Comparison between the persistence of post COVID-19 symptoms on critical patients requiring invasive mechanical ventilation and non-critical patients

Abstract

Background During follow-up, patients severely affected by coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation (IMV), show symptoms of Post-Intensive Care Syndrome (PICS) such as cognitive impairment, psychological disability, and neuromuscular deconditioning. In COVID-19 pandemic, it is a priority to develop multidisciplinary post-acute care services to address the long-term multisystemic impact of COVID-19. Research question Which are the most relevant multisystemic sequelae in severe post-COVID-19 patients? Study design and methods Observational chart review study that included adult patients discharged from a referral hospital for respiratory diseases in Mexico after recovering from severe COVID-19 disease from December 23, 2020, to April 24, 2021. Data were collected from 280 of 612 potentially eligible patients to evaluate persistent symptoms and compare sequelae in patients who required intubation, using a standardized questionnaire of symptoms, in addition to findings reported during the face-to-face health assessment. Univariable and multivariate analyses were performed for the association among the requirement of IMV and the long-term persistence of symptoms. Results 280 patients were included. The median age was 55 (range, 19 to 86) years, and 152 (54.3%) were men. The mean length of hospital stay was 19 (SD, 14.1) days. During hospitalization 168 (60%) participants received IMV. A large proportion of these patients reported fatigue (38.7%), paresthesia (35.1%), dyspnea (32.7%) and headache (28%); meanwhile only 3 (1.8%) of them were asymptomatic. Patients who required intubation were more likely to have neuropsychiatric (67.3% vs 55.4%; OR, 1.79 [95% CI, 1.08 to 2.97]) and musculoskeletal involvement (38.7% vs. 25.9%; OR, 1.92 [95% CI, 1.12 to 3.27]), adjusted for age,sex and hospitalization time. Interpretation The proportion of patients requiring intubation was 60%, reporting persistent symptoms in 98% of them. Neuropsychiatric and musculoskeletal symptoms were the most predominant symptoms in these patients, with a significant difference. Post-COVID-19 syndrome is a frequent problem in patients who required IVM. Physicians in ICU and in care of COVID-19 patients should be aware of this syndrome in order to avoid more complications.

Pathophysiological, immunological, and inflammatory features of long COVID

“…Some authors even report complete patient recovery one year after the acute phase, even in those patients with worse respiratory mechanics during invasive MV ( 117 ). However, other studies have shown that 60 to 70% of neuropsychiatric symptoms persisted between 3 and 6 months in patients who received MV ( 118 , 119 ). The emergence of psychiatric symptoms, including psychological distress, anxiety, depression, sleep disorders, and alterations, has been documented in survivors of severe illnesses ( 120 ), including those recuperated from severe infections with other coronaviruses ( 121 , 122 ).…”

“…A study of 81,337 volunteers showed a significant association between symptomatic COVID-19 and reduced cognitive function, especially in cases involving MV ( 141 ). MV alone, even without COVID-19, can cause neurological complications, which may contribute to long COVID neurological manifestations ( 119 , 177 ). Even fully recovered individuals displayed poorer cognitive performance than uninfected counterparts, indicating a link between symptomatic COVID-19 and cognitive impairment ( 141 ).…”

Residual radiological opacities correlate with disease outcomes in ICU-treated COVID-19

“…Patients requiring ICU admission and treatment with invasive mechanical ventilation have been shown to exhibit symptoms of post-intensive care syndrome (PICS) during follow-up, which includes cognitive impairment, neuromuscular deconditioning, and psychological disability. Some authors have suggested that COVID-19 critical patients undergoing prolonged mechanical ventilation, sedative use, and steroid treatment may be more susceptible to developing PICS ( 37 ).…”

Post-Acute COVID-19 Joint Pain and New Onset of Rheumatic Musculoskeletal Diseases: A Systematic Review

“…The largest was a population-based study involving 456,002 individuals from the United Kingdom at least 4 weeks after COVID-19, where arthralgia was present in 2% to 3% of the patients [72]. In 10 other studies, including 9756 patients overall, a prevalence of joint pain ranging from 10% to 19% was described [35,38,40,41,45,46,51,58,69,73], while 11 studies assessing post-COVID-19 symptoms in 28,303 patients showed higher figures, between 20% and 29% [28,34,42,43,47,49,64,66,71,75,76]. Most of these patients were contributed by Wang et al [71].…”