Abstract
BackgroundSurvivors of severe COVID-19 are at risk of impaired health-related quality of life (HRQoL) and persistent physical and psychological disability after ICU and hospital discharge. The subsequent social burden is a major concern. We aimed to assess the short-term HRQoL, physical function and prevalence of post-traumatic stress symptoms of invasively mechanically ventilated COVID-19 patients treated in our ICU.MethodsProspective, observational cohort study in a follow-up clinic. Patients completed a 6-min walking test (6MWT) to assess their cardio-pulmonary function around 2 months (early follow-up) from hospital discharge, the EQ-5D-5L questionnaire for quality of life assessment around 2 months and at 6 months from hospital discharge and an anonymous web-based Impact of Event Scale-Revised (IES-R) questionnaire for Post-Traumatic Stress symptoms at 2 months.Results47 patients attended our follow-up program, mean age 59 ± 10 years, median pre-morbid Clinical Frailty Scale (CFS) 2 [2–3]. The median distance walked in 6 min was 470 [406–516] m, 83 [67–99]% of the predicted value. Overall 1 out 3 patients and 4/18 (22%) among those with a good functional baseline prior to COVID-19 (CFS of 1 or 2) had lower (84%) than predicted 6MWT. EQ-5D-5L quality of life VAS was 80 [70–90] out of 100 at early follow-up with a slight improvement to 85 [77.5–90] at 6 months. Mobility, self-care and usual activities improved between the two timepoints, while pain/discomfort and depression/anxiety did not improve or got worse. The IES-R total score was greater than the threshold for concern of 1.6 in 27/41(66%) respondents.ConclusionsPatients recovering from severe COVID-19 requiring invasive mechanical ventilation surviving hospital discharge present with early mild to moderate functional impairment, mildly reduced quality of life from hospital discharge with an overall improvement of mobility, self-care and the ability of performing usual activities, while a worsening of pain and depression/anxiety symptoms at 6 months and a large proportion of symptoms of post-traumatic distress soon after hospital discharge.
Highlights
The novel coronavirus disease (COVID-19) has generated an extraordinary number of patients admitted to Intensive Care Units (ICU) for treatment of acute and severe respiratory failure [1, 2]
Intensive Care (2021) 11:91 illnesses associated with prolonged ICU stay are well known risk factors for reduction in health-related quality of life (HRQoL), physical function and psychological disability [3]
Several recent papers investigated short-term consequences of COVID-19 in more heterogeneous populations: Goertz et al [6] found a significant prevalence of fatigue and dyspnea at 3 months from symptoms onset but excluded ICU patients, similar symptoms were found in the work of Halpin et al [7], the work of Belli et al [8] is limited to inpatient rehabilitation symptoms, while the work of Arnold et al [9] is limited by a 28-day follow-up
Summary
The novel coronavirus disease (COVID-19) has generated an extraordinary number of patients admitted to Intensive Care Units (ICU) for treatment of acute and severe respiratory failure [1, 2]. Several recent papers investigated short-term consequences of COVID-19 in more heterogeneous populations: Goertz et al [6] found a significant prevalence of fatigue and dyspnea at 3 months from symptoms onset but excluded ICU patients, similar symptoms were found in the work of Halpin et al [7], the work of Belli et al [8] is limited to inpatient rehabilitation symptoms, while the work of Arnold et al [9] is limited by a 28-day follow-up It is still unclear whether those treated in the ICU might be at higher risk of persisting pulmonary and extrapulmonary disability [10,11,12] and pertinent data are still lacking. We aimed to assess the short-term HRQoL, physical function and prevalence of post-traumatic stress symptoms of invasively mechanically ventilated COVID-19 patients treated in our ICU
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