Intensive care-related loss of quality of life and autonomy at 6 months post-discharge: Does COVID-19 really make things worse?

Abstract

Objective To compare old patients hospitalized in ICU for respiratory distress due to COVID-19 with old patients hospitalized in ICU for a non-COVID-19-related reason in terms of autonomy and quality of life. Design Comparison of two prospective multi-centric studies. Setting This study was based on two prospective multi-centric studies, the Senior-COVID-Rea cohort (COVID-19-diagnosed ICU-admitted patients aged over 60) and the FRAGIREA cohort (ICU-admitted patients aged over 70). Patients We included herein the patients from both cohorts who had been evaluated at day 180 after admission (ADL score and quality of life). Interventions None. Measurements and main results A total of 93 COVID-19 patients and 185 control-ICU patients were included. Both groups were not balanced on age, body mass index, mechanical ventilation, length of ICU stay, and ADL and SAPS II scores. We modeled with ordered logistic regression the influence of COVID-19 on the quality of life and the ADL score. After adjustment on these factors, we observed COVID-19 patients were less likely to have a loss of usual activities (aOR [95% CI] 0.47 [0.23; 0.94]), a loss of mobility (aOR [95% CI] 0.30 [0.14; 0.63]), and a loss of ADL score (aOR [95% CI] 0.30 [0.14; 0.63]). On day 180, 52 (56%) COVID-19 patients presented signs of dyspnea, 37 (40%) still used analgesics, 17 (18%) used anxiolytics, and 14 (13%) used antidepressant. Conclusions COVID-19-related ICU stay was not associated with a lower quality of life or lower autonomy compared to non-COVID-19-related ICU stay.

Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation)

“…In univariate analysis, HEALTHY-MIND© VR system was associated with significant decrease in overall discomfort (median NRS = 4 [ 2 – 6 ]) before the session versus 2 [0–5] after the session, p = 0.02) . The two other specific relaxation techniques and the standard relaxation were not associated with significant changes (Table 2 ).…”

“…The consequences can be serious, from the development of an adrenergic stress response interfering with critical illness (tachycardia, polypnea, patient/ventilator asynchrony, agitation, immunosuppression, etc.) [ 3 , 4 ] to the development of a post-intensive care syndrome (PICS), including neuro-psychological disorders (anxiety, depression, post-traumatic stress syndrome) and chronic pain that delay the return to a social and professional normal life [ 5 , 6 ]. The link between suffering in ICU and the development of PICS has been highlighted for a long time [ 7 ], leading to conceptualize modern intensive care as the most humane possible [ 8 , 9 ].…”

Effects of Rehabilitation on Long-COVID-19 Patient’s Autonomy, Symptoms and Nutritional Observance

“…Whether such a result was mainly due to COVID-19 per se or to the related hospitalization cannot be inferred from our data. However, a recent and interesting study showed that, compared with patients requiring a stay in the intensive care unit, people infected with COVID-19 were less likely to suffer from a loss of usual activities [ 3 ]. Thus, rather than COVID-19 alone, hospitalization appears to be an important cause of the loss of autonomy in patients infected with COVID-19.…”

“…As the SARS-CoV-2 pandemic has spread throughout the world, research has allowed us to increase our knowledge of this virus and to optimize COVID-19 infection prevention and treatment [ 1 ]. However, to date, studies concerning the nutritional status of patients after a COVID-19 hospitalization, in the long term, are relatively few and those concerning their autonomy are even fewer [ 2 , 3 , 4 ].…”

“…These impacts have been observed previously, for example with influenza, in patients presenting with pneumonia [ 5 , 6 , 7 , 8 ]. Additionally, the SARS-CoV-2 disease initiates a hyper catabolic state [ 9 , 10 ], and studies showed a prevalence of malnutrition greater than 50% in severe coronavirus infections [ 11 ] and a reduced autonomy in people with severe infections [ 3 ]. Insufficient food intake to meet the sudden increase in the body’s need for anti-infective control during hospitalization and especially during ICU admission likely worsened the patient’s health.…”