Postintensive Care Syndrome in Survivors of Critical Illness Related to Coronavirus Disease 2019: Cohort Study From a New York City Critical Care Recovery Clinic*

Abstract

OBJECTIVE: Determine the characteristics of postintensive care syndrome in the cognitive, physical, and psychiatric domains in coronavirus disease 2019 ICU survivors. DESIGN: Single-center descriptive cohort study from April 21, to July 7, 2020. SETTING: Critical care recovery clinic at The Mount Sinai Hospital in New York City. PATIENTS: Adults who had critical illness due to coronavirus disease 2019 requiring an ICU stay of 7 days or more and who agreed to a telehealth follow-up in the critical care recovery clinic 1-month post hospital discharge. INTERVENTIONS: None. MEASURES AND MAIN RESULTS: Patient-reported outcome measures assessing physical and psychiatric domains were collected electronically, a cognitive test was performed by a clinician, and clinical data were obtained through electronic medical records. Outcome measures assessed postintensive care syndrome symptoms in the physical (Modified Rankin Scale, Dalhousie Clinical Frailty Scale, Neuro-Quality of Life Upper Extremity and Lower Extremity Function, Neuro-Quality of Life Fatigue), psychiatric (Insomnia Severity Scale; Patient Health Questionnaire-9; and Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and cognitive (Telephone Montreal Cognitive Assessment) domains. The 3-Level Version of Euro-QoL-5D was used to assess the physical and psychiatric domains. A diagnosis of postintensive care syndrome was made in cases with evidence of impairment in at least one postintensive care syndrome domain. We included 45 patients with a mean (sd) age of 54 (13) years, and 73% were male. Ninety-one percent of coronavirus disease 2019 ICU survivors fit diagnostic criteria for postintensive care syndrome. 86.7 % had impairments in the physical domain, 22 (48%) reported impairments in the psychiatric domain, and four (8%) had impairments on cognitive screening. We found that 58% had some degree of mobility impairment. In the psychiatric domain, 38% exhibited at least mild depression, and 18 % moderate to severe depression. Eighteen percent presented Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, scores suggestive of posttraumatic stress syndrome diagnosis. In the Telephone Montreal Cognitive Assessment, 9% had impaired cognition. CONCLUSIONS: Survivors of critical illness related to coronavirus disease 2019 are at high risk of developing postintensive care syndrome. These findings highlight the importance of planning for appropriate post-ICU care to diagnose and treat this population.

Psychological evaluation and support in COVID-19 critically ill patients: a feasibility study

“…In conclusion, this study shows that, even in the context of a pandemic situation, it is possible to provide an early and sustained psychological support in critically ill patients. We report lower rates of post-intensive care psychological sequelae than what has previously been reported [4,5] but the absence of control group prevent from drawing firm conclusions about the impact of psychological intervention. Nevertheless, these results strongly encourage future large randomized controlled studies to assess the efficacy of early psychological evaluation and personalized support in critically ill COVID-19 patients.…”

“…Higher rates-38.8%-of psychological sequelae were described in Middle East and Severe Acute Respiratory Syndromes' outbreaks [3]. Recent data described about 40 to 48% of COVID-19 critically ill patients with postintensive care disorder or acute stress disorder [4,5]. The aim of this pilot study is to assess the feasibility of an early psychological evaluation and sustained support in COVID-19 patients admitted to intensive care unit (ICU) and describe their mental health outcomes during a 6-month follow-up.…”

Post-COVID-19 Syndrome: Nine Months after SARS-CoV-2 Infection in a Cohort of 354 Patients: Data from the First Wave of COVID-19 in Nord Franche-Comté Hospital, France

“…However, it is known that patients presenting with critical illness and acute respiratory distress syndrome related to COVID-19 can develop post-intensive care syndrome afterwards. This syndrome may combine mental disorders, cognitive impairment, memory loss, muscle weakness, dysphagia, and reduced quality of life [ 26 , 27 ].…”

Neurological complications of COVID-19

“…1). The effects of this may be further compounded by post acute sequelae of COVID-19 (PASC), and so the rehabilitation needs of these patients may be significant [ 15 ]. Critical care recovery clinics with in-person and telehealth options have become valuable resources for ICU survivors and their families.…”

“…The impact of COVID-19 centres with multidisciplinary services to address the ongoing medical and rehabilitation needs of COVID-19 survivors needs to be studied to guide hospitals and health systems in planning and preparing resources for millions of survivors. Unsurprisingly, given the trauma of a critical care admission, and the added stresses of the pandemic including a lack of family visits in many hospital systems, there is a high prevalence of post-traumatic stress symptoms [ 15 ].…”