A Description of Post Intensive Care Syndrome in COVID19 Survivors

Abstract

RATIONALE: Over 40 million people have recovered from COVID-19. Many of them are intensive care unit (ICU) survivors who are known to frequently face Post Intensive Care Syndrome (PICS), a constellation of new or worsening physical, mental and cognitive impairments that occur after ICU stay. There is scarce data describing PICS in COVID-19 survivors. The Cleveland Clinic established a new Post ICU Recovery Clinic (PIRC) that began seeing COVID-19 survivors in May 2020. The objective of this abstract is to report the incidence of PICS in COVID-19 ICU survivors.METHODS: A retrospective chart review of all COVID-19 patients seen in PIRC from December 2019 to September 2020 was performed. In-hospital variables collected included demographics and clinical course. PIRC visit variables collected included oxygen requirement, scores on several validated questionnaires screening for depression, anxiety, post-traumatic stress disorder (PTSD), cognitive function, instrumental and activities of daily living (iADL and ADL), 6-minute walk test, pulmonary function tests, and change in occupational and driving status. Statistics reported reflect exclusion of the missing data points. RESULTS: A total of 63 patients were seen in PIRC. COVID-19 ICU survivors comprised of 83% (n= 52) and of these, 46.2% (n = 24) had ARDS. Our population was 58% male with near equal Caucasian and African American distribution. The median hospital and ICU length of stay was as 12.5 (IQR 9.0-18.5) and 6 (3.0-12.0) days respectively. PIRC visits took place roughly two months after hospital discharge and 61% (n=31) were virtual visits. Twenty one (45%) patients had a new oxygen requirement, six (38%) had new mild or moderate cognitive impairment as identified by the Montreal Cognitive Assessment (MOCA), 11(52%) screened positive for new anxiety or depression as identified by the Patient Health Questionnaire-4 (PHQ-4), three patients screened positive for new PTSD as identified by the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) or Impact of Event Scale-Revised (IES-R) survey. Majority were independent in all ADL and iADL (91% and 71% respectively). Median distance on 6-minute walk test, % predicted of FEV1, FVC, TLC, and DLCO was 1205 feet, 86.2, 79.7, 74.9, and 62.4 respectively. From the 64% of patients who were working and 94% who were driving prior to hospitalization, only 26% and 78% had returned to those activities respectively. CONCLUSIONS: COVID-19 ICU survivors experience every aspect of PICS two months after hospital discharge. These survivors require comprehensive evaluation to facilitate diagnosis and identify treatments to promote holistic recovery.