Pulmonary Function, Mental and Physical Health in Recovered COVID-19 Patients Requiring Invasive Versus Non-invasive Oxygen Therapy: A Prospective Follow-Up Study Post-ICU Discharge

Abstract

BackgroundSurvivors of COVID-19 pneumonia may have residual lung injury and poor physical and mental health even after discharge. We hypothesized that COVID-19 severe acute respiratory distress syndrome (ARDS) patients needing mechanical ventilation may be at a greater risk of deterioration in pulmonary function, mental health, and quality of life (QOL). This study analyses the differences in pulmonary function, mental health, and QOL after recovery, in patients having received non-invasive oxygen therapy versus invasive mechanical ventilation during ICU stay. MethodsPatients aged >18 years, who had completed 3 months post ICU discharge, with moderate to severe COVID-19 ARDS, were consecutively enrolled from May 1 to July 31, 2021. Patients were allocated into Group Ahaving required high flow nasal cannula (HFNC)/non-invasive ventilation (NIV) and Group B -having received invasive mechanical ventilation. Pulmonary function tests, 6-minute walk test (6-MWT), and health-related quality of life were compared. ResultsOf the 145 eligible patients, 31 were lost to follow-up and 21 died. Seventy-four patients were allocated into Groups A (57 patients) and B (17 patients). In Group A, abnormal forced expiratory volume in first second (FEV 1 ), forced vital capacity (FVC), forced expiratory flow in mid-half of FVC (FEF 25-75 ), and peak expiratory flow rate (PEFR) values were obtained in 27 (47.37%), 43 (75.44%), 11 (19.3%), and 25 (43.86%) patients, and in Group B, in 13 (76.47%), 17 (100%), 1 (5.88%), and 8 (47%) patients, respectively. No patient had abnormal FEV 1 /FVC. All Group B patients had a restrictive pattern in spirometry as compared to 77% in Group A. Group B had a lower arterial partial pressure of oxygen (PaO 2 ) (p=0.0019), % predicted FVC (p<0.0001), % predicted FEV 1 (p=0.001), and 6-MWT distance (p<0.001). The physical component score in the short-form survey 12 questionnaire was higher in group A, p<0.001, whereas the mental component score was comparable. ConclusionsPatients requiring invasive mechanical ventilation (MV) have a greater risk of impaired pulmonary function and reduced QOL post-ICU discharge. This warrants a greater need for following these patients for better rehabilitation.

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

“…Studies assessing pulmonary function following ARDS and SARS-CoV-2 show heterogeneous results, however we noted a similar degree of obstructive and restrictive lung disease which was stable during the first year of recovery. This may be worst in patients receiving invasive mechanical ventilation 49 ; but this question goes beyond the scope of this review. Follow-up CT images have demonstrated pulmonary fibrotic changes, ground-glass opacification, and traction bronchiectasis 91 even up to 5 years after severe ARDS 92,93 .…”

“…The 6 Minutes Walking test (6MWT) was the most common tool used to measure physical function in 15 studies 13,21,[47][48][49]56,58,62,65,66,71,74,77,78 with only one study 58 adding the 4-meter gait speed alongside it. The overall mean distance walked in 6 minutes was 401m (95% CI 363, 439; l 2 =99% P<0.001) at 3 months, 427m (95% CI 378, 476; l 2 =99% P<0.001) at 6 months and 410m (95% CI 385, 434; l 2 =99% P<0.001) at 12 months.…”

“…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.…”

“…At 6month follow-up, the mean (±SD) muscle strength, as a percentage of maximum MRC sumscore, was 92% (±8%), with 8% (13 of 169) having ICU-acquired weakness 66 . The composite MMT score was noted to increase over time [from 50 (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53) at hospital discharge to 57 (53-60) at 24 months] 21 , however 92% of survivors experienced a decline in muscle strength for 5 years follow-up 62 .…”

Depression, Anxiety, and Quality of Life in Patients Treated with Single Infusion Tocilizumab for COVID-19: A Follow-up, Controlled Study

“…24 Similarly, a study conducted at this center has reported modest impairments in QOL in patients with COVID-19 who were mechanically ventilated. 27 Studies have shown that COVID-19 leads to impairments in QOL that gradually show an improving trend. 28,29 Similar to results reported earlier in an Indian sample, in our study, QOL was most affected by the presence of pain/discomfort, followed by mobility problems, difficulties in self-care activities, difficulties in performing usual activities, and the presence of anxiety/ depression.…”