Prevalence of post-intensive care syndrome in mechanically ventilated patients with COVID-19

Abstract

Coronavirus disease 19 (COVID-19) patients usually require long periods of mechanical ventilation and sedation, which added to steroid therapy, favours a predisposition to the development of delirium and subsequent mental health disorders, as well as physical and respiratory sequelae. The aim of this study was to determine the prevalence of post-intensive care syndrome (PICS) at 3 months after hospital discharge, in a cohort of mechanically ventilated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An ambispective, observational study was conducted in three hospitals with intensive care unit (ICU) follow-up clinics. We studied adults who survived a critical illness due to SARS-CoV-2 infection requiring invasive mechanical ventilation. A physical (muscle strength and pulmonary function), functional [12-Item Short Form Health Survey (SF-12), and Barthel score], psychological [hospital anxiety and depression (HADS) and posttraumatic stress disorder symptom severity scales], and cognitive [Montreal cognitive assessment (MoCA) test] assessment were performed. A total of 186 patients were evaluated at 88 days (IQR 68–121) after hospital discharge. Mean age was 59 ± 12 years old, 126 (68%) patients were men, and median length of mechanical ventilation was 14 days (IQR 8–31). About 3 out of 4 patients (n = 139, 75%) met PICS criteria. Symptoms of cognitive and psychiatric disorders were found in 59 (32%) and 58 (31%) patients, respectively. Ninety-one (49%) patients had muscle weakness. Pulmonary function tests in patients with no respiratory comorbidities showed a normal pattern in 93 (50%) patients, and a restrictive disorder in 62 (33%) patients. Also, 69 patients (37%) were on sick leave, while 32 (17%) had resumed work at the time of assessment. In conclusion, survivors of critical illness due to SARS-CoV-2 infection requiring mechanical ventilation have a high prevalence of PICS. Physical domain is the most frequently damaged, followed by cognitive and psychiatric disorders. ICU follow-up clinics enable the assistance of this vulnerable population.

Delirium in hospitalized COVID-19 patients: Predictors and implications for patient outcome

“…Nevertheless, our study might even underestimate the incidence of delirium in the ICU, if one considers that some ICU patients were already transferred back to their referral hospitals before being weaned. This needs to be emphasized as other studies have described a higher predisposition to delirium in mechanically ventilated COVID-19 patients [ 24 ].…”

Challenges of nursing care for elderly intensive care unit patients: A qualitative study based on the third wave of COVID-19 in China

“…In our study, most participants mentioned that it was also a major challenge to provide psychological care and rehabilitation care while completing tasks involving the diagnosis and treatment of elderly patients with severe COVID-19. Previous studies have con rmed that elderly patients with severe illness often have a high level of psychological distress and need for psychological support [30][31][32]. However, the current status of psychological support for critically ill patients is unsatisfactory.…”

Incidence, Risk Factors, and Consequences of Post-Traumatic Stress Disorder Symptoms in Survivors of COVID-19-Related ARDS

“…Recent studies identified PTSD as a major health issue caused by COVID-19 infection, and survivors after an ICU stay are at higher risk of developing this condition, as compared to the population not exposed to the most severe forms of the disease or managed at home without any ventilatory support [ 17 , 24 , 25 ]. Risk factors related to the development of PTSD after ICU discharge include the length of hospital and ICU stays, mechanical ventilation, disease severity, higher levels of PCR, or lower PaO 2 /FiO 2 ratio [ 18 ].…”