Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial

Sonnweber, Thomas; Sahanic, Sabina; Pizzini, Alex; Luger, Anna; Schwabl, Christoph; Sonnweber, Bettina; Kurz, Katharina; Koppelstätter, Sabine; Haschka, David; Petzer, Verena; Boehm, Anna; Aichner, Magdalena; Tymoszuk, Piotr; Lener, Daniela; Theurl, Markus; Lorsbach-Köhler, Almut; Schapfl, Anna; Schaber, Marc; Hilbe, Richard; Nairz, Manfred; Puchner, Bernhard; Hüttenberger, Doris; Tschurtschenthaler, Christoph; Aßhoff, Malte; Peer, Andreas; Härtig, Frank; Bellmann, Romuald; Joannidis, Michael; Gollmann‐Tepeköylü, Can; Holfeld, Johannes; Feuchtner, Gudrun; Egger, Alexander; Hoermann, Gregor; Schroll, Andrea; Fritsche, Gernot; Wildner, Sophie; Bellmann‐Weiler, Rosa; Kirchmair, Rudolf; Helbok, Raimund; Prosch, Helmut; Rieder, Dietmar; Trajanoski, Zlatko; Kronenberg, Florian; Wöll, Ewald; Weiss, Günter; Widmann, Gerlig; Löffler‐Ragg, Judith; Tancevski, Ivan

doi:10.1183/13993003.03481-2020

Cited by 366 publications

(524 citation statements)

References 32 publications

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“… 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 Overall, 7 studies were conducted in China 12 , 22 , 26 , 27 , 36 , 51 , 52 ; 6 each in the United Kingdom 9 , 15 , 21 , 28 , 32 , 37 and Spain…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-three studies recruited only inpatients; 10 studies 11 , 13 , 29 , 34 , 35 , 40 , 41 , 45 , 47 , 48 included a combination of outpatients and inpatients, with the proportion of inpatients ranging from 23.0% to 80.0% ( Table 1 ), and 2 studies 24 , 33 included only outpatients. Three studies excluded patients who were unable or unwilling to receive a magnetic resonance imaging scan.…”

Section: Resultsmentioning

confidence: 99%

“…Data extracted included study and patient characteristics, selection criteria, length of follow-up, and outcome measurements ( Table 1 ). 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 We used 6 quality criteria based on the National Institutes of Health Quality Assessment Tool for Observational and Cohort Studies 53 to assess study design or features most likely to bias frequency estimates. Criteria comprised (1) prospective cohort (score range of 0-1, with 0 indicating no and 1 indicating yes), (2) representativeness (score range of 0-1, with 0 indicating sampling strategy unclear or nonconsecutive enrollees and 1 indicating patients were randomly selected or all eligible patients were included), (3) baseline severity of illness reported (score range of 0-1, with 0 indicating not reported and 1 indicating reported), (4) attrition (score range of 0-3, with 0 indicating not reported or attrition ≥30%, 1 indicating attrition of 20%-29%, 2 indicating attrition of 10%-19%, and 3 indicating attrition <10%), (5) repeated outcome measureme...…”

Section: Methodsmentioning

confidence: 99%

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Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19

2021

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Key Points Question What are the frequency and variety of persistent symptoms after COVID-19 infection? Findings In this systematic review of 45 studies including 9751 participants with COVID-19, the median proportion of individuals who experienced at least 1 persistent symptom was 73%; symptoms occurring most frequently included shortness of breath or dyspnea, fatigue or exhaustion, and sleep disorders or insomnia. However, the studies were highly heterogeneous and needed longer follow-up and more standardized designs. Meaning This systematic review found that COVID-19 symptoms commonly persisted beyond the acute phase of infection, with implications for health-associated functioning and quality of life; however, methodological improvements are needed to reliably quantify these risks.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19

2021

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“…Sonnweber's research evaluated data on 145 patients with COVID-19 at 60 and 100 days after confirmed diagnosis, and found that 41% of all subjects exhibited persistent symptoms 100 days after COVID-19 onset, with dyspnea being most frequent (36%). Accordingly, patients still displayed an impaired lung function, with a reduced diffusing capacity in 21% of the cohort being the most prominent finding (28). In our study, after two weeks of PR, the patients' mMRC score and oxygen intake decreased and SpO 2 increased significantly.…”

Section: Discussionmentioning

confidence: 44%

Pulmonary rehabilitation focusing on the regulation of respiratory movement can improve prognosis of severe patients with COVID-19

Sun¹,

Liu²,

Li³

et al. 2021

Ann Palliat Med

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Background: Since the coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, it has become a global public health emergency. Besides conventional care, pulmonary rehabilitation (PR) is an equally important treatment for patients with COVID-19 suffering from respiratory, physical and psychological disease. The aim of this study is to investigate the role of PR on the inpatients with severe COVID-19.Methods: This study was a self-pre-and post-control prospective clinical trial, which totally recruited 31 inpatients confirmed COVID-19 by RT-PCR. They were performed 3-weeks PR. The demographic data, medical records, symptoms, laboratory findings and chest computed tomographic (CT) scans of patients were collected at baseline. The effect of PR was assessed by questionnaires before PR as well as after 2-and 3-weeks PR.Results: After 3-weeks PR and treatment, neutrophil percentage decreased, while lymphocyte percentage and lymphocyte count increased (before vs. 2 weeks after PR respectively: P=0.001; P=0.001; P<0.0001).Besides, CRP and procalcitonin reduced significantly (before vs. after respectively: P<0.0001; P=0.023).Patients' oxygen intake decreased and oxygen saturation increased significantly. Meanwhile, PR relieved the patients' symptoms of cough and dyspnea, improved the patients' self-care ability, physical fitness and mental state significantly. Activities of daily living (ADL) score increased and Modified Medical Research Council Dyspnea Scale (mMRC) decreased after PR.Conclusions: PR can relieve symptoms, enhance health-related quality of life, improve respiratory muscle function and alleviate disease-related anxiety and depression of severe patients with COVID-19. PR should be provided throughout the diseases management process, regardless of whether the patient is hospitalized or at home.

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“…In line, radiological signs of fibrosis become apparent as early as 3 weeks after diagnosis (169) and persist over months (170,171). After 3 months, impaired diffusion capacity and persisting radiological abnormalities are observed in many survivors, while others recover completely (172)(173)(174)(175)(176). Further studies are ongoing whether radiological and functional impairments are chronic and even progressing.…”

Section: Emerging Evidence Of Covid-19-associated Lung Fibrosismentioning

confidence: 93%

Human-Based Advanced in vitro Approaches to Investigate Lung Fibrosis and Pulmonary Effects of COVID-19

et al. 2021

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The coronavirus disease 2019 (COVID-19) pandemic has caused considerable socio-economic burden, which fueled the development of treatment strategies and vaccines at an unprecedented speed. However, our knowledge on disease recovery is sparse and concerns about long-term pulmonary impairments are increasing. Causing a broad spectrum of symptoms, COVID-19 can manifest as acute respiratory distress syndrome (ARDS) in the most severely affected patients. Notably, pulmonary infection with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), the causing agent of COVID-19, induces diffuse alveolar damage (DAD) followed by fibrotic remodeling and persistent reduced oxygenation in some patients. It is currently not known whether tissue scaring fully resolves or progresses to interstitial pulmonary fibrosis. The most aggressive form of pulmonary fibrosis is idiopathic pulmonary fibrosis (IPF). IPF is a fatal disease that progressively destroys alveolar architecture by uncontrolled fibroblast proliferation and the deposition of collagen and extracellular matrix (ECM) proteins. It is assumed that micro-injuries to the alveolar epithelium may be induced by inhalation of micro-particles, pathophysiological mechanical stress or viral infections, which can result in abnormal wound healing response. However, the exact underlying causes and molecular mechanisms of lung fibrosis are poorly understood due to the limited availability of clinically relevant models. Recently, the emergence of SARS-CoV-2 with the urgent need to investigate its pathogenesis and address drug options, has led to the broad application of in vivo and in vitro models to study lung diseases. In particular, advanced in vitro models including precision-cut lung slices (PCLS), lung organoids, 3D in vitro tissues and lung-on-chip (LOC) models have been successfully employed for drug screens. In order to gain a deeper understanding of SARS-CoV-2 infection and ultimately alveolar tissue regeneration, it will be crucial to optimize the available models for SARS-CoV-2 infection in multicellular systems that recapitulate tissue regeneration and fibrotic remodeling. Current evidence for SARS-CoV-2 mediated pulmonary fibrosis and a selection of classical and novel lung models will be discussed in this review.

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Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial

Cited by 366 publications

References 32 publications

Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19

Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19

Pulmonary rehabilitation focusing on the regulation of respiratory movement can improve prognosis of severe patients with COVID-19

Human-Based Advanced in vitro Approaches to Investigate Lung Fibrosis and Pulmonary Effects of COVID-19

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