Chest
Volume 160, Issue 1, July 2021, Pages 187-198
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Critical Care: Original Research
Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19: A 3-Month Prospective Cohort

https://doi.org/10.1016/j.chest.2021.02.062Get rights and content

Background

More than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear.

Research Question

What are the major long-term pulmonary sequelae in critical patients who survive COVID-19?

Study Design and Methods

Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging.

Results

One hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay.

Interpretation

Three months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.

Key Words

COVID-19
CT abnormalities
ICU
lung function
SARS
SARS-CoV-2
sequelae

Abbreviations

6MWT
6-min walking test
Dlco
diffusing capacity for carbon monoxide
HADS
Hospital Anxiety and Depression Scale
HU
Hounsfield unit
IMV
invasive mechanical ventilation
IQR
interquartile range
LASSO
least absolute shrinkage and selection operator
MERS
Middle East respiratory syndrome
SARS
severe acute respiratory syndrome
SF-12
Short-Form Health Survey
TLC
total lung capacity
TSS
total severity score

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FUNDING/SUPPORT: This study was supported in part by the Instituto de Salud Carlos III [Grant CIBERESUCICOVID, COV20/00110] and was cofunded by European Regional Development Funds, “Una manera de hacer Europa.” D. d. G.-C. has received financial support from the Instituto de Salud Carlos III [Grant Miguel Servet 2020: CP20/00041], co-funded by the European Social Fund “Investing in Your Future.” L. P. acknowledges receiving financial support from the Ministry of Science, Innovation and Universities for the Training of University Lecturers (FPU19 / 03526).

Collaborators from the CIBERESUCICOVID Project (COV20/00110, ISCIII) are listed in the Acknowledgments.

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