Clinical characteristics and post-intensive care outcomes of COVID-19 pneumonia.

Abstract

Background: COVID-19 can result in a severe viral pneumonia, with high reported mortality rates in patients requiring mechanical ventilation. There is controversy as to whether established therapeutic approaches to acute respiratory distress syndrome are optimal in this condition, and numerous novel therapies have been used, often outside the context of randomised trials. In addition, longer term quality of life outcomes associated with COVID-19 are as yet unknown. The aim of this case series is to describe demographic, physiological and outcome data of patients with COVID-19 admitted to our intensive care units who were treated according to evidence-based guidelines for acute respiratory distress syndrome.Methods: We retrospectively reviewed the records of all patients admitted to intensive care units in our institution with COVID-19 between March and June, 2020. Physiological and laboratory data were recorded at baseline and daily until intensive care discharge or death. Quality of life was assessed at a virtual post-intensive care follow-up clinic around 10 weeks after ICU discharge.Results: 45 patients with COVID-19 were included, 37 (82.2%) of whom were male, with a mean age of 55 years. 42 (93.3%) of this cohort met criteria for acute respiratory distress syndrome at time of admission. Clinical management was consistent with evidence based institutional guidelines introduced for acute respiratory distress syndrome. Median length of intensive care stay was 14 days. The intensive care mortality rate was 8.9%. Functional and psychological morbidity post intensive care was significant: 45.2% of respondents had at least moderate impairment of mobility and 35.5% described at least moderate symptoms of anxiety or depression at the time of follow up.Conclusions : This case series demonstrates low mortality in a cohort of patients treated according to an established evidence-based approach for acute respiratory distress syndrome. However, COVID-19 survivors have a marked functional and psychological morbidity impacting quality of life following ICU admission. The therapeutic goal in the future will be to achieve similar survival outcomes while minimizing the significant morbidity associated with COVID-19 related critical care admission.

Health-Related Quality of Life in Survivors of Severe COVID-19 of a University Hospital in Northern Portugal

“…These findings are consistent with the results of a recent work from Belfast that highlighted a significant level of functional and psychological morbidity in COVID-19 patients post-intensive care admission where 61% had moderate to severe problems participating in previous activities, 45.2% had at least moderate impairment of mobility and 35.5% described at least moderate symptoms of anxiety/depression at the time of follow-up. 16 Additionally, in the present study, the 12-question WHODAS 2.0 questionnaire showed that mobility, life activities and participation were the most affected domains: 42% with moderate to extreme difficulty in standing for long periods, 40% in walking a long distance, 37% in day-to-day work/school responsibilities, 31% in joining community activities and 51% emotionally affected by their health problems. The largest clinical follow-up study published with COVID-19 adult patients so far reported that 86% of patients supported with HFNC, NIV or IMV presented at least one symptom six months after symptom onset with an important impact of the critical disease in mobility and physical status: 81% presenting fatigue or muscle weakness and 29% with a distance walked in 6-min that was below the lower limit of the normal range.…”