Similar pulmonary functional outcomes at 3 months in critical COVID-19 survivors hospitalized during the first, second, and third pandemic waves

Abstract

Introduction Despite improvements in the management of COVID-19 patients, we still don’t know whether pharmacological treatments and improvements in ventilatory support have changed outcomes for intensive care unit (ICU) survivors of the three consecutive waves (w) of the pandemic. The objective of this study was to assess pulmonary functional outcomes, radiologic pattern, and quality of life (QoL) in ICU COVID-19 survivors at 3 months, according to pandemic wave. Methods All patients admitted to the ICU for COVID-19 acute respiratory distress syndrome (ARDS) at two university hospitals were prospectively included and assessed 3 months post-ICU discharge by chest CT, pulmonary function test (PFT), 6-minute walking distance test (6MWDT), respiratory muscle strength (RMS) test, and Short Form 36 (SF-36) questionnaire. Results Eighty-four ARDS COVID-19 survivors were included. Hospital length of stay was shorter during w3 vs w1 (23.4 ± 14.2 days vs 34.7 ± 20.8 days, p = 0.03). Fewer patients required mechanical ventilation (MV) during w2 vs w1 (33.3% vs 63.9%, p = 0.0038). Three months after ICU discharge, PFT, 6MWDT, and RMS were similar, regardless of wave (p > 0.05). QoL (SF-36) was worse for patients in w1 vs w3 (64.7 ± 16.3 vs 49.2 ± 23.2, p = 0.0169). On linear/logistic regression analysis, MV was associated with decreased TLC, FEV1, DLCO, and RMS (w1,2,3, p < 0.05). Low SF-36 score was correlated with low 6MWDT (w3, p = 0.01). The use of glucocorticoids was associated with better TLC, FEV1, DLCO, and number of affected segments on chest CT (p = 0.0001), and tocilizumab was associated with higher TLC (p = 0.027). Remdesevir improved MV duration in wave 2 (p = 0.008). Conclusions Despite better understanding and management of COVID-19, PFT, 6MWDT, and RMS remained similar in ICU survivors, regardless of the pandemic wave in which they were hospitalized.