Respiratory recovery trajectories after severe-to-critical COVID-19: a 1-year prospective multicentre study

Abstract

BackgroundSurvivors of severe-to-critical COVID-19 may have functional impairment, radiological sequelae and persistent symptoms requiring prolonged follow-up. This pragmatic study aimed to describe their clinical follow-up and determine their respiratory recovery trajectories, and factors that could influence them and their health-related quality of life.MethodsAdults hospitalised for severe-to-critical COVID-19 were evaluated at 3 months and up to 12 months post-hospital discharge in this prospective, multicentre, cohort study.ResultsAmong 485 enrolled participants, 293 (60%) were reassessed at 6 months and 163 (35%) at 12 months; 89 (51%) and 47 (27%) of the 173 ones initially managed with standard oxygen were reassessed at 6 and 12 months, respectively. At 3 months, 34%, 70% and 56% of the participants had a restrictive lung defect, impaired DLCOand significant radiological sequelae, respectively. During extended follow-up, DLCOand FVC (% of predicted value) increased by means of +4 points at 6 months, and +6 points at 12 months. Sex, body mass index, chronic respiratory disease, immunosuppression, pneumonia extent or corticosteroid use during acute COVID-19 and prolonged invasive mechanical ventilation (IMV) were associated with DLCOat month 3, but not its trajectory thereafter. Among 475 (98%) patients with at least one chest computed-tomography scan during follow-up, 196 (41%) had significant sequelae on their last images.ConclusionAlthough pulmonary function and radiological abnormalities improved up to 1 year post-acute-COVID-19, high percentages of severe-to-critical disease survivors, including a notable proportion of those managed with standard oxygen, had significant lung sequelae and residual symptoms justifying prolonged follow-up.

Lung pathophysiology in patients with long COVID-19: one size definitely does not fit all

“…Loss of lung units secondary to parenchymal damage with persistent lung consolidations has been demonstrated especially in patients with severe pneumonia in association with reduced D LCO [ 15 , 16 ]. Recently, S chlemmer et al [ 17 ] have reported that during a follow-up of 12 months, >50% of COVID-19 patients still experienced dyspnoea on exertion independent of the severity of the initial disease, and in >40% of the study sample, D LCO showed a mild to severe impairment apparently not secondary to a diffusion defect. A functional loss of V A during tidal breathing and during forced expiration was also observed by S caramuzzo et al [ 10 ] while measuring the regional distribution of ventilation by means of electrical impedance tomography in patients with dyspnoea (mMRC ≥1) 12 months after SARS-CoV-2 infection.…”

Short- and Long-Term Chest-CT Findings after Recovery from COVID-19: A Systematic Review and Meta-Analysis

“…A total of 2517 studies were identified, of which 43 met the inclusion (N = 8858 patients) ( Figure 1 ) [ 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ]. The majority of studies were from China (14 studies [ 51 , 58 , 59 , 60 , 61 , 64 , 65 , …”

ERS International Congress 2022: highlights from the Respiratory Clinical Care and Physiology Assembly

“…Data on long-term sequelae of severe COVID-19 pneumonia beyond clinical follow-up at six months are scarce [111,112]. Barria Residual dyspnoea was the most common symptom, with a prevalence of 55% ~9 weeks post-infection.…”