Neuroleptics used in critical COVID associated with moderate- severe dyspnea after hospital discharge

Abstract

Background Dyspnea is a central symptom in patients with long-term COVID, both because of frequency and clinical impact. The effect of the drugs most used in critically ill patients on long-term dyspnea is not known. The aim of this study was to assess the risk factors and impacts associated with moderate to severe dyspnea in COVID-19 survivors.Methods Patients admitted to a university hospital between April 2020 and April 2021 were evaluated. It was collected data associated with clinical preconditions, hospital and ICU stay, use of corticosteroids, neuroleptics, neuromuscular blockers, midazolam, fentanyl, and noradrenaline. After hospital discharge, patients were evaluated in 1 and 12 months. In the evaluations, dyspnea, frailty, quality of life, functional capacity, anxiety and depression were measured. Descriptive statistics in the form of frequencies and percentages and a logistic regression analysis were done to assess the factors associated with moderate to severe dyspnea after 1 and 12 months from hospital discharge and statistical significance was set at P < 0.05.Results 100 patients were prospectively included, with 100 patients underwent the 1-month evaluation and 63 underwent the 12-month evaluation. Presented with limiting dyspnea (defined as mMRC score > 1) 56.6% of patients after 1 month and 33.9% after 12 months. Independent factors associated with limiting dyspnea 1 month after hospital discharge were the total dose of neuroleptics used during hospitalization and the presence of comorbidities prior to hospitalization. Use of corticosteroids, neuromuscular blockers, midazolam, fentanyl, and noradrenaline were not associated with limiting dyspnea. Dyspnea 1 month after hospital discharge was an independent risk factor for the occurrence of limiting dyspnea 12 months after discharge. Patients with limiting dyspnea 12 months after discharge showed more depression, anxiety and frailty, and had lower quality of life and functionality.Conclusions Patients with long-term severe COVID have a high frequency of limiting dyspnea. The total dose of neuroleptics used in hospital and the presence of comorbidities were independently related to the presence of limiting dyspnea after hospital discharge. After 12 months, patients who maintained limiting dyspnea presented in high frequency with other physical and mental dysfunction that should be evaluated and treated in the aim of reducing the burden of disabilities.