Post-ARDS Pulmonary Manifestations in COVID-19 Patients: Assessment of Risk Factors and Treatment Approaches

Abstract

Background: Mixed radiological pulmonary manifestations with persistent and even progressive dyspnea are the possible consequences of COVID-19 and ARDS and the most worrying long-term complications. Such patients are at high risk for pulmonary fibrosis and non-reversible lung dys-function. The aim of this study was the assessment of risk factors and possible approaches to the treatment of such residual complications in COVID-19 and ARDS patients. Methods: Our study was randomized and controlled. Ninety seven patients were assessed at pul-monary and critical care departments of University Hospital, Baku city 6 weeks after discharge from COVID-19 hospitals. All patients have been treated in ICU for acute respiratory distress syndrome (ARDS) related to severe COVID-19 infection. All patients had persistent, nonimproving symptoms, particularly dyspnea. Depending on residual fibrotic and non-fibrotic changes in lungs all patients have been divided in two groups: 1) 39 patients with lung involvement (50-75%); 2) 58 patients with lung involvement more than 75%. Results: At 6 weeks after discharge all patients reported persistent symptoms: dyspnea 100,0% (97/97), cough 42,3% (41/97), chest pain 51,5% (50/97), fever 29,0% (28/97) and hemoptysis 18,5% (18/97) were assessed. Pulmonary abnormalities were found in all subjects; however, most intensive abnormalities were noticed in intubated patients with severe ARDS (OR 3,75[0,91-8,44] 95% CI; p﹤0,001). In all patients persistent lung function impairment were evaluated. Severity of lung function deficiency was depending on severity of ARDS (p﹤0,001). Follow-up CT chest was done following negative PCR result after 12 weeks to assess degree of recovery and residual fibrotic and non-fibrotic changes. Pulmonary fibrosis has been seen in all patients with lung involvement more than 75% (OR 2,45 [0,81-6,29] 95% CI; p﹤0,001), and organ-izing pneumonia although seen commonly in patients with massive lung involvement (OR 4,24 [0,94-9,26] 95% CI; p﹤0,001). Traction bronchiectasis was higher in patients with massive lung involvement compared to non-massive (OR 2,11 [0,72-5,01] 95% CI; p﹤0,004). CT chest finding like ground glass opacities, consolidation, vascular and bronchial thickening were similar in both group patients (p﹥0,05). Lack of use dexamethasone in acute phase of the disease was higher in patients with lung involvement more than 75% (p﹤0,004) and lack of use prone position ventilation also was one of risk factors for excessive lung involvement (p﹤0,01). Invasive mechanical ventilation incidence was higher in massive lung involvement ((OR 2,84 [0,76-6,44] 95% CI; p﹤0,002). Lack of use HFNC also was associated with higher incidence of more massive lung involvement and development of pulmonary fibrosis (p﹤0,01) and organizing pneumonia (p﹤0,001).Conclusions: Following post-ARDS COVID-19 disease the patients have significant residual radiological inflammatory lung disease, persistent ventilation and functional deficit. There were several risk factors associated with more severe lung fibrotic and non-fibrotic residual changes. Treatment with corticosteroids at the time of ICU admission associated with decrease of extensity of radiological changes and functional impairment.