ICU-Acquired Pneumonia Is Associated with Poor Health Post-COVID-19 Syndrome

Abstract

Background. Some patients previously presenting with COVID-19 have been reported to develop persistent COVID-19 symptoms. While this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the incidence and factors associated with the characteristics of persistent COVID-19. On the other hand, these patients very often have intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence on poor health post-COVID 19 syndrome in ICU-discharged patients. Methods: This prospective, multicentre, and observational study was carrid out across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. Results: A total of 1255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP). Patients requiring invasive mechanical ventilation had more persistent post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, development of ICUAP, and ARDS were independent factors for persistent poor health post-COVID-19. Conclusions: Persistent post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay, development of ICUAP, and ARDS all comprised independent factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-COVID-19.

One Year Overview and Follow-Up in a Post-COVID Consultation of Critically Ill Patients

“…As a result of this situation, there is growing interest in the long-term sequelae after recovery from acute COVID-19. Previous reports indicate that at 6 months of follow-up, at least three-quarters of COVID-19 survivors discharged from the hospital still had persisting symptoms ( 5 – 7 ). Importantly, patients with more severe acute disease and those who were critically ill during their hospital stay had a higher risk of lung diffusion impairment (up to 56%) and radiological abnormalities ( 4 , 6 ).…”

Methodology of a Large Multicenter Observational Study of Patients with COVID-19 in Spanish Intensive Care Units

“…In the overall cohort, age, ARDS, length of ICU stay, and ICU acquired nosocomial pneumonia were independently associated with long COVID syndrome at 3 months. 26 In the Lleida cohort of patients with COVID-19 who were mechanically ventilated, 82% of patients who survived critical COVID-19 illness showed a lung diffusing capacity of less than 80% and abnormal chest CT scan in 70.2% at 3 months. 27 .…”

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“…This study, with limitations but well conducted, puts the spotlight on the need to establish prevalence in this continent, because if the data obtained were generalizable, the impact of COVID-19 in Africa would have been considerably underestimated. logical alterations in the CT, with 10% of totally established fibrosis and around 15% with persistent interstitial infiltrate [116]. A substudy published by one of the participating hospitals shows even higher figures of pulmonary fibrosis, reaching 21% and ground glass pattern in 30% [117].…”