and Sinai Health System, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
28
|
Clayton NA, Freeman-Sanderson A, Walker E. Dysphagia Prevalence and Outcomes Associated with the Evolution of COVID-19 and Its Variants in Critically Ill Patients. Dysphagia 2024; 39:109-118. [PMID: 37347254 PMCID: PMC10781836 DOI: 10.1007/s00455-023-10598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
Data collected during the 2020-21 COVID-19 alpha wave indicated dysphagia prevalence rates up to 93%. Whilst many patients recovered during hospital admission, some experienced persistent dysphagia with protracted recovery. To explore (1) prevalence, (2) treatment, and (3) recovery patterns and outcomes for swallowing, in the ICU patient with Delta and subsequent variants of COVID-19. Prospective observational study. Patients admitted to 26 Intensive Care Units (ICUs) over 12 months, diagnosed with COVID-19, treated for survival and seen by Speech-Language Pathology (SLP) for clinical swallowing assessment were included. Demographic, medical, SLP treatment, and swallowing outcome data were collected. 235 participants (63% male, median age = 58 years) were recruited. Median mechanical ventilation was 16 days, and ICU and hospital length of stay (LOS) were 20 and 42 days, respectively. ICU-Acquired Weakness (54%) and delirium (49%) were frequently observed. Prevalence of dysphagia was 94% with the majority (45%) exhibiting profound dysphagia (Functional Oral Intake Scale = 1) at initial assessment. Median duration to initiate oral feeding was 19 days (IQR = 11-44 days) from ICU admission, and 24% received dysphagia rehabilitation. Dysphagia recovery by hospital discharge was observed in 71% (median duration = 30 days [IQR = 17-56 days]). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU LOS, and duration to SLP assessment (p = 0.000), dysphagia severity (p = 0.000), commencing oral intake (p = 0.000), dysphagia recovery (p < 0.01), and enteral feeding (p = 0.000). Whilst older participants had more severe dysphagia (p = 0.028), younger participants took longer to commence oral feeding (p = 0.047). Dysphagia remains highly prevalent in ICU COVID-19 patients. Whilst invasive ventilation duration is associated with swallowing outcomes, more evidence on dysphagia pathophysiology is required to guide rehabilitation.
Collapse
Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department & Intensive Care Unit, Concord Repatriation General Hospital, Building 42, Hospital Rd, Concord, Sydney, NSW, 2139, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Amy Freeman-Sanderson
- Speech Pathology Department & Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
- Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Walker
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
29
|
Ashton Rennison VL, Chovaz CJ, Zirul S. Cognition and psychological well-being in adults with post COVID-19 condition and analyses of symptom sequelae. Clin Neuropsychol 2024; 38:326-353. [PMID: 37350239 DOI: 10.1080/13854046.2023.2227407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE As the coronavirus disease 2019 (COVID-19) pandemic moves into its fourth year, gaining a better clinical understanding of individuals with post COVID-19 condition is paramount. The current study examined the neurocognitive and psychological status of adults with post COVID-19 condition, as well as explored the impact of high psychological burden on objective neurocognitive functioning and the relationship between subjective cognitive concerns and objective neurocognitive findings. METHOD Valid neuropsychological assessments were completed with 51 symptomatic adults who were 297.55 days, on average, following a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Participants completed brief self-report depression, anxiety, and PTSD questionnaires, a questionnaire with subjective ratings of cognitive abilities, and standardized neurocognitive tests that examined performance validity, attention, processing speed, verbal learning and memory, naming, visual construction, and executive functioning. RESULTS The participants were mostly Caucasian (80.39%), middle-aged (average 47.37 years), women (82.35%), who were never hospitalized (86.27%). Despite all individuals reporting cognitive problems in daily life, mean performances on objective testing did not reveal any neurocognitive deficits (at or below the 8th percentile) at a group level. Approximately half (49.02%) of the participants reported co-occurring mental health symptoms that were considered clinically elevated based on questionnaire results. High psychological symptom burden was associated with greater subjective cognitive difficulties but did not result in neurocognitive dysfunction on objective testing. CONCLUSIONS This study contributes to the literature regarding post COVID-19 condition in adults including the relationship between the cognitive and psychological symptoms. Results are summarized in key clinical learning points.
Collapse
Affiliation(s)
- V Lynn Ashton Rennison
- Psychology Department, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine & Dentistry Department of Psychiatry, Western University, London, ON, Canada
| | - Cathy J Chovaz
- Psychology Department, King's University College at Western University, London, ON, Canada
| | - Sandra Zirul
- Psychology Department, London Health Sciences Centre, London, ON, Canada
| |
Collapse
|
30
|
Clayton NA, Freeman-Sanderson A, Walker E. Prevalence and recovery of dysphonia in COVID-19 patients requiring intensive care treatment. Aust Crit Care 2024; 37:151-157. [PMID: 37709656 DOI: 10.1016/j.aucc.2023.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Dysphonia and laryngeal pathology are considerable issues in patients hospitalised with COVID-19 with prevalence rates cited between 29% and 79%. Most studies currently are limited to reporting single-institution data with many retrospective. OBJECTIVES The aims of this study were to prospectively explore the following: (i) prevalence; (ii) treatment; and (iii) recovery pattern and outcomes for dysphonia, in patients with COVID-19 requiring intensive care unit (ICU) treatment. METHODS Patients admitted to 26 ICUs over 12 months, diagnosed with COVID-19, treated for survival, and seen by speech-language pathology for clinical voice assessment were considered. Demographic, medical, speech-language pathology treatment, and voice outcome data (grade, roughness, breathiness, asthenia, strain [GRBAS]) were collected on initial consultation and continuously monitored throughout the hospital admission. FINDINGS Two-hundred and thirty five participants (63% male, median age = 58 yrs) were recruited. Median mechanical ventilation duration and ICU and hospital lengths of stay (LOSs) were 16, 20, and 42 days, respectively. Dysphonia prevalence was 72% (170/235), with 22% (38/170) exhibiting profound impairment (GRBAS score = 3). Of those with dysphonia, rehabilitation was provided in 32% (54/170) cases, with dysphonia recovery by hospital discharge observed in 66% (112/170, median duration = 35 days [interquartile range = 21-61 days]). Twenty-five percent (n = 42) of patients underwent nasendoscopy: oedema (40%, 17/42), granuloma (31%, 13/42), and vocal fold palsy/paresis (26%, 11/42). Presence of dysphonia was inversely associated with the number of intubations (p = 0.002), intubation duration (p = 0.037), ICU LOS (p = 0.003), and hospital LOS (p = 0.009). Conversely, duration of dysphonia was positively associated with the number of intubations (p = 0.012), durations of intubation (p = 0.000), tracheostomy (p = 0.004), mechanical ventilation (p = 0.000), ICU LOS (p = 0.000), and hospital LOS (p = 0.000). More severe dysphonia was associated with younger age (p = 0.045). Proning was not associated with presence (p = 0.075), severity (p = 0.164), or duration (p = 0.738) of dysphonia. CONCLUSIONS Dysphonia and laryngeal pathology are common in critically ill patients with COVID-19 and are associated with younger age and protracted recovery in those with longer critical care interventions.
Collapse
Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department & Intensive Care Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Amy Freeman-Sanderson
- Speech Pathology Department & Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Walker
- Speech Pathology Department & Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
31
|
Gouda SR, Pinto NP. Parental Perception and Measured Functional Status Following Pediatric Critical Illness: A Secondary Analysis of the Survivor Outcomes Study. Pediatr Crit Care Med 2023; 24:e621-e626. [PMID: 37548521 DOI: 10.1097/pcc.0000000000003342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES We evaluated the concordance between parent/guardian perception of child long-term function and objectively scored long-term functional status using the Functional Status Scale (FSS) among PICU survivors. DESIGN Secondary analysis of prospective cohort study. SETTING Urban, tertiary, academic PICU. PATIENTS PICU patients less than 18 years old were admitted between June and August 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We conducted telephone interviews of parents/guardians of PICU survivors ( n = 77) 6 months post-PICU discharge. We asked parents/guardians to characterize their child's functional status, and we determined FSS scores using scripted interview questions. Concordance between parent/guardian perceptions and FSS scores was assessed, revealing that parent/guardian perceptions of their child's functional status aligned poorly with FSS scores at 6 months (kappa coefficient 0.16). CONCLUSIONS These findings shed light on a critical disconnect between parent/guardian perspective and our current tools to measure a child's functional status following critical illness. In an era of decreased PICU mortality and increased long-term morbidity, the discordance between parent/guardian perception and available scoring tools in the assessment of long-term functional status highlights a key opportunity to improve communication and anchor expectations for long-term outcomes among PICU survivors.
Collapse
Affiliation(s)
- Suzanne R Gouda
- Divsion of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Neethi P Pinto
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| |
Collapse
|
32
|
Castro-Avila A, Merino-Osorio C, González-Seguel F, Camus-Molina A, Muñoz-Muñoz F, Leppe J, on behalf of the IMPACCT COVID-19 study group. Six-month post-intensive care outcomes during high and low bed occupancy due to the COVID-19 pandemic: A multicenter prospective cohort study. PLoS One 2023; 18:e0294631. [PMID: 37972091 PMCID: PMC10653414 DOI: 10.1371/journal.pone.0294631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient's functional outcomes. To compare by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic. METHODS Prospective cohort of adults mechanically ventilated >48 hours in 19 ICUs from seven Chilean public and private hospitals. Ninety percent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0. Quality of life, mental, physical, and cognitive outcomes were also evaluated following the core outcome set for acute respiratory failure. RESULTS We enrolled 252 participants, 103 (41%) during low and 149 (59%) during high bed occupancy. Patients treated during high occupancy were younger (P50 [P25-P75]: 55 [44-63] vs 61 [51-71]; p<0.001), more likely to be admitted due to COVID-19 (126 [85%] vs 65 [63%]; p<0.001), and have higher education qualification (94 [63%] vs 48 [47%]; p = 0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p = 0.6), 3-month (74% vs 63%; p = 0.2) and 6-month (57% vs 57%; p = 0.9) follow-up. CONCLUSIONS There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients (>90%) had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up (57%). CLINICAL TRIAL REGISTRATION NCT04979897 (clinicaltrials.gov).
Collapse
Affiliation(s)
- Ana Castro-Avila
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Department of Health Sciences, University of York, Heslington, United Kingdom
| | - Catalina Merino-Osorio
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Felipe González-Seguel
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Agustín Camus-Molina
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Jaime Leppe
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | |
Collapse
|
33
|
Snyder M, Njie BY, Grabenstein I, Viola S, Abbas H, Bhatti W, Lee R, Traficante R, Yeung SYA, Chow JH, Tabatabai A, Taylor BS, Dahi S, Scalea T, Rabin J, Grazioli A, Calfee CS, Britton N, Levine AR. Functional recovery in a cohort of ECMO and non-ECMO acute respiratory distress syndrome survivors. Crit Care 2023; 27:440. [PMID: 37964311 PMCID: PMC10644522 DOI: 10.1186/s13054-023-04724-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The mortality benefit of VV-ECMO in ARDS has been extensively studied, but the impact on long-term functional outcomes of survivors is poorly defined. We aimed to assess the association between ECMO and functional outcomes in a contemporaneous cohort of survivors of ARDS. METHODS Multicenter retrospective cohort study of ARDS survivors who presented to follow-up clinic. The primary outcome was FVC% predicted. Univariate and multivariate regression models were used to evaluate the impact of ECMO on the primary outcome. RESULTS This study enrolled 110 survivors of ARDS, 34 of whom were managed using ECMO. The ECMO cohort was younger (35 [28, 50] vs. 51 [44, 61] years old, p < 0.01), less likely to have COVID-19 (58% vs. 96%, p < 0.01), more severely ill based on the Sequential Organ Failure Assessment (SOFA) score (7 [5, 9] vs. 4 [3, 6], p < 0.01), dynamic lung compliance (15 mL/cmH20 [11, 20] vs. 27 mL/cmH20 [23, 35], p < 0.01), oxygenation index (26 [22, 33] vs. 9 [6, 11], p < 0.01), and their need for rescue modes of ventilation. ECMO patients had significantly longer lengths of hospitalization (46 [27, 62] vs. 16 [12, 31] days, p < 0.01) ICU stay (29 [19, 43] vs. 10 [5, 17] days, p < 0.01), and duration of mechanical ventilation (24 [14, 42] vs. 10 [7, 17] days, p < 0.01). Functional outcomes were similar in ECMO and non-ECMO patients. ECMO did not predict changes in lung function when adjusting for age, SOFA, COVID-19 status, or length of hospitalization. CONCLUSIONS There were no significant differences in the FVC% predicted, or other markers of pulmonary, neurocognitive, or psychiatric functional recovery outcomes, when comparing a contemporaneous clinic-based cohort of survivors of ARDS managed with ECMO to those without ECMO.
Collapse
Affiliation(s)
| | - Binta Y Njie
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Sara Viola
- Department of Medicine, Division of Critical Care Medicine, University of Maryland Baltimore Washington Medical Center, Baltimore, MD, USA
| | - Hatoon Abbas
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca St, Baltimore, MD, 21231, USA
| | - Waqas Bhatti
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca St, Baltimore, MD, 21231, USA
| | - Ryan Lee
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca St, Baltimore, MD, 21231, USA
| | - Rosalie Traficante
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca St, Baltimore, MD, 21231, USA
| | - Siu Yan Amy Yeung
- Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jonathan H Chow
- Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine, Washington, DC, USA
| | - Ali Tabatabai
- Department of Medicine, Division of Education, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bradley S Taylor
- Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Siamak Dahi
- Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thomas Scalea
- Department of Surgery and Program in Trauma, R Adams Crowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph Rabin
- Department of Surgery and Program in Trauma, R Adams Crowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alison Grazioli
- Department of Medicine, University of Maryland School of Medicine, Program in Trauma, Baltimore, MD, USA
| | - Carolyn S Calfee
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, CA, USA
| | - Noel Britton
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea R Levine
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca St, Baltimore, MD, 21231, USA.
| |
Collapse
|
34
|
Hedberg P, Baltzer N, Granath F, Fored M, Mårtensson J, Nauclér P. Clinical outcomes during and beyond different COVID-19 critical illness variant periods compared with other lower respiratory tract infections. Crit Care 2023; 27:427. [PMID: 37932793 PMCID: PMC10629059 DOI: 10.1186/s13054-023-04722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND It is yet to be better understood how outcomes during and after the critical illness potentially differ between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants from other lower respiratory tract infections (LRTIs). We aimed to compare outcomes in adults admitted to an intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) during the Wild-type, Alpha, Delta, and Omicron periods with individuals admitted with other LRTI. METHODS Population-based cohort study in Stockholm, Sweden, using health registries with high coverage, including ICU-admitted adults from 1 January 2016 to 15 September 2022. Outcomes were in-hospital mortality, 180-day post-discharge mortality, 180-day hospital readmission, 180-day days alive and at home (DAAH), and incident diagnoses registered during follow-up. RESULTS The number of ICU admitted individuals were 1421 Wild-type, 551 Alpha, 190 Delta, 223 Omicron, and 2380 LRTI. In-hospital mortality ranged from 28% (n = 665) in the LRTI cohort to 35% (n = 77) in the Delta cohort. The adjusted cause-specific hazard ratio (CSHR) compared with the LRTI cohort was 1.33 (95% confidence interval [CI] 1.16-1.53) in the Wild-type cohort, 1.53 (1.28-1.82) in the Alpha cohort, 1.70 (1.30-2.24) in the Delta cohort, and 1.59 (1.24-2.02) in the Omicron cohort. Among patients discharged alive from their COVID-19 hospitalization, the post-discharge mortality rates were lower (1-3%) compared with the LRTI cohort (9%), and the risk of hospital readmission was lower (CSHRs ranging from 0.42 to 0.68). Moreover, all COVID-19 cohorts had compared with the LRTI cohort more DAAH after compared with before the critical illness. CONCLUSION Overall, COVID-19 critical was associated with an increased hazard of in-hospital mortality, but among those discharged alive from the hospital, less severe long-term outcomes were observed compared with other LRTIs.
Collapse
Affiliation(s)
- Pontus Hedberg
- Department of Medicine, Huddinge, Karolinska Institutet, H7 Medicin, Huddinge, H7 Infektion och Hud Sönnerborg, 171 77, Stockholm, Sweden.
| | - Nicholas Baltzer
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Granath
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Michael Fored
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Division of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
35
|
Madahar P, Capaccione KM, Salvatore MM, Short B, Wahab R, Abrams D, Parekh M, Geleris JD, Furfaro D, Anderson MR, Zucker J, Brodie D, Cummings MJ, O’Donnell M, McGroder CF, Wei Y, Garcia CK, Baldwin MR. Fibrotic-Like Pulmonary Radiographic Patterns Are Not Associated With Adverse Outcomes in COVID-19 Chronic Critical Illness. Crit Care Med 2023; 51:e209-e220. [PMID: 37294143 PMCID: PMC10615871 DOI: 10.1097/ccm.0000000000005954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Pulmonary fibrosis is a feared complication of COVID-19. To characterize the risks and outcomes associated with fibrotic-like radiographic abnormalities in patients with COVID-19-related acute respiratory distress syndrome (ARDS) and chronic critical illness. DESIGN Single-center prospective cohort study. SETTING We examined chest CT scans performed between ICU discharge and 30 days after hospital discharge using established methods to quantify nonfibrotic and fibrotic-like patterns. PATIENTS Adults hospitalized with COVID-19-related ARDS and chronic critical illness (> 21 d of mechanical ventilation, tracheostomy, and survival to ICU discharge) between March 2020 and May 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We tested associations of fibrotic-like patterns with clinical characteristics and biomarkers, and with time to mechanical ventilator liberation and 6-month survival, controlling for demographics, comorbidities, and COVID-19 therapies. A total of 141 of 616 adults (23%) with COVID-19-related ARDS developed chronic critical illness, and 64 of 141 (46%) had a chest CT a median (interquartile range) 66 days (42-82 d) after intubation. Fifty-five percent had fibrotic-like patterns characterized by reticulations and/or traction bronchiectasis. In adjusted analyses, interleukin-6 level on the day of intubation was associated with fibrotic-like patterns (odds ratio, 4.40 per quartile change; 95% CI, 1.90-10.1 per quartile change). Other inflammatory biomarkers, Sequential Organ Failure Assessment score, age, tidal volume, driving pressure, and ventilator days were not. Fibrotic-like patterns were not associated with longer time to mechanical ventilator liberation or worse 6-month survival. CONCLUSIONS Approximately half of adults with COVID-19-associated chronic critical illness have fibrotic-like patterns that are associated with higher interleukin-6 levels at intubation. Fibrotic-like patterns are not associated with longer time to liberation from mechanical ventilation or worse 6-month survival.
Collapse
Affiliation(s)
- Purnema Madahar
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Kathleen M. Capaccione
- Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Mary M. Salvatore
- Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Briana Short
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Romina Wahab
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Madhavi Parekh
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Joshua D. Geleris
- Division of General Medicine, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - David Furfaro
- Division of Pulmonary, Allergy, and Critical Care, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michaela R Anderson
- Division of Pulmonary and Critical Care, University of Pennsylvania Medical School, Philadelphia, PA, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Matthew J. Cummings
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Max O’Donnell
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Claire F. McGroder
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Christine K. Garcia
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Matthew R. Baldwin
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| |
Collapse
|
36
|
van Houwelingen F, van Dellen E, Visser-Meily JMA, Valkenet K, Heijnen GH, Vernooij LM, Kerckhoffs MC, Slooter AJC. Mental, cognitive and physical outcomes after intensive care unit treatment during the COVID-19 pandemic: a comparison between COVID-19 and non-COVID-19 patients. Sci Rep 2023; 13:14414. [PMID: 37660228 PMCID: PMC10475104 DOI: 10.1038/s41598-023-41667-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023] Open
Abstract
To compare mental, cognitive and physical outcomes between COVID-19 and non-COVID-19 patients, 3-6 months after Intensive Care Unit (ICU) treatment during the COVID-19 pandemic and to compare mental outcomes between relatives of these patients. This retrospective cohort study included 209 ICU survivors (141 COVID-19 patients and 68 non-COVID-19 patients) and 168 of their relatives (maximum one per patient) during the COVID-19 pandemic. Primary outcomes were self-reported occurrence of mental, cognitive and/or physical symptoms 3-6 months after ICU discharge. The occurrence of mental symptoms did not differ between former COVID-19 patients (34.7% [43/124]) and non-COVID-19 patients (43.5% [27/62]) (p = 0.309), neither between relatives of COVID-19 patients (37.6% [38/101]) and relatives of non-COVID-19 patients (39.6% [21/53]) (p = 0.946). Depression scores on the Hospital Anxiety and Depression Scale were lower in former COVID-19 patients, compared to non-COVID-19 patients (p = 0.025). We found no differences between COVID-19 and non-COVID-19 patients in cognitive and physical outcomes. Mental, cognitive and physical outcomes in COVID-19 ICU survivors were similar to non-COVID-19 ICU survivors. Mental symptoms in relatives of COVID-19 ICU survivors did not differ from relatives of non-COVID-19 ICU survivors, within the same time frame.
Collapse
Affiliation(s)
- Fedor van Houwelingen
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Edwin van Dellen
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - J M Anne Visser-Meily
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Germijn H Heijnen
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Lisette M Vernooij
- Department of Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Monika C Kerckhoffs
- Department of Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Arjen J C Slooter
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, 3584 CX, Utrecht, The Netherlands
- Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
37
|
Bates A, Golding H, Rushbrook S, Shapiro E, Pattison N, Baldwin DS, Grocott MPW, Cusack R. A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19. J Intensive Care Soc 2023; 24:309-319. [PMID: 37744073 PMCID: PMC9679313 DOI: 10.1177/17511437221136828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Approximately 50% of intensive care survivors experience persistent psychological symptoms. Eye-movement desensitisation and reprocessing (EMDR) is a widely recommended trauma-focussed psychological therapy, which has not been investigated systematically in a cohort of intensive care survivors: We therefore conducted a randomised pilot feasibility study of EMDR, using the Recent Traumatic Episode Protocol (R-TEP), to prevent psychological distress in intensive care survivors. Findings will determine whether it would be possible to conduct a fully-powered clinical effectiveness trial and inform trial design. Method We aimed to recruit 26 patients who had been admitted to intensive care for over 24 h with COVID-19 infection. Consenting participants were randomised (1:1) to receive either usual care plus remotely delivered EMDR R-TEP or usual care alone (controls). The primary outcome was feasibility. We also report factors related to safety and symptom changes in post-traumatic stress disorder, (PTSD) anxiety and depression. Results We approached 51 eligible patients, with 26 (51%) providing consent. Intervention adherence (sessions offered/sessions completed) was 83%, and 23/26 participants completed all study procedures. There were no attributable adverse events. Between baseline and 6-month follow-up, mean change in PTSD score was -8 (SD = 10.5) in the intervention group versus +0.75 (SD = 15.2) in controls (p = 0.126). There were no significant changes to anxiety or depression. Conclusion Remotely delivered EMDR R-TEP met pre-determined feasibility and safety objectives. Whilst we achieved group separation in PTSD symptom change, we have identified a number of protocol refinements that would improve the design of a fully powered, multi-centre randomised controlled trial, consistent with currently recommended rehabilitation clinical pathways. Trial registration ClinicalTrials.gov: NCT04455360.
Collapse
Affiliation(s)
- Andrew Bates
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hannah Golding
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
| | - Sophie Rushbrook
- Intensive Psychological Therapies Service, Dorset Healthcare University National Health Service Foundation Trust, Poole, UK
| | - Elan Shapiro
- Independent EMDR Europe Consultant Practitioner, Haifa, Israel
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - David S Baldwin
- Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Michael P W Grocott
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rebecca Cusack
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
38
|
Pandharipande P, Williams Roberson S, Harrison FE, Wilson JE, Bastarache JA, Ely EW. Mitigating neurological, cognitive, and psychiatric sequelae of COVID-19-related critical illness. THE LANCET. RESPIRATORY MEDICINE 2023; 11:726-738. [PMID: 37475124 PMCID: PMC10706757 DOI: 10.1016/s2213-2600(23)00238-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/22/2023]
Abstract
Despite advances in the treatment and mitigation of critical illness caused by infection with SARS-CoV-2, millions of survivors have a devastating, post-acute infection syndrome known as long COVID. A large proportion of patients with long COVID have nervous system dysfunction, which is also seen in the distinct but overlapping condition of post-intensive care syndrome (PICS), putting survivors of COVID-19-related critical illness at high risk of long-lasting morbidity affecting multiple organ systems and, as a result, engendering measurable deficits in quality of life and productivity. In this Series paper, we discuss neurological, cognitive, and psychiatric sequelae in patients who have survived critical illness due to COVID-19. We review current knowledge of the epidemiology and pathophysiology of persistent neuropsychological impairments, and outline potential preventive strategies based on safe, evidence-based approaches to the management of pain, agitation, delirium, anticoagulation, and ventilator weaning during critical illness. We highlight priorities for current and future research, including possible therapeutic approaches, and offer considerations for health services to address the escalating health burden of long COVID.
Collapse
Affiliation(s)
- Pratik Pandharipande
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Shawniqua Williams Roberson
- Departments of Neurology and Biomedical Engineering, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fiona E Harrison
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jo Ellen Wilson
- Department of Psychiatry and Behavioral Sciences, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Julie A Bastarache
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Wesley Ely
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| |
Collapse
|
39
|
Pozzi M, Giani M, Andreossi M, Annoni A, Villa M, Bellin V, Ferlicca D, Piva S, Rona R, Avalli L, Lucchini A, Foti G. Long-Term Physical, Cognitive, and Psychological Outcomes in Severe COVID-19 Patients Managed With Extracorporeal Membrane Oxygenation: A Prospective Study. ASAIO J 2023; 69:e376-e383. [PMID: 37531088 PMCID: PMC10627404 DOI: 10.1097/mat.0000000000001997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) has been used in highly selected COVID-19 patients with severe respiratory failure. Scarce data exist on long-term outcomes of these patients. We performed a single-center prospective evaluation of consecutive COVID-19 ECMO patients successfully discharged from the intensive care unit between February 2020 and January 2022. Physical, cognitive and psychological outcome was assessed at 3, 6, and 12 months by in-person evaluation. All the 34 discharged patients (median age 49 years old) were alive at one year, and 25 of them were evaluated at the follow-up clinic. 67% of patients had muscle weakness, with improvement over time (p = 0.032). The percentage of patients able to return to work progressively increased, up to 86% at 1 year. 23% of patients experienced fatigue. Participation restriction improved over time for both physical (p = 0.050) and emotional (p = 0.005) problems. Cognitive impairment, anxiety, and depression occurred in 29%, 29%, and 23% of patients, respectively, with no changes over time. Health-related quality of life was good. In conclusion, COVID-19 ECMO patients suffer from significant long-term sequelae. However, multidimensional outcomes continued to improve over the follow-up time.
Collapse
Affiliation(s)
- Matteo Pozzi
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Marco Giani
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Mara Andreossi
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Alice Annoni
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Marta Villa
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Valeria Bellin
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Daniela Ferlicca
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Roberto Rona
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Leonello Avalli
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Alberto Lucchini
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Foti
- From the Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
40
|
Parotto M, Gyöngyösi M, Howe K, Myatra SN, Ranzani O, Shankar-Hari M, Herridge MS. Post-acute sequelae of COVID-19: understanding and addressing the burden of multisystem manifestations. THE LANCET. RESPIRATORY MEDICINE 2023:S2213-2600(23)00239-4. [PMID: 37475125 DOI: 10.1016/s2213-2600(23)00239-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023]
Abstract
Individuals with SARS-CoV-2 infection can develop symptoms that persist well beyond the acute phase of COVID-19 or emerge after the acute phase, lasting for weeks or months after the initial acute illness. The post-acute sequelae of COVID-19, which include physical, cognitive, and mental health impairments, are known collectively as long COVID or post-COVID-19 condition. The substantial burden of this multisystem condition is felt at individual, health-care system, and socioeconomic levels, on an unprecedented scale. Survivors of COVID-19-related critical illness are at risk of the well known sequelae of acute respiratory distress syndrome, sepsis, and chronic critical illness, and these multidimensional morbidities might be difficult to differentiate from the specific effects of SARS-CoV-2 and COVID-19. We provide an overview of the manifestations of post-COVID-19 condition after critical illness in adults. We explore the effects on various organ systems, describe potential pathophysiological mechanisms, and consider the challenges of providing clinical care and support for survivors of critical illness with multisystem manifestations. Research is needed to reduce the incidence of post-acute sequelae of COVID-19-related critical illness and to optimise therapeutic and rehabilitative care and support for patients.
Collapse
Affiliation(s)
- Matteo Parotto
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada; Department of Anesthesia and Pain Medicine, Toronto General Hospital, Toronto, ON, Canada.
| | - Mariann Gyöngyösi
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Kathryn Howe
- Division of Vascular Surgery, University Health Network, Toronto, ON, Canada
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Otavio Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Pulmonary Division, Heart Institute, Faculty of Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Manu Shankar-Hari
- The Queen's Medical Research Institute, Edinburgh BioQuarter, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Margaret S Herridge
- Department of Medicine, University of Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
| |
Collapse
|
41
|
Sarkanen T, Partinen M, Bjorvatn B, Merikanto I, Benedict C, Nadorff MR, Bolstad CJ, Espie C, Matsui K, Chung F, Morin CM, Wing YK, Penzel T, Macêdo T, Mota-Rolim S, Holzinger B, Plazzi G, De Gennaro L, Landtblom AM, Inoue Y, Sieminski M, Leger D, Dauvilliers Y. Association between hypersomnolence and the COVID-19 pandemic: The International COVID-19 Sleep Study (ICOSS). Sleep Med 2023; 107:108-115. [PMID: 37156053 PMCID: PMC10163923 DOI: 10.1016/j.sleep.2023.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND The COVID-19 pandemic and related restriction measures have affected our daily life, sleep, and circadian rhythms worldwide. Their effects on hypersomnolence and fatigue remain unclear. METHODS The International COVID-19 Sleep Study questionnaire which included items on hypersomnolence such as excessive daytime sleepiness (EDS), and excessive quantity of sleep (EQS), as well as sociodemographic factors, sleep patterns, psychological symptoms, and quality of life was distributed in 15 countries across the world from May to September in 2020. RESULTS Altogether responses from 18,785 survey participants (65% women, median age 39 years) were available for analysis. Only 2.8% reported having had COVID-19. Compared to before the pandemic, the prevalence of EDS, EQS, and fatigue increased from 17.9% to 25.5%, 1.6%-4.9%, and 19.4%-28.3% amid the pandemic, respectively. In univariate logistic regression models, reports of having a COVID-19 were associated with EQS (OR 5.3; 95%-CI 3.6-8.0), EDS (2.6; 2.0-3.4), and fatigue (2.8; 2.1-3.6). In adjusted multivariate logistic regression, sleep duration shorter than desired (3.9; 3.2-4.7), depressive symptoms (3.1; 2.7-3.5), use of hypnotics (2.3; 1.9-2.8), and having reported COVID-19 (1.9; 1.3-2.6) remained strong predictors of EDS. Similar associations emerged for fatigue. In the multivariate model, depressive symptoms (4.1; 3.6-4.6) and reports of having COVID-19 (2.0; 1.4-2.8) remained associated with EQS. CONCLUSIONS A large increase in EDS, EQS, and fatigue occurred due to the COVID-19 pandemic, and especially in self-reported cases of COVID-19. These findings warrant a thorough understanding of their pathophysiology to target prevention and treatment strategies for long COVID condition.
Collapse
Affiliation(s)
- Tomi Sarkanen
- Department of Neurology, Tampere University Hospital, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Markku Partinen
- Department of Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland; Helsinki Sleep Clinic, Terveystalo Healthcare, Helsinki, Finland.
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Ilona Merikanto
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland; Orton Orthopaedics Hospital, Helsinki, Finland
| | - Christian Benedict
- Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, MS, 39762, USA; Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Courtney J Bolstad
- Department of Psychology, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Colin Espie
- Sir Jules Thorn Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Kentaro Matsui
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Frances Chung
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas Penzel
- Sleep Medicine Center, Charite University Hospital, Berlin, Germany
| | - Tainá Macêdo
- Department of Psychology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Sérgio Mota-Rolim
- Brain Institute, Physiology and Behavior Department, Onofre Lopes University Hospital - Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Giuseppe Plazzi
- IRCCS-Istituto delle Scienze Neurologiche Di Bologna, Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy; IRCCS Fondazione Santa Lucia, Roma, Italy
| | | | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Mariuz Sieminski
- Department of Emergency Medicine, Medical University of Gdansk, Poland
| | - Damien Leger
- VIFASOM, Université Paris Cité et APHP Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France.
| |
Collapse
|
42
|
Teixeira-Vaz A, Rocha JA, Oliveira M, Simões-Moreira T, Reis DAE, Silva AI, Paiva JA. Surviving critical COVID-19: How functionality, physical, mental and cognitive outcomes evolve? PLoS One 2023; 18:e0284597. [PMID: 37352178 PMCID: PMC10289386 DOI: 10.1371/journal.pone.0284597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/03/2023] [Indexed: 06/25/2023] Open
Abstract
PURPOSE To analyze the long-term consequences of critical COVID-19, regarding physical, mental, cognitive and functional impairments, and to describe its evolution through time. METHODS Prospective cohort study, with consecutive inclusion of patients admitted due to SARS-CoV-2 to intensive care units(ICU) of a tertiary-care center, between May/2020 and September/2021. All included patients were included in Physical and Rehabilitation Medicine(PRM) inpatient programs during ICU stay. Eligible patients were evaluated on PRM appointments 6 and 12 months after ICU discharge. In each visit, physical examination and a predefined set of scales were applied, aiming to comprehensively evaluate the three domains (physical, mental and cognitive) of post-intensive care syndrome and the patients' functionality. Statistical analysis encompassed descriptive and univariate analysis. RESULTS A total of 42 patients were included: 66.7% males, mean age of 62 yo. In the physical domain, 6 months after ICU discharge, there was a significant reduction in quality of life (p-value = 0.034), muscle strength (p-value = 0.002), gait ability (p-value<0.001) and balance (p-values<0.001) and increased fatigue levels (p-value = 0.009), in comparison with reference values. Yet, a significative positive evolution was observed in all referred subdomains (p-values<0.05). Nevertheless, 12 months after discharge, muscle strength (p-value = 0.001), gait (p-value<0.001) and balance (p-value<0.001) were still significantly compromised. Regarding the mental domain, both at 6 and 12 months after discharge, the levels of anxiety and depression were significantly increased (p-values<0.001). Nonetheless, a positive evolution was also found (p-values<0.02). Cognitive performance was significantly impaired in comparison with reference values, both at 6 and 12 months (p-value<0.001). Yet, a global improvement was also depicted (p-value = 0.003). Six months after ICU discharge, 54.8% were autonomous in activities of daily living, a value that improved to 74.0% in the subsequent 6 months (p-value = 0.002). CONCLUSION Critical COVID-19 survivors present significant physical, mental and cognitive impairments 6 and 12 months after ICU discharge, despite their positive evolution through time.
Collapse
Affiliation(s)
- Ana Teixeira-Vaz
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Afonso Rocha
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Mafalda Oliveira
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Tiago Simões-Moreira
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - David Almeida e Reis
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Isabel Silva
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
43
|
Alabsi H, Emerson K, Lin DJ. Neurorecovery after Critical COVID-19 Illness. Semin Neurol 2023. [PMID: 37168008 DOI: 10.1055/s-0043-1768714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
With the hundreds of millions of people worldwide who have been, and continue to be, affected by pandemic coronavirus disease (COVID-19) and its chronic sequelae, strategies to improve recovery and rehabilitation from COVID-19 are critical global public health priorities. Neurologic complications have been associated with acute COVID-19 infection, usually in the setting of critical COVID-19 illness. Neurologic complications are also a core feature of the symptom constellation of long COVID and portend poor outcomes. In this article, we review neurologic complications and their mechanisms in critical COVID-19 illness and long COVID. We focus on parallels with neurologic disease associated with non-COVID critical systemic illness. We conclude with a discussion of how recent findings can guide both neurologists working in post-acute neurologic rehabilitation facilities and policy makers who influence neurologic resource allocation.
Collapse
Affiliation(s)
- Haitham Alabsi
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kristi Emerson
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Lin
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
44
|
Kuperminc E, Heming N, Carlos M, Annane D. Corticosteroids in ARDS. J Clin Med 2023; 12:jcm12093340. [PMID: 37176780 PMCID: PMC10179626 DOI: 10.3390/jcm12093340] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is frequently associated with sepsis. ARDS and sepsis exhibit a common pathobiology, namely excessive inflammation. Corticosteroids are powerful anti-inflammatory agents that are routinely used in septic shock and in oxygen-dependent SARS-CoV-2 related acute respiratory failure. Recently, corticosteroids were found to reduce mortality in severe community-acquired pneumonia. Corticosteroids may therefore also have a role to play in the treatment of ARDS. This narrative review was undertaken following a PubMed search for English language reports published before January 2023 using the terms acute respiratory distress syndrome, sepsis and steroids. Additional reports were identified by examining the reference lists of selected articles and based on personnel knowledge of the authors of the field. High-quality research is needed to fully understand the role of corticosteroids in the treatment of ARDS and to determine the optimal timing, dosing and duration of treatment.
Collapse
Affiliation(s)
- Emmanuelle Kuperminc
- Department of Intensive Care, Hôpital Raymond Poincaré, APHP University Versailles Saint Quentin-University Paris Saclay, 92380 Garches, France
| | - Nicholas Heming
- Department of Intensive Care, Hôpital Raymond Poincaré, APHP University Versailles Saint Quentin-University Paris Saclay, 92380 Garches, France
- Laboratory of Infection & Inflammation-U1173, School of Medicine Simone Veil, University Versailles Saint Quentin-University Paris Saclay, INSERM, 92380 Garches, France
- FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), 92380 Garches, France
| | - Miguel Carlos
- Department of Intensive Care, Hôpital Raymond Poincaré, APHP University Versailles Saint Quentin-University Paris Saclay, 92380 Garches, France
| | - Djillali Annane
- Department of Intensive Care, Hôpital Raymond Poincaré, APHP University Versailles Saint Quentin-University Paris Saclay, 92380 Garches, France
- Laboratory of Infection & Inflammation-U1173, School of Medicine Simone Veil, University Versailles Saint Quentin-University Paris Saclay, INSERM, 92380 Garches, France
- FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), 92380 Garches, France
| |
Collapse
|
45
|
Pozzi M, Ripa C, Meroni V, Ferlicca D, Annoni A, Villa M, Strepparava MG, Rezoagli E, Piva S, Lucchini A, Bellani G, Foti G. Hospital Memories and Six-Month Psychological Outcome: A Prospective Study in Critical Ill Patients with COVID-19 Respiratory Failure. J Clin Med 2023; 12:jcm12093344. [PMID: 37176785 PMCID: PMC10179721 DOI: 10.3390/jcm12093344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
ICU survivors suffer from various long-term physical and psychological impairments. Memories from the critical illness may influence long-term psychological outcome. In particular, the role of ICU memories in COVID-19 critically ill patients is unknown. In a prospective observational study, we aimed to investigate patients' memories from the experience of critical illness and their association with a six-month psychological outcome involving quality of life evaluation. Patients' memories were investigated with ICU Memory tool, while psychological outcome and quality of life were evaluated by means of a battery of validated questionnaires during an in-person interview at the follow-up clinic. 149 adult patients were enrolled. 60% retained memories from pre-ICU days spent on a general ward, while 70% reported memories from the in-ICU period. Delusional memories (i.e., memories of facts that never happened) were reported by 69% of patients. According to a multivariable analysis, the lack of pre-ICU memories was an independent predictor of worse psychological outcomes in terms of anxiety, depression and Post-traumatic Stress Disorder (PTDS). Factors associated with long-term outcome in ICU survivors are not still fully understood and patients' experience during the day spent before ICU admission may be associated with psychological sequelae.
Collapse
Affiliation(s)
- Matteo Pozzi
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Claudio Ripa
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Valeria Meroni
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Daniela Ferlicca
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Alice Annoni
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Marta Villa
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | | | - Emanuele Rezoagli
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, 25123 Brescia, Italy
| | - Alberto Lucchini
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giacomo Bellani
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giuseppe Foti
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| |
Collapse
|
46
|
Hermann B, Benghanem S, Jouan Y, Lafarge A, Beurton A. The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists. Ann Intensive Care 2023; 13:28. [PMID: 37039936 PMCID: PMC10088619 DOI: 10.1186/s13613-023-01118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/04/2023] [Indexed: 04/12/2023] Open
Abstract
Over the past 2 years, SARS-CoV-2 infection has resulted in numerous hospitalizations and deaths worldwide. As young intensivists, we have been at the forefront of the fight against the COVID-19 pandemic and it has been an intense learning experience affecting all aspects of our specialty. Critical care was put forward as a priority and managed to adapt to the influx of patients and the growing demand for beds, financial and material resources, thereby highlighting its flexibility and central role in the healthcare system. Intensivists assumed an essential and unprecedented role in public life, which was important when claiming for indispensable material and human investments. Physicians and researchers around the world worked hand-in-hand to advance research and better manage this disease by integrating a rapidly growing body of evidence into guidelines. Our daily ethical practices and communication with families were challenged by the massive influx of patients and restricted visitation policies, forcing us to improve our collaboration with other specialties and innovate with new communication channels. However, the picture was not all bright, and some of these achievements are already fading over time despite the ongoing pandemic and hospital crisis. In addition, the pandemic has demonstrated the need to improve the working conditions and well-being of critical care workers to cope with the current shortage of human resources. Despite the gloomy atmosphere, we remain optimistic. In this ten-key points review, we outline our vision on how to capitalize on the lasting impact of the pandemic to face future challenges and foster transformative changes of critical care for the better.
Collapse
Affiliation(s)
- Bertrand Hermann
- Service de Médecine Intensive - Réanimation, Hôpital Européen Georges Pompidou (HEGP), Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Centre - Université Paris Cité (GHU AP-HP Centre - Université Paris Cité), Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
| | - Sarah Benghanem
- Faculté de Médecine, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
- Service de Médecine Intensive - Réanimation, Hôpital Cochin, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Centre - Université Paris Cité (GHU AP-HP Centre - Université Paris Cité), Paris, France
| | - Youenn Jouan
- Service de Médecine Intensive - Réanimation, CHRU Tours, Tours, France
- Service de Réanimation Chirurgicale Cardiovasculaire & Chirurgie Cardiaque, CHRU Tours, Tours, France
- INSERM U1100 Centre d'Etudes des Pathologies Respiratoires, Faculté de Médecine de Tours, Tours, France
| | - Antoine Lafarge
- Faculté de Médecine, Université Paris Cité, Paris, France
- Service de Médecine Intensive - Réanimation, Hôpital Saint Louis, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Nord - Université Paris Cité (AP-HP Nord - Université Paris Cité), Paris, France
| | - Alexandra Beurton
- Service de Médecine Intensive - Réanimation, Hôpital Tenon, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Sorbonne Université (GHU AP-HP Sorbonne Université), Paris, France.
- Service de Médecine Intensive - Réanimation, Hôpital Pitié Salpêtrière, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.
- UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.
| |
Collapse
|
47
|
Piva S, Pozzi M, Bellani G, Peli E, Gitti N, Lucchini A, Bertoni M, Goffi A, Marshall JC, Calza S, Rasulo FA, Foti G, Latronico N. Long-term physical impairments in survivors of COVID-19-associated ARDS compared with classic ARDS: A two-center study. J Crit Care 2023; 76:154285. [PMID: 36889040 DOI: 10.1016/j.jcrc.2023.154285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/22/2023] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE This work aimed to compare physical impairment in survivors of classic ARDS compared with COVID-19-associated ARDS (CARDS) survivors. MATERIAL AND METHODS This is a prospective observational cohort study on 248 patients with CARDS and compared them with a historical cohort of 48 patients with classic ARDS. Physical performance was evaluated at 6 and 12 months after ICU discharge, using the Medical Research Council Scale (MRCss), 6-min walk test (6MWT), handgrip dynamometry (HGD), and fatigue severity score (FSS). We also assessed activities of daily living (ADLs) using the Barthel index. RESULTS At 6 months, patients with classic ARDS had lower HGD (estimated difference [ED]: 11.71 kg, p < 0.001; ED 31.9% of predicted value, p < 0.001), 6MWT distance (ED: 89.11 m, p < 0.001; ED 12.96% of predicted value, p = 0.032), and more frequent significant fatigue (OR 0.35, p = 0.046). At 12 months, patients with classic ARDS had lower HGD (ED: 9.08 kg, p = 0.0014; ED 25.9% of predicted value, p < 0.001) and no difference in terms of 6MWT and fatigue. At 12 months, patients with classic ARDS improved their MRCss (ED 2.50, p = 0.006) and HGD (ED: 4.13 kg, p = 0.002; ED 9.45% of predicted value, p = 0.005), while those with CARDS did not. Most patients in both groups regained independence in ADLs at 6 months. COVID-19 diagnosis was a significant independent predictor of better HGD (p < 0.0001) and 6MWT performance (p = 0.001), and lower prevalence of fatigue (p = 0.018). CONCLUSIONS Both classic ARDS and CARDS survivors experienced long-term impairments in physical functioning, confirming that post-intensive care syndrome remains a major legacy of critical illness. Surprisingly, however, persisting disability was more common in survivors of classic ARDS than in CARDS survivors. In fact, muscle strength measured with HGD was reduced in survivors of classic ARDS compared to CARDS patients at both 6 and 12 months. The 6MWT was reduced and fatigue was more common in classic ARDS compared to CARDS at 6 months but differences were no longer significant at 12 months. Most patients in both groups regained independent function in ADLs at 6 months.
Collapse
Affiliation(s)
- Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.
| | - Matteo Pozzi
- Department of Emergency and Intensive Care, ASST Monza, Monza, Italy
| | - Giacomo Bellani
- Department of Emergency and Intensive Care, ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Elena Peli
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Nicola Gitti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Alberto Lucchini
- Department of Emergency and Intensive Care, ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Michele Bertoni
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John C Marshall
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesco A Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Giuseppe Foti
- Department of Emergency and Intensive Care, ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| |
Collapse
|
48
|
Abstract
Rationale: Recent reports suggest that patients with severe coronavirus disease (COVID-19) often experience long-term consequences of the infection. However, studies on intensive care unit (ICU) survivors are underrepresented. Objectives: We aimed to explore 12-month clinical outcomes after critical COVID-19, describing the longitudinal progress of disabilities, frailty status, frequency of cognitive impairment, and clinical events (rehospitalization, institutionalization, and falls). Methods: We performed a prospective cohort study of survivors of COVID-19 ICU admissions in Sao Paulo, Brazil. We assessed patients every 3 months for 1 year after hospital discharge and obtained information on 15 activities of daily living (basic, instrumental, and mobility activities), frailty, cognition, and clinical events. Results: We included 428 patients (mean age of 64 yr, 61% required invasive mechanical ventilation during ICU stay). The number of disabilities peaked at 3 months compared with the pre-COVID-19 period (mean difference, 2.46; 99% confidence interval, 1.94-2.99) and then decreased at 12 months (mean difference, 0.67; 99% confidence interval, 0.28-1.07). At 12-month follow-up, 12% of patients were frail, but half of them presented frailty only after COVID-19. The prevalence of cognitive symptoms was 17% at 3 months and progressively decreased to 12.1% (P = 0.012 for trend) at the end of 1 year. Clinical events occurred in all assessments. Conclusions: Although a higher burden of disabilities and cognitive symptoms occurred 3 months after hospital discharge of critical COVID-19 survivors, a significant improvement occurred during the 1-year follow-up. However, one-third of the patients remained in worse conditions than their pre-COVID-19 status.
Collapse
|
49
|
Characteristics of Mid-Term Post-Intensive Care Syndrome in Patients Attending a Follow-Up Clinic: A Prospective Comparison Between COVID-19 and Non-COVID-19 Survivors. Crit Care Explor 2023; 5:e0850. [PMID: 36699242 PMCID: PMC9851681 DOI: 10.1097/cce.0000000000000850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
At present, it is not clear if critically ill COVID-19 survivors have different needs in terms of follow-up compared with other critically ill survivors, and thus if duplicated post-ICU trajectories are mandatory. OBJECTIVES To compare the post-intensive care syndrome (PICS) of COVID-19 acute respiratory distress syndrome and non-COVID-19 (NC) survivors referred to a follow-up clinic at 3 months (M3) after ICU discharge. DESIGN SETTING AND PARTICIPANTS Adults who survived an ICU stay greater than or equal to 7 days and attended the M3 consultation were included in this observational study performed in a post-ICU follow-up clinic of a single tertiary hospital. MAIN OUTCOMES AND MEASURES Patients underwent a standardized assessment, addressing health-related quality of life (3-level version of EQ-5D), sleep disorders (Pittsburgh Sleep Quality Index [PSQI]), physical status (Barthel index, handgrip and quadriceps strengths), mental health disorders (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised [IES-R]), and cognitive impairment (Montreal Cognitive Assessment [MoCA]). RESULTS A total of 143 survivors (86 COVID and 57 NC) attended the M3 consultation. Their median age and severity scores were similar. NC patients had a shorter ICU stay (10 d [8-17.2 d]) compared with COVID group (18 d [10.8-30 d]) (p = 0.001). M3 outcomes were similar in the two groups, except for a higher PSQI (p = 0.038) in the COVID group (6 [3-9.5]) versus NC group (4 [2-7]), and a slightly lower Barthel index in the NC group (100 [100-100]) than in the COVID group (100 [85-100]) (p = 0.026). However, the proportion of patients with abnormal values at each score was similar in the two groups. Health-related quality of life was similar in the two groups. The three MoCA (≥ 26), IES-R (<33), and Barthel (=100) were normal in 58 of 143 patients (40.6%). In contrast, 68.5% (98/143) had not returned to their baseline level of daily activities. CONCLUSIONS AND RELEVANCE In our follow-up clinic at 3 months after discharge, the proportion of patients presenting alterations in the main PICS domains was similar whether they survived a COVID-19 or another critical illness, despite longer ICU stay in COVID group. Cognition and sleep were the two most affected PICS domains.
Collapse
|
50
|
Chommeloux J, Valentin S, Winiszewski H, Adda M, Pineton de Chambrun M, Moyon Q, Mathian A, Capellier G, Guervilly C, Levy B, Jaquet P, Sonneville R, Voiriot G, Demoule A, Boussouar S, Painvin B, Lebreton G, Combes A, Schmidt M. One-Year Mental and Physical Health Assessment in Survivors after Extracorporeal Membrane Oxygenation for COVID-19-related Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2023; 207:150-159. [PMID: 36150112 PMCID: PMC9893333 DOI: 10.1164/rccm.202206-1145oc] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Rationale: Long-term outcomes of patients with coronavirus disease (COVID-19)-related acute respiratory distress syndrome treated with extracorporeal membrane oxygenation (ECMO) are unknown. Objectives: To assess physical examination, pulmonary function tests, anxiety, depression, post-traumatic stress disorder and quality of life at 6 and 12 months after ECMO onset. Methods: Multicenter, prospective study in patients who received ECMO for COVID-19 acute respiratory distress syndrome from March to June 2020 and survived hospital discharge. Measurements and Main Results: Of 80 eligible patients, 62 were enrolled in seven French ICUs. ECMO and invasive mechanical ventilation duration were 18 (11-25) and 36 (27-62) days, respectively. All were alive, but only 19/50 (38%) returned to work and 13/42 (31%) had recovered a normal sex drive at 1 year. Pulmonary function tests were almost normal at 6 months, except for DlCO, which was still impaired at 12 months. Mental health, role-emotional, and role-physical were the most impaired domain compared with patients receiving ECMO who did not have COVID-19. One year after ICU admission, 19/43 (44%) patients had significant anxiety, 18/43 (42%) had depression symptoms, and 21/50 (42%) were at risk for post-traumatic stress disorders. Conclusions: Despite the partial recovery of the lung function tests at 1 year, the physical and psychological function of this population remains impaired. Based on the comparison with long-term follow-up of patients receiving ECMO who did not have COVID-19, poor mental and physical health may be more related to COVID-19 than to ECMO in itself, although this needs confirmation.
Collapse
Affiliation(s)
- Juliette Chommeloux
- Sorbonne University, Groupe de Recherche Clinique 30 RESPIRE, Institute of Cardiometabolism and Nutrition, INSERM UMRS_1166-iCAN, Paris, France;,Medical Intensive Care Unit and
| | - Simon Valentin
- Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France;,Faculté de Médecine, INSERM U1116, Vandoeuvre-les-Nancy, France;,Université de Lorraine, Nancy, France
| | | | - Mélanie Adda
- Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique Hopitaux de Marseille Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de Vie EA 3279, Marseille, France
| | - Marc Pineton de Chambrun
- Sorbonne University, Groupe de Recherche Clinique 30 RESPIRE, Institute of Cardiometabolism and Nutrition, INSERM UMRS_1166-iCAN, Paris, France;,Medical Intensive Care Unit and
| | - Quentin Moyon
- Medical Intensive Care Unit and,Sorbonne Universite, AP-HP, Groupement Hospitalier Pitié–Salpêtrière, Service de Medecine Interne 2, Inserm UMRS, Paris, France
| | - Alexis Mathian
- Sorbonne Universite, AP-HP, Groupement Hospitalier Pitié–Salpêtrière, Service de Medecine Interne 2, Inserm UMRS, Paris, France
| | - Gilles Capellier
- Medical Intensive Care Unit, University Hospital, Besancon, France
| | - Christophe Guervilly
- Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique Hopitaux de Marseille Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de Vie EA 3279, Marseille, France
| | - Bruno Levy
- Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France;,Faculté de Médecine, INSERM U1116, Vandoeuvre-les-Nancy, France;,Université de Lorraine, Nancy, France
| | - Pierre Jaquet
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Romain Sonneville
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Centre de Recherche Saint-Antoine (CRSA) UMRS_938 INSERM, Assistance Publique-Hôpitaux de Paris, Service de médecine intensive réanimation, Hôpital Tenon, Paris, France
| | - Alexandre Demoule
- Sorbonne Universite, Groupe Hospitalier Universitaire Pitié–Salpêtrière, Service de Medecine Intensive et Reanimation (Departement R3S), UMRS-1158 Neurophysiologie Respiratoire Experimentale et Clinique, Paris, France
| | - Samia Boussouar
- Cardiothoracic Imaging Unit, Pitié–Salpêtrière Hospital, AP-HP, ICAN Institute of Cardiometabolism and Nutrition, INSERM, Sorbonne University, Paris, France; and
| | - Benoit Painvin
- Réanimation Médicale, Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, Rennes, France
| | - Guillaume Lebreton
- Thoracic and Cardiovascular Department, Assistance Publique–Hôpitaux de Paris (AP-HP), Pitié–Salpêtrière Hospital, Paris, France
| | - Alain Combes
- Sorbonne University, Groupe de Recherche Clinique 30 RESPIRE, Institute of Cardiometabolism and Nutrition, INSERM UMRS_1166-iCAN, Paris, France;,Medical Intensive Care Unit and
| | - Matthieu Schmidt
- Sorbonne University, Groupe de Recherche Clinique 30 RESPIRE, Institute of Cardiometabolism and Nutrition, INSERM UMRS_1166-iCAN, Paris, France;,Medical Intensive Care Unit and
| |
Collapse
|