Post-Intensive Care COVID Survivorship Clinic: A Single-Center Experience

Abstract

OBJECTIVES: Patients discharged from the ICU post-COVID-19 pneumonitis may experience long-term morbidity related to their critical illness, the treatment for this and the ICU environment. The aim of this study was to characterize the cognitive, psychologic, and physical consequences of COVID-19 in patients admitted to the ICU and discharged alive. DESIGN: Prospective cohort study. SETTING: Post-intensive care syndrome (PICS) follow-up clinic at Tallaght University Hospital, a tertiary referral center with a 16-bed mixed medical-surgical ICU, including critical care physicians, a psychologist, a physiotherapist, and a research nurse. PATIENTS: Patients who had been admitted to the ICU in our tertiary referral center with COVID-19 pneumonitis 6 months earlier. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 22 patients attended the 6-month PICS follow-up clinic following admission to ICU with COVID-19 pneumonitis. Mean grip strength was low at the 6-month follow-up at 24.1 pounds (sd 9.8) with a minimally active median metabolic equivalent (MET) of 970 METs/wk (interquartile range, 0–7,794 METs/wk). Only 59% of patients were independent with regard to their activities of daily living. Eight of 14 patients (57%) had returned to work by 6 months post-ICU discharge. Their mean Intensive Care Psychological Assessment Tool (IPAT) score was 6.6 (sd 4.6) with a Post-Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5th Edition (PCL-5) score of 21.1 (sd 17.5) and a mean Montreal Cognitive Assessment (MoCA) score of 24 (sd 8.4); suggestive of mild cognitive impairment. In a multivariable regression model, only Acute Physiology and Chronic Health Evaluation II score was significantly independently associated with MoCA score as a cognitive PICS outcome (beta-coefficient, –1.6; se, 0.6; p = 0.04). None of the predictor variables were significantly independently associated with IPAT and PCL-5 as psychologic outcomes, nor with International Physical Activity Questionnaire-Short Form as a physical PICS outcome. CONCLUSIONS: In this single-center prospective cohort study, we found that patients have a high burden of physical and psychologic impairment at 6 months following ICU discharge post-COVID-19 pneumonitis; in many cases requiring specialist referrals for long-term input. We advocate for increased resources for this much needed follow-up multidisciplinary intervention for an ever-growing population of patients.

Post intensive care syndrome in survivors of COVID-19 who required mechanical ventilation during the third wave of the pandemic: A prospective study

“…Recently, in a prospective study of 22 patients conducted in Ireland, Apache II strongly correlated with the MoCA at 6 months. 26 In a linear regression analysis, the authors observed that for each point that Apache II increases, the MoCA score decreases by 1.6 points (Coefficient β: −1.6, p: 0.04).…”

Return-to-Work Prevalence Among COVID-19 Patients After Receiving Intensive Care: A Systematic Review and Meta-Analysis

“…All the included studies were published from 2021 to 2023 (Table 1 ). Two studies [ 23 , 32 ] were conducted in the United States, 16 in Europe [ 15 , 17 , 18 , 20 - 22 , 24 - 31 , 33 , 34 ], one in Brazil [ 16 ], and one in Australia [ 19 ]. Four studies [ 16 , 25 , 26 , 33 ] assessed return-to-work in patients receiving ECMO.…”

“…A total of 42 studies were assessed; 20 studies involving 1254 patients were included in the quantitative synthesis and 19 studies were used for the meta-analysis. The number of studies (i.e., number of patients) reporting an instance of return-to-work at 0-3 months, 4-6 months, and 7-12 months were three [15][16][17], eleven [18][19][20][21][22][23][24][25][26][27], and eight [17,25,[27][28][29][30][31][32], respectively. Studies in which outcome assessments were conducted over an extended time frame were excluded.…”

Predictors of early and long-term mortality after ICU discharge in critically ill COVID-19 patients: A prospective cohort study

“…A prospective cohort study conducted in Spain in 2021, evaluating the sequelae occurred at the first month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia, concluded that these patients need a long-term follow-up due to its expected bad prognosis, and this should be extended beyond 30 days after ICU discharge [ 6 ]. However, evidence regarding the optimal duration for follow-up care in individuals who have survived COVID-19 after being admitted to the ICU is still lacking [ 7 ]. The present study aimed to assess early and late mortality after ICU discharge among surviving critical COVID-19 patients and describe their most relevant predictors, in order to propose recommendations regarding the most appropriate follow-up strategy for COVID-19 ICU survivors.…”