P283 PULMONARY, CARDIAC AND NEUROLOGIC FOLLOW–UP AFTER SEVERE COVID–19 PNEUMONIA

Abstract

Abstract Background Since December 2019 COVID–19 has been burdening all health systems worldwide. However, pulmonary and extrapulmonary sequelae of COVID–19 after recovery from the acute disease are still under study. Purpose: The aim of this study was to investigate pulmonary impairments, neurologic disorders and the prevalence of right ventricle dysfunctions in patients with severe COVID–19 pneumonia, almost six months after discharge from hospital. Material and methods: Hospitalized COVID–19 patients with severe pneumonia, requiring mechanical ventilation were included in the study and evaluated at about 6 months after hospital discharge. Pulmonary function tests, echocardiography, EMG were performed to all patients, and a sitting psychotherapy was proposed. Results A total of 56 patients (median age 64 years) with severe COVID–19 pneumonia were included in the study. The disease was complicated by pulmonary embolism in 5 patients, by cerebral stroke in 1 patient, by bacterial infections in 4 patients, by pericarditis in 1 patient, by Guillain Barrè syndrome in 2 patients. At almost 6 months after hospital discharge, 17 patients (30%) had dyspnea NYHA II, 1 was in NYHA III (1.8%), and 4 (7%) suffered from symptoms of fatigue. Pulmonary function tests did not reveal any significant limitation (FVC: 96.9% {78–101}; FEV1: 99% {72–103}; FEV1/FVC 81.3% {76–85}; except for slightly reduced DLCO (61% {69–95}). Only 3 (5%) patients developed a severe DLCO alteration, among them only one patient had acute pulmonary embolism. There were no echocardiographic impairments, in particular right chambers were normal in size and function (median TAPSE=23 mm, median S1 = 12 cm/sec) and there were no cases of pericardial effusion. From the neurological point of view, in addition to the 2 patients who have developed a Guillain Barré syndrome, the patients recovered from COVID–19 who have left the Resuscitation of our Hospital have manifested after–effects of Critical Illness Myopathy and Neuropathy (CRIMYNE), a form of neuromuscular pathology considered in all respects an "organ failure" linked to the stay in intensive care caused by inflammatory mediators. Conclusions Hospitalized patients with severe COVID–19 pneumonia, requiring mechanical ventilation, are unlikely to develop pulmonary long–term impairments or cardiac dysfunction after discharge, but frequently suffer from symptoms of fatigue and persisting dyspnea on effort, due to CRIMYNE syndrome.