Cardiopulmonary Exercise Testing in Critically Ill Coronavirus Disease 2019 Survivors: Evidence of a Sustained Exercise Intolerance and Hypermetabolism

Joris, Maurice; Minguet, Pauline; Colson, Camille; Joris, Jean; Fadeur, Marjorie; Minguet, Grégory; Guiot, Julien; Benoît, Michel; Rousseau, Anne-Françoise

doi:10.1097/cce.0000000000000491

Cited by 17 publications

(24 citation statements)

References 42 publications

(45 reference statements)

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“…Spirometry parameters ⇔ ⇓ DLCO ⇔ ⇓ (88% of pred.) Breathing reserve ⇔ O 2 pulse ⇔ (Hb NR) Deconditioning is the most common cause of impaired CRF in patients after severe COVID-19 pneumonitis Joris et al [ 16 ] N = 14 59 (10) y, 71% male 40 (18) days ex-/smoker = NR/7% diabetes = 38% Critical ( n = 14) Inclusion: surviving an intensive care unit stay > 6 days Exclusion: NR Assessed at 3 months post-discharge: O 2peak ⇓ (81% of pred.) Spirometry parameters NR DLCO NA E/ CO 2 ⇔ (mean slope: 29) HR peak ⇓ (71% of pred.)…”

Section: Resultsmentioning

confidence: 99%

“…However, more than one-fourth of patients present with ventilatory inefficiency. This might be a sign of systemic alterations Joris et al [ 16 ] N = 14 59 (10) y, 71% male 40 (18) days ex-/smoker = NR/7% diabetes = 38% Critical ( n = 14) Inclusion: surviving an intensive care unit stay > 6 days Exclusion: NR Assessed at 6 months post-discharge: O 2peak ⇓ (80% of pred.) Spirometry parameters ⇔ ⇓ DLCO ⇓ (71% of pred.)…”

Section: Resultsmentioning

confidence: 99%

“…If a dot is coloured, this group is included in the particular study a-vO 2 diff arteriovenous oxygen difference, COVID-19 coronavirus disease 2019, CPET cardiopulmonary exercise testing, CRF cardiorespiratory fitness, DLCO lung diffusion capacity using carbon monoxide, FEV1 forced expiratory volume in 1 s, FVC forced vital capacity, Hb haemoglobin, HR peak peak heart rate, NR not reported, pred. predicted, SARS-CoV-2 severe acute respiratory syndrome-coronavirus-2, SD standard deviation, E/ CO 2 ventilatory efficiency, O 2peak peak oxygen uptake, VT1 ventilatory threshold 1 (defined in [ 16 ]), WR work rate, # significantly different from control group; # # significantly different from group without fibrosis; ⇑ increased; ⇓ decreased; ⇔ normal, ⇔ ⇑ slightly increased; ⇔ ⇓ slightly decreased; ? unclear…”

Section: Resultsmentioning

confidence: 99%

“…2 B, DLCO seems to recover slowly. Within the first 4 months post-infection, DLCO ranged between 69 and 84% of predicted [ 5 , 16 , 29 , 32 , 33 , 42 , 43 ]. Yet, even in the two studies showing higher mean values in DLCO (84% and 82%), 20% and 40% of patients were diagnosed with mild to moderate alterations [ 5 , 43 ].…”

Section: Resultsmentioning

confidence: 99%

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Low Cardiorespiratory Fitness Post-COVID-19: A Narrative Review

et al. 2022

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Patients recovering from COVID-19 often report symptoms of exhaustion, fatigue and dyspnoea and present with exercise intolerance persisting for months post-infection. Numerous studies investigated these sequelae and their possible underlying mechanisms using cardiopulmonary exercise testing. We aimed to provide an in-depth discussion as well as an overview of the contribution of selected organ systems to exercise intolerance based on the Wasserman gears. The gears represent the pulmonary system, cardiovascular system, and periphery/musculature and mitochondria. Thirty-two studies that examined adult patients post-COVID-19 via cardiopulmonary exercise testing were included. In 22 of 26 studies reporting cardiorespiratory fitness (herein defined as peak oxygen uptake— V O 2peak ), V O 2peak was < 90% of predicted value in patients. V O 2peak was notably below normal even in the long-term. Given the available evidence, the contribution of respiratory function to low V O 2peak seems to be only minor except for lung diffusion capacity. The prevalence of low lung diffusion capacity was high in the included studies. The cardiovascular system might contribute to low V O 2peak via subnormal cardiac output due to chronotropic incompetence and reduced stroke volume, especially in the first months post-infection. Chronotropic incompetence was similarly present in the moderate- and long-term follow-up. However, contrary findings exist. Peripheral factors such as muscle mass, strength and perfusion, mitochondrial function, or arteriovenous oxygen difference may also contribute to low V O 2peak . More data are required, however. The findings of this review do not support deconditioning as the primary mechanism of low V O 2peak post-COVID-19. Post-COVID-19 sequelae are multifaceted and require individual diagnosis and treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s40279-022-01751-7.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Low Cardiorespiratory Fitness Post-COVID-19: A Narrative Review

et al. 2022

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“…In a recent study, we confirmed a marked exercise limitation in critically ill COVID-19 survivors 3 months after intensive care unit (ICU) discharge, mainly related to metabolic disorders rather than cardiac or pulmonary residual impairments. The exercise limitation persisted 6 months after ICU discharge [ 11 ]. Of note, all these patients were obese, as an overweight condition and obesity were observed in most patients with severe COVID-19 [ 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Exercise Limitation after Critical versus Mild COVID-19 Infection: A Metabolic Perspective

Joris¹,

Pincemaïl

Colson

et al. 2022

JCM

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Exercise limitation in COVID-19 survivors is poorly explained. In this retrospective study, cardiopulmonary exercise testing (CPET) was coupled with an oxidative stress assessment in COVID-19 critically ill survivors (ICU group). Thirty-one patients were included in this group. At rest, their oxygen uptake (VO2) was elevated (8 [5.6–9.7] mL/min/kg). The maximum effort was reached at low values of workload and VO2 (66 [40.9–79.2]% and 74.5 [62.6–102.8]% of the respective predicted values). The ventilatory equivalent for carbon dioxide remained within normal ranges. Their metabolic efficiency was low: 15.2 [12.9–17.8]%. The 50% decrease in VO2 after maximum effort was delayed, at 130 [120–170] s, with a still-high respiratory exchange ratio (1.13 [1–1.2]). The blood myeloperoxidase was elevated (92 [75.5–106.5] ng/mL), and the OSS was altered. The CPET profile of the ICU group was compared with long COVID patients after mid-disease (MLC group) and obese patients (OB group). The MLC patients (n = 23) reached peak workload and predicted VO2 values, but their resting VO2, metabolic efficiency, and recovery profiles were similar to the ICU group to a lesser extent. In the OB group (n = 15), no hypermetabolism at rest was observed. In conclusion, the exercise limitation after a critical COVID-19 bout resulted from an altered metabolic profile in the context of persistent inflammation and oxidative stress. Altered exercise and metabolic profiles were also observed in the MLC group. The contribution of obesity on the physiopathology of exercise limitation after a critical bout of COVID-19 did not seem relevant.

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Cardiopulmonary function in paediatric post-COVID-19: a controlled clinical trial

Schoeffl,

Raming,

Tratzky

et al. 2024

Eur J Pediatr

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Recently, the importance of post-COVID-19 in children has been recognized in surveys and retrospective chart analysis. However, objective data in the form of cardiopulmonary exercise test as performed in adults suffering from this condition are still lacking. This study aimed to investigate the cardiopulmonary effects of post-COVID-19 on children and adolescents. In this cross-sectional study (the FASCINATE study), children fulfilling the criteria of post-COVID-19 and an age- and sex-matched control group underwent cardiopulmonary exercise testing on a treadmill and completed a questionnaire with regard to physical activity before, during and after the infection with SARS-CoV-2. We were able to recruit 20 children suffering from post-COVID-19 (mean age 12.8 ± 2.4 years, 60% females) and 28 control children (mean age 11.7 ± 3.5 years, 50% females). All participants completed a maximal treadmill test with a significantly lower $$\dot{{\text{V}}}{{\text{O}}}_{2}{\text{peak}}$$ V ˙ O 2 peak in the post-COVID-19 group (37.4 ± 8.8 ml/kg/min vs. 43.0 ± 6.7 ml/kg/min. p = 0.019). This significance did not persist when comparing the achieved percentage of predicted $$\dot{{\text{V}}}{{\text{O}}}_{2}{\text{peak}}$$ V ˙ O 2 peak . There were no significant differences for oxygen pulse, heart rate, minute ventilation or breathing frequency. Conclusion: This is the first study to investigate post-COVID-19 in children using the cardiopulmonary exercise test. Although there was a significantly reduced $$\dot{{\text{V}}}{{\text{O}}}_{2}{\text{peak}}$$ V ˙ O 2 peak in the post-COVID-19 group, this was not true for the percent of predicted values. No pathological findings with respect to cardiac or pulmonary functions could be discerned. Deconditioning was the most plausible cause for the experienced symptoms. Trial registration: clinicaltrials.gov, NCT054445531, Low-field Magnetic Resonance Imaging in Pediatric Post Covid-19—Full Text View—ClinicalTrials.gov. What is Known:• The persistence of symptoms after an infection with SARS-CoV 2, so-called post-COVID-19 exists also in children.• So far little research has been conducted to analyze this entity in the pediatric population. What is New:• This is the first study proving a significantly lower cardiopulmonary function in pediatric patients suffering from post-COVID-19 symptoms.• The cardiac and pulmonary function appear similar between children suffering from post-COVID-19 and those who don’t, but the peripheral muscles seem affected.

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Cardiopulmonary Exercise Testing in Critically Ill Coronavirus Disease 2019 Survivors: Evidence of a Sustained Exercise Intolerance and Hypermetabolism

Cited by 17 publications

References 42 publications

Low Cardiorespiratory Fitness Post-COVID-19: A Narrative Review

Low Cardiorespiratory Fitness Post-COVID-19: A Narrative Review

Exercise Limitation after Critical versus Mild COVID-19 Infection: A Metabolic Perspective

Cardiopulmonary function in paediatric post-COVID-19: a controlled clinical trial

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