The role of ventilatory support for long‐term outcomes after critical infection with COVID‐19: A prospective cohort study

Abstract

Objectives The full range of long‐term health consequences in intensive care unit (ICU) survivors with COVID‐19 is unclear. This study aims to investigate the role of ventilatory support for long‐term pulmonary impairment in critically ill patients and further to identify risk factors for prolonged radiological recovery. Methods A prospective observational study from a single general hospital, including all with COVID‐19 admitted to ICU between March and August 2020, investigating the association between ventilatory support and the extent of residual parenchymal changes on chest computed tomography (CT) scan and measurement of lung volumes at follow‐up comparing high‐flow nasal oxygen (HFNO) or non‐invasive ventilation (NIV) with invasive ventilation. A semi‐quantitative score (CT involvement score) based on lobar involvement and a total score for all five lobes was used to estimate residual parenchymal changes. The association was calculated with logistic regression and adjusted for age, sex, smoking, and severity of illness. Results Among the 187 eligible, 86 had a chest CT scan and 76 a pulmonary function test at the follow‐up with a median time of 6 months after ICU discharge. Residual lung changes were seen in 74%. The extent of pulmonary changes was similar regardless of ventilatory support, but patients with invasive ventilation had a lower total lung capacity 84% versus 92% of predicted ( p < 0.001). Conclusions The majority of ICU‐treated patients with COVID‐19 had residual lung changes at 6 months of follow‐up regardless of ventilator support or not, but the total lung capacity was lower in those treated with invasive ventilation.

Comparing severe COVID-19 outcomes of first and second/third waves: a prospective single-centre cohort study of health-related quality of life and pulmonary outcomes 6 months after infection

“…A detailed description of this data collection can be found in other publications 7 8. Data on demographic and clinical details were retrieved from medical charts regarding age (≤50, 50–65, >65 years), sex (male/female), body mass index (BMI), smoking habits (ever/never), comorbidities (ie, diabetes, hypertension/cardiovascular disease, chronic lung disease) Simplified Acute Physiological Score III (a scoring system used to predict mortality risk in the ICU), where a higher score indicates a higher mortality risk,14 corticosteroid treatment (yes/no), respiratory support (invasive vs HFNO/NIV) and ICU length of stay.…”

“…The majority survived the acute episode of a critical illness but were confronted with physical and psychological sequelae after discharge from hospital which prolonged recovery 3. Approximately 35%–80% of the survivors experienced persistent symptoms of fatigue, dyspnoea, joint pain, sleep disorders, and loss of memory and concentration lasting beyond 4 weeks after a moderate to severe acute infection, which is referred to as ‘postacute COVID-19 syndrome’4–6 Long-lasting respiratory complications as well as other functional deficits which may cause substantial morbidity have been reported among intensive care unit (ICU) survivors in the first year after hospital discharge 7–10. Furthermore, a high number of residual abnormalities on chest CT scan have been found several months after discharge from hospital, and acute respiratory distress syndrome has been associated with more severe radiological findings 11.…”

Physical and psychological impairment in survivors of acute respiratory distress syndrome: a systematic review and meta-analysis

“…Pulmonary function was measured in 11 studies 13,48,49,51,56,66,71,74,75,77,79 , of these 7 were on classical ARDS with 723 patients and 6 studies on SARS-CoV-2 ARDS with 651 patients. Studies mainly reported Forced Vital Capacity (FVC) and Forced Expiratory Volume (FEV 1 ) over 12 months.…”

Recovery after admission with COVID-19 pneumonia – A follow-up study

“…One study comparing critical COVID-19 patients who underwent non-invasive versus invasive mechanical ventilation showed a lower TLC for patients with invasive ventilation 6 months after discharge. [19] Further studies reporting on long-term outcomes of critical patients treated with non-invasive ventilation or high-flow nasal oxygen compared with invasive mechanical ventilation could shed more light on the magnitude of this damage.…”