One Year Overview and Follow-Up in a Post-COVID Consultation of Critically Ill Patients

Abstract

The long-term clinical management and evolution of a cohort of critical COVID-19 survivors have not been described in detail. We report a prospective observational study of COVID-19 patients admitted to the ICU between March and August 2020. The follow-up in a post-COVID consultation comprised symptoms, pulmonary function tests, the 6-minute walking test (6MWT), and chest computed tomography (CT). Additionally, questionnaires to evaluate the prevalence of post-COVID-19 syndrome were administered at 1 year. A total of 181 patients were admitted to the ICU during the study period. They were middle-aged (median [IQR] of 61 [52;67]) and male (66.9%), with a median ICU stay of 9 (5–24.2) days. 20% died in the hospital, and 39 were not able to be included. A cohort of 105 patients initiated the follow-up. At 1 year, 32.2% persisted with respiratory alterations and needed to continue the follow-up. Ten percent still had moderate/severe lung diffusion (DLCO) involvement (<60%), and 53.7% had a fibrotic pattern on CT. Moreover, patients had a mean (SD) number of symptoms of 5.7 ± 4.6, and 61.3% met the criteria for post-COVID syndrome at 1 year. During the follow-up, 46 patients were discharged, and 16 were transferred to other consultations. Other conditions, such as emphysema (21.6%), COPD (8.2%), severe neurocognitive disorders (4.1%), and lung cancer (1%) were identified. A high use of health care resources is observed in the first year. In conclusion, one-third of critically ill COVID-19 patients need to continue follow-up beyond 1 year, due to abnormalities on DLCO, chest CT, or persistent symptoms.

Respiratory recovery trajectories after severe-to-critical COVID-19: a 1-year prospective multicentre study

“…To date, data on long-term respiratory outcomes after severe-to-critical COVID-19 remain sparse [24][25][26], with only a few published longitudinal studies up to 1 year after acute disease [27][28][29][30][31][32]. Overall, respiratory recovery trajectories after severe-to-critical COVID-19 and factors potentially influencing them remain insufficiently described, as does the percentage of these hospitalised patients requiring prolonged follow-up, which was only estimated in a monocentric cohort of ICU-survivors [32].…”

COVID-19 and lung damage in obese patients: results of a prospective study

“…Так, например, X. Wu et al в своем годичном исследовании продемонстрировали достоверную связь между женским полом и худшими показателями DLCO [31]. Если говорить о диффузионной способности легких, то по результатам исследования J. González, включаю щего 181 пациента, госпитализированных в ОРИТ во время острой фазы COVID-19, выявлено, что через 1 год после выписки из стационара у 10% пациентов сохранялось снижение DLCO ниже 60% [35]. Несмотря на то что в данном обзоре не показана роль ожирения как достоверного фактора риска худших исходов, ожирение, наряду с гипертонической болезнью и сахарным диабетом, относилось к наиболее часто встречаемым сопутствующим заболеваниям у исследованных пациентов.…”

Reduction of Post-Covid Pulmonary Fibrosis and Bronchiectasis by Physiotherapy

“…Other findings identified in more than half of the cases were: coarse subpleural reticulation with irregular interfaces due to architectural distortion, but with no honeycombing (66%); areas of ground-glass opacity (58%), and a mosaic pattern due to air trapping demonstrated in the expiratory phase of the scan (51%), existence of pneumatoceles (14%) [5]. In a prospective observational study performed in patients who had a critical care admission due to COVID-19 between March and August 2020 in Hospital Universitari Arnau de Vilanova and Hospital Universitari Santa Maria in Lleida (Spain) at 12 month follow-up 40.9 and 70.2% had abnormal TLC (Total Lung Capacity) and DLCO (diffusing capacity for carbon monoxide) values, respectively; the chest CT of these more affected patients showed a high proportion of abnormalities, with the most frequent finding being interlobular septal thickening (100%) and bronchiectasis (90.2%); presence of reticular and fibrotic patterns in 53.7 and 36.6% of patients, respectively; solid nodule (43%) [6].…”