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

Heart Lung. 2023 Nov-Dec:62:72-80. doi: 10.1016/j.hrtlng.2023.06.021. Epub 2023 Jun 19.

Abstract

Background: Post intensive care syndrome is defined as the presence of any impairment affecting the physical, psychiatric, or cognitive domains as a result of critical illnesses.

Objectives: To explore functional, cognitive and psychological outcomes at 30 days post hospital discharge among survivors of COVID-19-associated acute respiratory distress syndrome, who required mechanical ventilation.

Methods: Prospective cohort study. We included adult patients with COVID-19-associated acute respiratory distress syndrome, invasively ventilated in two ICUs in Buenos Aires. We measured functional, cognitive and psychological impairments with Barthel index, Montreal Cognitive Assessment test, Patient Health Questionnaire-9 and General Anxiety Disorder-7. Primary outcome was post-intensive care syndrome. Secondary outcome was mortality at 60 days.

Results: We admitted 40 patients, median age was 69 (60-75) and mostly male (75%). Mortality at 60 days was 37%. Cox regression analysis identified diabetes and Apache II as independent predictors of mortality. Out of 22 patients studied, 14 (64%) developed PICS after discharge. With a physical, cognitive and psychological impairment in 64%, 41% and 32% of patients, respectively. Obesity, days of mechanical ventilation, Apache II, vasopressors use, delirium duration and cumulative midazolam dose were associated with functional dependence.

Conclusions: We identified a high prevalence of functional, cognitive and mental impairment at 30 days after hospital discharge in COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated. The physical domain was the most frequently affected. These findings suggest the need for long-term follow-up of this population.

Keywords: Acute respiratory distress syndrome; COVID-19; Cognitive impairments; Depression; Functional dependency; Post-intensive care syndrome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • COVID-19* / epidemiology
  • Critical Care
  • Critical Illness / epidemiology
  • Critical Illness / therapy
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Pandemics
  • Prospective Studies
  • Respiration, Artificial
  • Respiratory Distress Syndrome* / epidemiology
  • Respiratory Distress Syndrome* / etiology
  • Respiratory Distress Syndrome* / therapy
  • Survivors / psychology

Supplementary concepts

  • postintensive care syndrome