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Sanal-Hayes NEM, Hayes LD, Mclaughlin M, Berry ECJ, Sculthorpe NF. Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in People with Long COVID, ME/CFS, and Controls. Am J Med 2023:S0002-9343(23)00756-8. [PMID: 38104642 DOI: 10.1016/j.amjmed.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Prevalences of post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) have not previously been compared between individuals with long coronavirus disease (COVID) and individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and healthy age-matched controls. For these reasons, this study aimed to determine the prevalence of PTSD and CPTSD in individuals with long COVID (n = 21) and ME/CFS (n = 20) and age-matched controls (n = 20). METHODS A case-case-control approach was employed; participants completed the International Trauma Questionnaire, a self-report measure of the International Classification of Diseases of PTSD and CPTSD consisting of 18 items. Scores were calculated for each PTSD and Disturbances in Self-Organization (DSO) symptom cluster and summed to produce PTSD and DSO scores. PTSD was diagnosed if the criteria for PTSD were met but not DSO, and CPTSD was diagnosed if the criteria for PTSD and DSO were met. Moreover, each cluster of PTSD and DSO were compared among individuals with long COVID, ME/CFS, and healthy controls. RESULTS Individuals with long COVID (PTSD = 5%, CPTSD = 33%) had more prevalence of PTSD and CPTSD than individuals with ME/CFS (PTSD = 0%, CPTSD = 20%) and healthy controls (PTSD = 0%, CPTSD = 0%). PTSD and CPTSD prevalence was greater in individuals with long COVID and ME/CFS than controls. Individuals with long COVID had greater values controls for all PTSD values. Moreover, individuals with long COVID had greater values than controls for all DSO values. Individuals with ME/CFS had greater values than controls for all DSO values. Both long COVID and ME/CFS groups differed in overall symptom scores compared with controls. CONCLUSION Findings of this study demonstrated that individuals with long COVID generally had more cases of PTSD and CPTSD than individuals with ME/CFS and healthy controls.
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Affiliation(s)
- Nilihan E M Sanal-Hayes
- School of Health and Society, University of Salford, Salford, UK; Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
| | - Lawrence D Hayes
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK.
| | - Marie Mclaughlin
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK; School of Sport, Exercise & Rehabilitation Sciences, University of Hull, Hull, UK
| | - Ethan C J Berry
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
| | - Nicholas F Sculthorpe
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, UK
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Sturgill JL, Mayer KP, Kalema AG, Dave K, Mora S, Kalantar A, Carter DJ, Montgomery-Yates AA, Morris PE. Post-intensive care syndrome and pulmonary fibrosis in patients surviving ARDS-pneumonia of COVID-19 and non-COVID-19 etiologies. Sci Rep 2023; 13:6554. [PMID: 37085548 PMCID: PMC10119831 DOI: 10.1038/s41598-023-32699-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 03/31/2023] [Indexed: 04/23/2023] Open
Abstract
The purpose was to examine patient-centered outcomes and the occurrence of lung fibrotic changes on Chest computed tomography (CT) imaging following pneumonia-related acute respiratory distress syndrome (ARDS). We sought to investigate outpatient clinic chest CT imaging in survivors of COVID19-related ARDS and non-COVID-related ARDS, to determine group differences and explore relationships between lung fibrotic changes and functional outcomes. A retrospective practice analysis of electronic health records at an ICU Recovery Clinic in a tertiary academic medical center was performed in adult patients surviving ARDS due to COVID-19 and non-COVID etiologies. Ninety-four patients with mean age 53 ± 13 and 51% male were included (n = 64 COVID-19 and n = 30 non-COVID groups). There were no differences for age, sex, hospital length of stay, ICU length of stay, mechanical ventilation duration, or sequential organ failure assessment (SOFA) scores between the two groups. Fibrotic changes visualized on CT imaging occurred in a higher proportion of COVID-19 survivors (70%) compared to the non-COVID group (43%, p < 0.001). Across both groups, patients with fibrotic changes (n = 58) were older, had a lower BMI, longer hospital and ICU LOS, lower mean RASS scores, longer total duration of supplemental oxygen. While not statistically different, patients with fibrotic changes did have reduced respiratory function, worse performance on the six-minute walk test, and had high occurrences of anxiety, depression, emotional distress, and mild cognitive impairment regardless of initial presenting diagnosis. Patients surviving pneumonia-ARDS are at high risk of impairments in physical, emotional, and cognitive health related to Post-Intensive Care Syndrome. Of clinical importance, pulmonary fibrotic changes on chest CT occurred in a higher proportion in COVID-ARDS group; however, no functional differences were measured in spirometry or physical assessments at ICU follow-up. Whether COVID infection imparts a unique recovery is not evident from these data but suggest that long-term follow up is necessary for all survivors of ARDS.
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Affiliation(s)
- Jamie L Sturgill
- Department of Microbiology, Immunology, and Molecular Genetics College of Medicine, University of Kentucky, Lexington, KY, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Anna G Kalema
- Division of Pulmonary, Critical Care, and Sleep Medicine College of Medicine, Department of Internal Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY, L54340536, USA.
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA.
| | - Kinjal Dave
- Division of Pulmonary, Critical Care, and Sleep Medicine College of Medicine, Department of Internal Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY, L54340536, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Stephanie Mora
- College of Pharmacy, University of Kentucky, Lexington, KY, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Alborz Kalantar
- Department of Microbiology, Immunology, and Molecular Genetics College of Medicine, University of Kentucky, Lexington, KY, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - David J Carter
- Division of Pulmonary, Critical Care, and Sleep Medicine College of Medicine, Department of Internal Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY, L54340536, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Ashley A Montgomery-Yates
- Division of Pulmonary, Critical Care, and Sleep Medicine College of Medicine, Department of Internal Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY, L54340536, USA
- Kentucky Research Alliance for Lung Disease, Lexington, KY, USA
| | - Peter E Morris
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL, USA
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3
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Tisler A, Stirrup O, Pisarev H, Kalda R, Meister T, Suija K, Kolde R, Piirsoo M, Uusküla A. Post-acute sequelae of COVID-19 among hospitalized patients in Estonia: Nationwide matched cohort study. PLoS One 2022; 17:e0278057. [PMID: 36417409 PMCID: PMC9683565 DOI: 10.1371/journal.pone.0278057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Post-acute COVID-19 sequelae refers to a variety of health complications involving different organ systems that have been described among individuals after acute phase of illness. Data from unselected population groups with long-time follow up is needed to comprehensively describe the full spectrum of post-acute COVID-19 complications. METHODS In this retrospective nationwide cohort study, we used data obtained from electronic health record database. Our primary cohort were adults hospitalized with confirmed COVID-19 and matched (age, sex, Charlson Comorbidity Index) unaffected controls from general population. Individuals included from February 2020 until March 2021 were followed up for 12 months. We estimated risks of all-cause mortality, readmission and incidence of 16 clinical sequelae after acute COVID-19 phase. Using a frailty Cox model, we compared incidences of outcomes in two cohorts. RESULTS The cohort comprised 3949 patients older than 18 years who were alive 30 days after COVID-19 hospital admission and 15511 controls. Among cases 40.3% developed at least one incident clinical sequelae after the acute phase of SARS-CoV-2 infection, which was two times higher than in general population group. We report substantially higher risk of all-cause mortality (adjusted hazard ratio (aHR) = 2.57 (95%CI 2.23-2.96) and hospital readmission aHR = 1.73 (95%CI 1.58-1.90) among hospitalized COVID-19 patients. We found that the risks for new clinical sequalae were significantly higher in COVID-19 patients than their controls, especially for dementia aHR = 4.50 (95% CI 2.35-8.64), chronic lower respiratory disease aHR = 4.39 (95% CI 3.09-6.22), liver disease aHR 4.20 (95% CI 2.01-8.77) and other (than ischemic) forms of heart diseases aHR = 3.39 (95%CI 2.58-4.44). CONCLUSION Our results provide evidence that the post-acute COVID-19 morbidity within the first year after COVID-19 hospitalization is substantial. Risks of all-cause mortality, hospitalisation and majority of clinical sequelae were significantly higher in hospitalized COVID-19 patients than in general population controls and warrant targeted prevention efforts.
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Affiliation(s)
- Anna Tisler
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, United Kingdom
| | - Heti Pisarev
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ruth Kalda
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Tatjana Meister
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Kadri Suija
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Marko Piirsoo
- Institute of Technology, University of Tartu, Tartu, Estonia
| | - Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Rapin A, Boyer FC, Mourvillier B, Giordano Orsini G, Launois C, Taiar R, Deslee G, Goury A, Carazo-Mendez S. Post-Intensive Care Syndrome Prevalence Six Months after Critical Covid-19: Comparison between First and Second Waves. J Rehabil Med 2022; 54:jrm00339. [PMID: 36193697 PMCID: PMC9627539 DOI: 10.2340/jrm.v54.4363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the impact of improved intensive care for COVID-19 patients on the prevalence of post-intensive care syndrome (PICS). DESIGN Ambispective cohort study. PATIENTS Post-intensive care unit COVID-19 patients from the first and second waves of COVID-19. METHODS Patients were evaluated at 6 months after infection. PICS was defined as the presence of a 1-min sit-to-stand test (1STS) score < 2.5th percentile or a Symbol Digit Modalities Test (SDMT) below the 2 standard deviation cut-off, or a Hospital Anxiety and Depression Scale score ≥ 11. RESULTS A total of 60 patients were included (34 from wave 1 and 26 from wave 2). Intensive care unit management improved between waves, with shorter duration of orotracheal intubation (7 vs 23.5 days, p = 0.015) and intensive care unit stay (6 vs 9.5 days, p = 0.006) in wave 2. PICS was present in 51.5% of patients after wave 1 and 52% after wave 2 (p = 0.971). Female sex and diabetes were significantly associated with PICS by multivariate analysis. CONCLUSION Approximately half of post-intensive care unit COVID-19 patients have 1 or more impairments consistent with PICS at 6 months, with an impact on quality of life and participation. Improved intensive care unit management was not associated with a decrease in the prevalence of PICS. Identification of patients at risk, particularly women and diabetic patients, is essential. Further studies of underlying mechanisms and the need for rehabilitation are essential to reduce the risk of PICS.
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Affiliation(s)
- Amandine Rapin
- Centre Hospitalo-Universitaire de Reims (CHU), Hôpital Sébastopol, Département de Médecine Physique et de Réadaptation, Reims, France; Université de Reims Champagne-Ardenne, Faculté de Médecine, Vieillissement, Fragilité (VieFra) Reims, France.
| | - François Constant Boyer
- Centre Hospitalo-Universitaire de Reims (CHU), Hôpital Sébastopol, Département de Médecine Physique et de Réadaptation, Reims, France; Université de Reims Champagne-Ardenne, Faculté de Médecine, Vieillissement, Fragilité (VieFra) Reims, France
| | - Bruno Mourvillier
- Centre Hospitalo-Universitaire de Reims (CHU), Hôpital Robert-Debré, Service de Réanimation médicale, Reims, France
| | - Guillaume Giordano Orsini
- Centre Hospitalo-Universitaire de Reims (CHU), Hôpital Robert-Debré, Service de Réanimation médicale, Reims, France
| | - Claire Launois
- Centre Hospitalo-Universitaire de Reims (CHU), Département de Médecine Pulmonaire, Reims, France; Université de Reims Champagne- Ardenne, Institut National de la Santé et de la Recherche Médicale Pathologies Pulmonaires et Plasticité Cellulaire (P3Cell) Unité Médicale de Recherche-S1250, Structure Fédérative de Recherche (SFR) CAP-SANTE, Reims, France
| | - Redha Taiar
- Université de Reims Champagne-Ardenne, Laboratoire MATériaux et Ingénieurerie Mécanique (MATIM), Reims, France
| | - Gaëtan Deslee
- Centre Hospitalo-Universitaire de Reims (CHU), Département de Médecine Pulmonaire, Reims, France; Université de Reims Champagne- Ardenne, Institut National de la Santé et de la Recherche Médicale Pathologies Pulmonaires et Plasticité Cellulaire (P3Cell) Unité Médicale de Recherche-S1250, Structure Fédérative de Recherche (SFR) CAP-SANTE, Reims, France
| | - Antoine Goury
- Centre Hospitalo-Universitaire de Reims (CHU), Hôpital Robert-Debré, Service de Réanimation médicale, Reims, France
| | - Sandy Carazo-Mendez
- Centre Hospitalo-Universitaire de Reims (CHU), Hôpital Sébastopol, Département de Médecine Physique et de Réadaptation, Reims, France
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5
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Robinson JM, Aronson J, Daniels CB, Goodwin N, Liddicoat C, Orlando L, Phillips D, Stanhope J, Weinstein P, Cross AT, Breed MF. Ecosystem restoration is integral to humanity's recovery from COVID-19. Lancet Planet Health 2022; 6:e769-e773. [PMID: 36087607 PMCID: PMC9451495 DOI: 10.1016/s2542-5196(22)00171-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 06/30/2022] [Accepted: 07/13/2022] [Indexed: 05/19/2023]
Abstract
COVID-19 has devastated global communities and economies. The pandemic has exposed socioeconomic disparities and weaknesses in health systems worldwide. Long-term health effects and economic recovery are major concerns. Ecosystem restoration-ie, the repair of ecosystems that have been degraded-relates directly to tackling the health and socioeconomic burdens of COVID-19, because stable and resilient ecosystems are fundamental determinants of health and socioeconomic stability. Here, we use COVID-19 as a case study, showing how ecosystem restoration can reduce the risk of infection and adverse sequelae and have an integral role in humanity's recovery from COVID-19. The next decade will be crucial for humanity's recovery from COVID-19 and for ecosystem repair. Indeed, in the absence of effective, large-scale restoration, 95% of the Earth's land could be degraded by 2050. The UN Decade on Ecosystem Restoration (2021-30) declaration reflects the growing urgency and scale at which we should repair ecosystems. Importantly, ecosystem restoration could also help to combat the health and socioeconomic issues that are associated with COVID-19, yet it is poorly integrated into current responses to the disease. Ecosystem restoration can be a core public health intervention and assist in COVID-19 recovery if it is closely integrated with socioeconomic, health, and environmental policies.
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Affiliation(s)
- Jake M Robinson
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia
| | - James Aronson
- Center for Conservation and Sustainable Development, Missouri Botanical Garden, St Louis, MO, USA
| | | | - Neva Goodwin
- Economics in Context Initiative, Boston University, Boston, MA, USA
| | - Craig Liddicoat
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia; School of Public Health, The University of Adelaide, Adelaide SA, Australia
| | - Laura Orlando
- School of Public Health, Boston University, Boston, MA, USA
| | - David Phillips
- Department of Medical Science and Public Health, Bournemouth University, Poole, UK
| | - Jessica Stanhope
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide SA, Australia
| | - Philip Weinstein
- School of Public Health, The University of Adelaide, Adelaide SA, Australia
| | - Adam T Cross
- School of Molecular and Life Sciences, Curtin University, Bentley, WA, Australia.
| | - Martin F Breed
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia.
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Owen A, Patel JM, Parekh D, Bangash MN. Mechanisms of Post-critical Illness Cardiovascular Disease. Front Cardiovasc Med 2022; 9:854421. [PMID: 35911546 PMCID: PMC9334745 DOI: 10.3389/fcvm.2022.854421] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Prolonged critical care stays commonly follow trauma, severe burn injury, sepsis, ARDS, and complications of major surgery. Although patients leave critical care following homeostatic recovery, significant additional diseases affect these patients during and beyond the convalescent phase. New cardiovascular and renal disease is commonly seen and roughly one third of all deaths in the year following discharge from critical care may come from this cluster of diseases. During prolonged critical care stays, the immunometabolic, inflammatory and neurohumoral response to severe illness in conjunction with resuscitative treatments primes the immune system and parenchymal tissues to develop a long-lived pro-inflammatory and immunosenescent state. This state is perpetuated by persistent Toll-like receptor signaling, free radical mediated isolevuglandin protein adduct formation and presentation by antigen presenting cells, abnormal circulating HDL and LDL isoforms, redox and metabolite mediated epigenetic reprogramming of the innate immune arm (trained immunity), and the development of immunosenescence through T-cell exhaustion/anergy through epigenetic modification of the T-cell genome. Under this state, tissue remodeling in the vascular, cardiac, and renal parenchymal beds occurs through the activation of pro-fibrotic cellular signaling pathways, causing vascular dysfunction and atherosclerosis, adverse cardiac remodeling and dysfunction, and proteinuria and accelerated chronic kidney disease.
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Affiliation(s)
- Andrew Owen
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Jaimin M. Patel
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Dhruv Parekh
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Mansoor N. Bangash
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Mansoor N. Bangash
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7
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Puthucheary ZA, Rice TW. Nutritional priorities in patients with severe COVID-19. Curr Opin Clin Nutr Metab Care 2022; 25:277-281. [PMID: 35703977 PMCID: PMC9247039 DOI: 10.1097/mco.0000000000000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has altered the profile of critical care services internationally, as professionals around the globe have struggled to rise to the unprecedented challenge faced, both in terms of individual patient management and the sheer volume of patients that require treatment and management in intensive care. This review article sets out key priorities in nutritional interventions during the patient journey, both in the acute and recovery phases. RECENT FINDINGS The current review covers the care of the acutely unwell patient, and the evidence base for nutritional interventions in the COVID-19 population. One of the biggest differences in caring for critically ill patients with acute respiratory failure from COVID-19 is often the time prior to intubation. This represents specific nutritional challenges, as does nursing patients in the prone position or in the setting of limited resources. This article goes on to discuss nutritional support for COVID-19 sufferers as they transition through hospital wards and into the community. SUMMARY Nutritional support of patients with severe COVID-19 is essential. Given the longer duration of their critical illness, combined with hypermetabolism and energy expenditure, patients with COVID-19 are at increased risk for malnutrition during and after their hospital stay.
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Affiliation(s)
- Zudin A Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London
- Adult Critical Care Unit, Royal London Hospital, London, UK
| | - Todd W Rice
- Vanderbilt Institute for Clinical and Translational Research
- Division of Allergy, Department of Medicine, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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8
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Tenforde MW, Devine OJ, Reese HE, Silk BJ, Iuliano AD, Threlkel R, Vu QM, Plumb ID, Cadwell BL, Rose C, Steele MK, Briggs-Hagen M, Ayoubkhani D, Pawelek P, Nafilyan V, Saydah SH, Bertolli J. Point Prevalence Estimates of Activity-Limiting Long-Term Symptoms among U.S. Adults ≥1 Month After Reported SARS-CoV-2 Infection, November 1, 2021. J Infect Dis 2022; 227:855-863. [PMID: 35776165 PMCID: PMC9278232 DOI: 10.1093/infdis/jiac281] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/22/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although most adults infected with SARS-CoV-2 fully recover, a proportion have ongoing symptoms, or post-COVID conditions (PCC), after infection. The objective of this analysis was to estimate the number of US adults with activity-limiting PCC on November 1, 2021. Methods We modeled the prevalence of PCC using reported infections occurring from February 1, 2020 – September 30, 2021, and population-based, household survey data on new activity-limiting symptoms ≥1 month following SARS-CoV-2 infection. From these data sources, we estimated the number and proportion of US adults with activity-limiting PCC on November 1, 2021, as 95% uncertainty intervals, stratified by sex and age. Sensitivity analyses adjusted for under-ascertainment of infections and uncertainty about symptom duration. Results On November 1, 2021, at least 3.0–5.0 million US adults were estimated to have activity-limiting PCC of ≥1 month duration, or 1.2%–1.9% of US adults. Population prevalence was higher in females (1.4%–2.2%) than males. The estimated prevalence after adjusting for under-ascertainment of infections was 1.7%–3.8%. Conclusion Millions of US adults were estimated to have activity-limiting PCC. These estimates can support future efforts to address the impact of PCC on the U.S. population.
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Affiliation(s)
| | | | | | | | | | - Ryan Threlkel
- General Dynamics Information Technology, Inc., Atlanta, GA, USA
| | - Quan M Vu
- CDC COVID-19 Response Team, Atlanta, GA, USA
| | - Ian D Plumb
- CDC COVID-19 Response Team, Atlanta, GA, USA
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9
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Wisk LE, Nichol G, Elmore JG. Toward Unbiased Evaluation of Postacute Sequelae of SARS-CoV-2 Infection: Challenges and Solutions for the Long Haul Ahead. Ann Intern Med 2022; 175:740-743. [PMID: 35254883 PMCID: PMC8906529 DOI: 10.7326/m21-4664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The authors argue that postacute SARS-CoV-2 syndrome presents unique challenges in determining risk factors, natural history, and proper management. They call for strategies and actions that are based on rigorous, high-quality evidence.
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Affiliation(s)
- Lauren E Wisk
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, and Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California (L.E.W., J.G.E.)
| | - Graham Nichol
- Departments of Medicine and Emergency Medicine, University of Washington Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, Washington (G.N.)
| | - Joann G Elmore
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, and Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California (L.E.W., J.G.E.)
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10
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Vrettou CS, Mantziou V, Vassiliou AG, Orfanos SE, Kotanidou A, Dimopoulou I. Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review. Life (Basel) 2022; 12:life12010107. [PMID: 35054500 PMCID: PMC8778667 DOI: 10.3390/life12010107] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/21/2022] Open
Abstract
Current achievements in medical science and technological advancements in intensive care medicine have allowed better support of critically ill patients in intensive care units (ICUs) and have increased survival probability. Post-intensive care syndrome (PICS) is a relatively new term introduced almost 10 years ago, defined as "new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization". A significant percentage of critically ill patients suffer from PICS for a prolonged period of time, with physical problems being the most common. The exact prevalence of PICS is unknown, and many risk factors have been described well. Coronavirus disease 2019 (COVID-19) survivors seem to be at especially high risk for developing PICS. The families of ICU survivors can also be affected as a response to the stress suffered during the critical illness of their kin. This separate entity is described as PICS family (PICS-F). A multidisciplinary approach is warranted for the treatment of PICS, involving healthcare professionals, clinicians, and scientists from different areas. Improving outcomes is both challenging and imperative for the critical care community. The review of the relevant literature and the study of the physical, cognitive, and mental sequelae could lead to the prevention and timely management of PICS and the subsequent improvement of the quality of life for ICU survivors.
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Martin-Loeches I, Motos A, Menéndez R, Gabarrús A, González J, Fernández-Barat L, Ceccato A, Pérez-Arnal R, García-Gasulla D, Ferrer R, Riera J, Lorente JÁ, Peñuelas Ó, Bermejo-Martin JF, de Gonzalo-Calvo D, Rodríguez A, Barbé F, Aguilera L, Amaya-Villar R, Barberà C, Barberán J, Blandino Ortiz A, Bustamante-Munguira E, Caballero J, Carbajales C, Carbonell N, Catalán-González M, Galbán C, Gumucio-Sanguino VD, de la Torre MDC, Díaz E, Gallego E, García Garmendia JL, Garnacho-Montero J, Gómez JM, Jorge García RN, Loza-Vázquez A, Marín-Corral J, Martínez de la Gándara A, Martínez Varela I, Lopez Messa J, Albaiceta GM, Novo MA, Peñasco Y, Ricart P, Urrelo-Cerrón L, Sánchez-Miralles A, Sancho Chinesta S, Socias L, Solé-Violan J, Tamayo Lomas L, Vidal P, Torres A. ICU-Acquired Pneumonia Is Associated with Poor Health Post-COVID-19 Syndrome. J Clin Med 2021; 11:224. [PMID: 35011967 PMCID: PMC8746263 DOI: 10.3390/jcm11010224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Some patients previously presenting with COVID-19 have been reported to develop persistent COVID-19 symptoms. While this information has been adequately recognised and extensively published with respect to non-critically ill patients, less is known about the incidence and factors associated with the characteristics of persistent COVID-19. On the other hand, these patients very often have intensive care unit-acquired pneumonia (ICUAP). A second infectious hit after COVID increases the length of ICU stay and mechanical ventilation and could have an influence on poor health post-COVID 19 syndrome in ICU-discharged patients. METHODS This prospective, multicentre, and observational study was carrid out across 40 selected ICUs in Spain. Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated three months after hospital discharge. RESULTS A total of 1255 ICU patients were scheduled to be followed up at 3 months; however, the final cohort comprised 991 (78.9%) patients. A total of 315 patients developed ICUAP (97% of them had ventilated ICUAP). Patients requiring invasive mechanical ventilation had more persistent post-COVID-19 symptoms than those who did not require mechanical ventilation. Female sex, duration of ICU stay, development of ICUAP, and ARDS were independent factors for persistent poor health post-COVID-19. CONCLUSIONS Persistent post-COVID-19 symptoms occurred in more than two-thirds of patients. Female sex, duration of ICU stay, development of ICUAP, and ARDS all comprised independent factors for persistent poor health post-COVID-19. Prevention of ICUAP could have beneficial effects in poor health post-COVID-19.
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Affiliation(s)
- Ignacio Martin-Loeches
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Pulmonary Department, Hospital Clinic, Universitat de Barcelona, IDIBAPS, 08036 Barcelona, Spain
- Department of Intensive Care Medicine, St. James’s Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), James’s Street, D08 NHY1 Dublin, Ireland
| | - Anna Motos
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Department of Intensive Care Medicine, St. James’s Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), James’s Street, D08 NHY1 Dublin, Ireland
| | - Rosario Menéndez
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Pulmonary Department, University and Polytechnic Hospital La Fe, 46026 Valencia, Spain
| | - Albert Gabarrús
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Pulmonary Department, University and Polytechnic Hospital La Fe, 46026 Valencia, Spain
| | - Jessica González
- Translational Research in Respiratory Medicine Group (TRRM), Lleida Biomedical Research Institute (IRBLleida), 25198 Lleida, Spain; (J.G.); (D.d.G.-C.); (F.B.)
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, 25198 Lleida, Spain
| | - Laia Fernández-Barat
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Department of Intensive Care Medicine, St. James’s Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), James’s Street, D08 NHY1 Dublin, Ireland
| | - Adrián Ceccato
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Department of Intensive Care Medicine, St. James’s Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), James’s Street, D08 NHY1 Dublin, Ireland
| | - Raquel Pérez-Arnal
- Barcelona Supercomputing Centre (BSC), 08034 Barcelona, Spain; (R.P.-A.); (D.G.-G.)
| | - Dario García-Gasulla
- Barcelona Supercomputing Centre (BSC), 08034 Barcelona, Spain; (R.P.-A.); (D.G.-G.)
| | - Ricard Ferrer
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Intensive Care Department, Vall d’Hebron Hospital Universitari, SODIR Research Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | - Jordi Riera
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Intensive Care Department, Vall d’Hebron Hospital Universitari, SODIR Research Group, Vall d’Hebron Institut de Recerca (VHIR), 08035 Barcelona, Spain
| | - José Ángel Lorente
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Hospital Universitario de Getafe, 28905 Madrid, Spain
| | - Óscar Peñuelas
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Hospital Universitario de Getafe, 28905 Madrid, Spain
| | - Jesús F. Bermejo-Martin
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Hospital Universitario Río Hortega de Valladolid, 47012 Valladolid, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Gerencia Regional de Salud de Castilla y León, 47007 Valladolid, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine Group (TRRM), Lleida Biomedical Research Institute (IRBLleida), 25198 Lleida, Spain; (J.G.); (D.d.G.-C.); (F.B.)
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, 25198 Lleida, Spain
| | | | - Ferran Barbé
- Translational Research in Respiratory Medicine Group (TRRM), Lleida Biomedical Research Institute (IRBLleida), 25198 Lleida, Spain; (J.G.); (D.d.G.-C.); (F.B.)
- Pulmonary Department, Hospital Universitari Arnau de Vilanova and Santa Maria, 25198 Lleida, Spain
| | - Luciano Aguilera
- Anestesia, Reanimación y Terapia del Dolor, Hospital Universitario de Basurto, 48013 Bilbao, Spain;
| | - Rosario Amaya-Villar
- Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, 41013 Sevilla, Spain;
| | - Carme Barberà
- Hospital Santa Maria, IRBLleida, 25198 Lleida, Spain;
| | - José Barberán
- Critical Care Department, Hospital Universitario HM Montepríncipe, Universidad San Pablo-CEU, 28660 Madrid, Spain;
| | - Aaron Blandino Ortiz
- Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Elena Bustamante-Munguira
- Department of Intensive Care Medicine, Hospital Clínico Universitario Valladolid, 47003 Valladolid, Spain;
| | - Jesús Caballero
- Critical Care Department, Hospital Universitari Arnau de Vilanova, IRBLleida, 25198 Lleida, Spain;
| | | | - Nieves Carbonell
- Intensive Care Unit, Hospital Clínico y Universitario de Valencia, 46010 Valencia, Spain;
| | | | - Cristóbal Galbán
- Department of Medicine, CHUS, Complejo Hospitalario Universitario de Santiago, 15076 Santiago de Compostela, Spain;
| | - Víctor D. Gumucio-Sanguino
- Department of Intensive Care, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | | | - Emili Díaz
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Critical Care Department, Corpo-Ració Sanitària Parc Taulí, Sabadell, 08208 Barcelona, Spain;
| | - Elena Gallego
- Unidad de Cuidados Intensivos, Hospital San Pedro de Alcántara, 10003 Cáceres, Spain;
| | | | - José Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, 41009 Seville, Spain;
| | - José M. Gómez
- Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain;
| | | | - Ana Loza-Vázquez
- Unidad de Medicina Intensiva, Hospital Universitario Virgen de Valme, 41014 Sevilla, Spain;
| | | | | | | | - Juan Lopez Messa
- Critical Care Department, Complejo Asistencial Universitario de Palencia, 34005 Palencia, Spain;
| | - Guillermo M. Albaiceta
- Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, 33011 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Central de Asturias, 33011 Oviedo, Spain
| | - Mariana Andrea Novo
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, 07120 Illes Balears, Spain;
| | - Yhivian Peñasco
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Pilar Ricart
- Servei de Medicina Intensiva, Hospital Universitari Germans Trias, 08916 Badalona, Spain;
| | | | | | - Susana Sancho Chinesta
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
| | - Lorenzo Socias
- Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, 07198 Illes Balears, Spain;
| | - Jordi Solé-Violan
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Critical Care Department, Hospital Dr. Negrín., 35019 Las Palmas de GC, Spain
| | - Luis Tamayo Lomas
- Critical Care Department, Hospital Universitario Río Hortega de Valladolid, 47102 Valladolid, Spain;
| | - Pablo Vidal
- Intensive Care Unit, Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain; (I.M.-L.); (A.M.); (R.M.); (A.G.); (L.F.-B.); (A.C.); (R.F.); (J.R.); (J.Á.L.); (Ó.P.); (J.F.B.-M.); (J.S.-V.)
- Department of Intensive Care Medicine, St. James’s Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), James’s Street, D08 NHY1 Dublin, Ireland
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Yong SJ, Liu S. Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies. Rev Med Virol 2021; 32:e2315. [PMID: 34888989 DOI: 10.1002/rmv.2315] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022]
Abstract
The effects of coronavirus disease 2019 (COVID-19), a highly transmissible infectious respiratory disease that has initiated an ongoing pandemic since early 2020, do not always end in the acute phase. Depending on the study referred, about 10%-30% (or more) of COVID-19 survivors may develop long-COVID or post-COVID-19 syndrome (PCS), characterised by persistent symptoms (most commonly fatigue, dyspnoea, and cognitive impairments) lasting for 3 months or more after acute COVID-19. While the pathophysiological mechanisms of PCS have been extensively described elsewhere, the subtypes of PCS have not. Owing to its highly multifaceted nature, this review proposes and characterises six subtypes of PCS based on the existing literature. The subtypes are non-severe COVID-19 multi-organ sequelae (NSC-MOS), pulmonary fibrosis sequelae (PFS), myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), post-intensive care syndrome (PICS) and medical or clinical sequelae (MCS). Original studies supporting each of these subtypes are documented in this review, as well as their respective symptoms and potential interventions. Ultimately, the subtyping proposed herein aims to provide better clarity on the current understanding of PCS.
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Affiliation(s)
- Shin Jie Yong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Shiliang Liu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Gardashkhani S, Ajri-Khameslou M, Heidarzadeh M, Rajaei Sedigh S. Post-Intensive Care Syndrome in Covid-19 Patients Discharged From the Intensive Care Unit. J Hosp Palliat Nurs 2021; 23:530-538. [PMID: 34534991 PMCID: PMC8560146 DOI: 10.1097/njh.0000000000000789] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Patients with Covid-19, after discharge from the intensive care unit (ICU), experience some psychological, physical, and cognitive disorders, which is known as the post-intensive care syndrome and has adverse effects on patients and their families. The aim of this study was to evaluate the post-intensive care syndrome and its predictors in Covid-19 patients discharged from the ICU. In this study, 84 Covid-19 patients discharged from the ICU were selected by census method based on inclusion and exclusion criteria. After completing the demographic information, the Healthy Aging Brain Care Monitor Self Report Tool was used to assess post-intensive care syndrome. Sixty-nine percent of participants experienced different degrees of post-intensive care syndrome, and its mean score was 8.86 ± 12.50; the most common disorder was related to the physical dimension. Among individual social variables, age and duration after discharge were able to predict 12.3% and 8.4% of the variance of post-intensive care syndrome, respectively. Covid-19 patients who are admitted to the ICU, after discharge from the hospital, face cognitive, psychological, and functional disorders, and there is a need for planning to prevent, follow up, and care for them by health care providers in the hospice and palliative care centers.
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Daste C, Ficarra S, Dumitrache A, Cariou A, Lefèbvre A, Pène F, Roche N, Roren A, Thery C, Vidal J, Nguyen C, Rannou F, Lefèvre-Colau MM. Post-intensive care syndrome in patients surviving COVID-19. Ann Phys Rehabil Med 2021; 64:101549. [PMID: 34182168 PMCID: PMC8233854 DOI: 10.1016/j.rehab.2021.101549] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/06/2021] [Accepted: 05/31/2021] [Indexed: 10/29/2022]
Affiliation(s)
- Camille Daste
- Université de Paris, Faculté de Santé, UFR Médecine de Paris Centre, 75006 Paris, France; AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France; INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris (CRESS), ECaMO Team, 75004 Paris, France.
| | - Simona Ficarra
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Alina Dumitrache
- AP-HP, Centre-Université de Paris, Hôpital Corentin Celton, Service de Rééducation et de Réadaptation, 92130 Issy-les-Moulineaux, France
| | - Alain Cariou
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Médecine intensive et Réanimation, 75014 Paris, France
| | - Aurélie Lefèbvre
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Pneumologie, 75014 Paris, France
| | - Frédéric Pène
- AP-HP, Centre-Université de Paris, Hôpital Corentin Celton, Service de Rééducation et de Réadaptation, 92130 Issy-les-Moulineaux, France
| | - Nicolas Roche
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Pneumologie, 75014 Paris, France
| | - Alexandra Roren
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France,INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris (CRESS), ECaMO Team, 75004 Paris, France
| | - Camille Thery
- AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France
| | - Jean Vidal
- AP-HP, Centre-Université de Paris, Hôpital Corentin Celton, Service de Rééducation et de Réadaptation, 92130 Issy-les-Moulineaux, France
| | - Christelle Nguyen
- Université de Paris, Faculté de Santé, UFR Médecine de Paris Centre, 75006 Paris, France,AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Centre Universitaire des Saints-Pères, 75006 Paris, France
| | - François Rannou
- Université de Paris, Faculté de Santé, UFR Médecine de Paris Centre, 75006 Paris, France,AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Centre Universitaire des Saints-Pères, 75006 Paris, France,Institut Fédératif de Recherche sur le Handicap, 75013 Paris, France
| | - Marie-Martine Lefèvre-Colau
- Université de Paris, Faculté de Santé, UFR Médecine de Paris Centre, 75006 Paris, France,AP-HP, Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France,INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique Paris (CRESS), ECaMO Team, 75004 Paris, France
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Rasulo FA, Piva S, Latronico N. Long-term complications of COVID-19 in ICU survivors: what do we know? Minerva Anestesiol 2021; 88:72-79. [PMID: 34709019 DOI: 10.23736/s0375-9393.21.16032-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has caused more than 175 million persons infected and 3.8 million deaths so far and is having a devastating impact on both low and high-income countries, in particular on hospitals and intensive care units (ICU). The ICU mortality during the first pandemic wave ranged from 40% to 85% during the busiest ICU period for admissions around the peak of the surge, and those surviving are frequently faced with impairments affecting physical, cognitive, and mental health status, complicating the post-acute phase of COVID-19, which in the pre-COVID period, were defined collectively as post-intensive care syndrome (PICS). Long COVID is defined as four weeks of persisting symptoms after the acute illness, and post-COVID syndrome and chronic COVID-19 are the proposed terms to describe continued symptomatology for more than 12 weeks. Overall, 50% of ICU survivors suffer from new physical, mental, and/or cognitive problems at 1 year after ICU discharge. The prevalence, severity, and duration of the various impairments in ICU survivors are poorly defined, with substantial variations among published series, and may reflect differences in the timing of assessment, the outcome measured, the instruments utilized, and thresholds adopted to establish the diagnosis, the qualification of personnel delivering the tests, the resource availability as well diversity in patients' case-mix. Future longitudinal studies of adequate sample size with repeated assessments of validated outcomes and comparison with non-COVID-19 ICU patients are needed to fully explore the long-term outcome of ICU patients with COVID-19. In this article, we focus on chronic COVID-19 in ICU survivors and present state of the art data regarding long-term complications related to critical illness and the treatments and organ support received.
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Affiliation(s)
- Frank A Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy - .,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy - .,Alessandra Bono Interdepartmental Research Center for LOng-Term Outcome (LOTO) in survivors of critical Illness, University of Brescia, Brescia, Italy -
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.,Alessandra Bono Interdepartmental Research Center for LOng-Term Outcome (LOTO) in survivors of critical Illness, University of Brescia, Brescia, Italy
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Latronico N, Peli E, Calza S, Rodella F, Novelli MP, Cella A, Marshall J, Needham DM, Rasulo FA, Piva S. Physical, cognitive and mental health outcomes in 1-year survivors of COVID-19-associated ARDS. Thorax 2021; 77:300-303. [PMID: 34588274 DOI: 10.1136/thoraxjnl-2021-218064] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/10/2021] [Indexed: 11/04/2022]
Abstract
We report on the outcome of 114 COVID-19-associated acute respiratory distress syndrome (ARDS) survivors evaluated at 3, 6 and 12 months after intensive care unit discharge with assessment of physical, mental and cognitive impairments. Critical illness polyneuromyopathy was diagnosed in 23 patients (39%). Handgrip dynamometry was 70% predicted at 3 months and significantly improved over time, whereas the 6 min walk test (80% predicted) and severe fatigue (27% of patients) did not. Independence in activities of daily living (ADL) was achieved by 98% at 3 months. Cognitive impairment (28% at 3 months) improved over time, whereas depression, anxiety and post-traumatic stress disorder symptoms, present in 9%, 10% and 4% at 3 months, did not. Normalised health-related quality of life was good. COVID-19-associated ARDS leads to persisting impairment in performance-based measures of physical function, while ADL, cognitive and mental health status, and health-related quality of life may be less impaired. Trial registration number NCT04608994.
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Affiliation(s)
- Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy .,Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili di Brescia, Brescia, Italy.,'Alessandra Bono' University Research Center on long-term outcome in patients who survive critical illness, University of Brescia, Brescia, Italy
| | - Elena Peli
- Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Federica Rodella
- Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maria Paola Novelli
- Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Cella
- Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili di Brescia, Brescia, Italy
| | - John Marshall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Frank Antony Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili di Brescia, Brescia, Italy.,'Alessandra Bono' University Research Center on long-term outcome in patients who survive critical illness, University of Brescia, Brescia, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili di Brescia, Brescia, Italy
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17
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Mohiuddin Chowdhury ATM, Karim MR, Ali MA, Islam J, Li Y, He S. Clinical Characteristics and the Long-Term Post-recovery Manifestations of the COVID-19 Patients-A Prospective Multicenter Cross-Sectional Study. Front Med (Lausanne) 2021; 8:663670. [PMID: 34490284 PMCID: PMC8416537 DOI: 10.3389/fmed.2021.663670] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/21/2021] [Indexed: 01/21/2023] Open
Abstract
Objective: Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a global issue. In addition to managing acute cases, post-COVID-19 persisting symptoms/complaints and different hematological values are of great concern. These have an impact on the patient's well-being and are yet to be evaluated. Therefore, clinical and primary diagnosis based on routine laboratory findings bears high importance during the initial period of COVID-19, especially in regions with fewer diagnostic facilities. Methods: Clinical information and associated complaints of the COVID-19 illness confirmed by reverse transcription-polymerase chain reaction (RT-PCR) were collected directly from the patients. Regular follow-ups were obtained on the phone every 2 weeks following recovery for 20 weeks. Initial hematological and radiology findings of the hospitalized patients except for intensive care unit (ICU) and high dependency units (HDUs) and a follow-up evaluation after 4 weeks following recovery were analyzed. Results: The post-COVID-19 persisting symptoms/complaints were found among 21.4% of symptomatic patients, which persisted for ≥20 weeks and had a significant relationship with the duration of COVID-19 illness and the existing comorbidity (p < 0.05). Post-COVID-19 primary type 2 diabetes mellitus (DM, 0.64%) and hypertension (HTN, 1.28%) and unstable DM (54.55%) and HTN (34.78%) to the pre-existing diabetic and hypertensive patients were observed. Post-recovery remarkable changes in the laboratory values included leukocytosis (16.1%), lymphocytosis (14.5%), and an increased prothrombin time (PT, 25.8%). Abnormalities in the D-dimer, serum ferritin, hemoglobin, and erythrocyte sedimentation rate (ESR) levels were present to an extent. Laboratory findings like chest X-ray, ESR, white blood cell (WBC) count, lymphocyte count, C-reactive protein (CRP), serum glutamic pyruvic transaminase (SGPT), serum ferritin, PT, D-dimer, and serum creatinine are important markers for the diagnosis and prognosis of COVID-19 illness (p < 0.05). Conclusion: Post-COVID-19 persisting symptoms and the changes in the laboratory values need to be considered with importance and as a routine clinical measure. Post-COVID-19 periodic follow-up for evaluating the patient's physical condition and the biochemical values should be scheduled with care and managed accordingly to prevent future comorbidity in patients with the post-COVID-19 syndrome.
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Affiliation(s)
- Abu Taiub Mohammed Mohiuddin Chowdhury
- Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Ministry of Health and Family Welfare (OSD-DGHS), Dhaka, Bangladesh
| | - Md Rezaul Karim
- Hubei Key Laboratory of Embryonic Stem Cell Research, Institute of Neuroscience, Hubei University of Medicine, Shiyan, China
| | - Md Ahasan Ali
- Department of Pathology and Pathophysiology, Xi'an Jiaotong University, Xi'an, China
| | - Jahirul Islam
- Department of Epidemiology and Health Statistics, Xi'an Jiaotong University, Xi'an, China
| | - Yarui Li
- Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuixiang He
- Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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18
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Cascino TM, Desai AA, Kanthi Y. At a crossroads: coronavirus disease 2019 recovery and the risk of pulmonary vascular disease. Curr Opin Pulm Med 2021; 27:342-349. [PMID: 34127622 PMCID: PMC8373709 DOI: 10.1097/mcp.0000000000000792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 (COVID-19) pandemic has led to almost 3,000,000 deaths across 139 million people infected worldwide. Involvement of the pulmonary vasculature is considered a major driving force for morbidity and mortality. We set out to summarize current knowledge on the acute manifestations of pulmonary vascular disease (PVD) resulting from COVID-19 and prioritize long-term complications that may result in pulmonary hypertension (PH). RECENT FINDINGS Acute COVID-19 infection can result in widespread involvement of the pulmonary vasculature, myocardial injury, evidence of persistent lung disease, and venous thromboembolism. Post COVID-19 survivors frequently report ongoing symptoms and may be at risk for the spectrum of PH, including group 1 pulmonary arterial hypertension, group 2 PH due to left heart disease, group 3 PH due to lung disease and/or hypoxia, and group 4 chronic thromboembolic PH. SUMMARY The impact of COVID-19 on the pulmonary vasculature is central to determining disease severity. Although the long-term PVD manifestations of COVID-19 are currently uncertain, optimizing the care of risk factors for PH and monitoring for the development of PVD will be critical to reducing long-term morbidity and improving the health of survivors.
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Affiliation(s)
- Thomas M Cascino
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ankit A Desai
- Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Yogendra Kanthi
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
- Laboratory of Vascular Thrombosis and Inflammation, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
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19
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Post-COVID-19 Syndrome: Nine Months after SARS-CoV-2 Infection in a Cohort of 354 Patients: Data from the First Wave of COVID-19 in Nord Franche-Comté Hospital, France. Microorganisms 2021; 9:microorganisms9081719. [PMID: 34442798 PMCID: PMC8401026 DOI: 10.3390/microorganisms9081719] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/10/2021] [Indexed: 01/05/2023] Open
Abstract
(1) Background. Post-COVID-19 syndrome is defined as the persistence of symptoms after confirmed SARS-CoV-2 infection. (2) Methods. ANOSVID is an observational retrospective study in Nord Franche-Comté Hospital in France that included adult COVID-19 patients confirmed by RT-PCR from 1 March 2020 to 31 May 2020. The aim was to describe patients with post-COVID-19 syndrome with persistent symptoms (PS group) and to compare them with the patients without persistent symptoms (no-PS group). (3) Results. Of the 354 COVID-19 patients, 35.9% (n = 127) reported persistence of at least one symptom after a mean of 289.1 ± 24.5 days after symptom onset. Moreover, 115 patients reported a recurrence of symptoms after recovery, and only 12 patients reported continuous symptoms. The mean age of patients was 48.6 years (19–93) ± 19.4, and 81 patients (63.8%) were female. Patients in the PS group had a longer duration of symptoms of initial acute SARS-CoV-2 infection than patients in the no-PS group (respectively, 57.1 ± 82.1 days versus 29.7 ± 42.1 days, p < 0.001). A majority of patients (n = 104, 81.9%) reported three or more symptoms. The most prevalent persistent symptoms were loss of smell (74.0%, n = 94), fatigue (53.5%, n = 68), loss of taste (31.5%, n = 40), and dyspnea (30.7%, n = 39). These were followed by pain symptoms (26.8% (n = 34), 26.0% (n = 33), 24.4% (n = 31); headache, arthralgia, and myalgia, respectively). More than half of patients reporting persistent symptoms (58%, n = 73) were healthcare workers (HCWs). Among outpatients, this population was more present in the PS group than the no-PS group ((86.6%) n = 71/82 versus (72.2%) n = 109/151, p = 0.012). Post-COVID-19 syndrome was more frequent in patients with a past history of chronic rhinosinusitis (8.7% (n = 11%) versus 1.3% (n = 3), p < 0.001). No significant difference was found regarding clinical characteristics and outcome, laboratory, imaging findings, and treatment received in the two groups. (4) Conclusions. More than a third of our COVID-19 patients presented persistent symptoms after SARS-CoV-2 infection, particularly through loss of smell, loss of taste, fatigue, and dyspnea, with a high prevalence in HCWs among COVID-19 outpatients.
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20
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Cardiopulmonary Exercise Testing in Critically Ill Coronavirus Disease 2019 Survivors: Evidence of a Sustained Exercise Intolerance and Hypermetabolism. Crit Care Explor 2021; 3:e0491. [PMID: 34278318 PMCID: PMC8280004 DOI: 10.1097/cce.0000000000000491] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: To investigate exercise capacity at 3 and 6 months after a prolonged ICU stay. DESIGN: Observational monocentric study. SETTING: A post-ICU follow-up clinic in a tertiary university hospital in Liège, Belgium. PATIENTS: Patients surviving an ICU stay greater than or equal to 7 days for a severe coronavirus disease 2019 pneumonia and attending our post-ICU follow-up clinic. MEASUREMENTS AND MAIN RESULTS: Cardiopulmonary and metabolic variables provided by a cardiopulmonary exercise testing on a cycle ergometer were collected at rest, at peak exercise, and during recovery. Fourteen patients (10 males, 59 yr [52–62 yr], all obese with body mass index > 27 kg/m2) were included after a hospital stay of 40 days (35–53 d). At rest, respiratory quotient was abnormally high at both 3 and 6 months (0.9 [0.83–0.96] and 0.94 [0.86–0.97], respectively). Oxygen uptake was also abnormally increased at 3 months (8.24 mL/min/kg [5.38–10.54 mL/min/kg]) but significantly decreased at 6 months (p = 0.013). At 3 months, at the maximum workload (67% [55–89%] of predicted workload), oxygen uptake peaked at 81% (64–104%) of predicted maximum oxygen uptake, with oxygen pulse and heart rate reaching respectively 110% (76–140%) and 71% (64–81%) of predicted maximum values. Ventilatory equivalent for carbon dioxide remains within normal ranges. The 50% decrease in oxygen uptake after maximum effort was delayed, at 130 seconds (115–142 s). Recovery was incomplete with a persistent anaerobic metabolism. At 6 months, no significant improvement was observed, excepting an increase in heart rate reaching 79% (72–95%) (p = 0.008). CONCLUSIONS: Prolonged reduced exercise capacity was observed up to 6 months in critically ill coronavirus disease 2019 survivors. This disability did not result from residual pulmonary or cardiac dysfunction but rather from a metabolic disorder characterized by a sustained hypermetabolism and an impaired oxygen utilization.
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21
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Singer P. Nutritional and metabolic management of COVID-19 intensive care patients. JOURNAL OF INTENSIVE MEDICINE 2021; 1:31-34. [PMID: 36943801 PMCID: PMC7919505 DOI: 10.1016/j.jointm.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 04/15/2023]
Abstract
Nutritional and metabolic disturbances are observed in patients critically ill with Coronavirus disease 19 (COVID-19) patients. The aim of this review is to describe these disturbances during the progression of the disease, from the pre-intubation phase through the ventilated condition to the post extubation phase. The analysis of new data describing the prevalence of malnutrition, the modifications in energy expenditure and body composition are guiding medical nutritional therapy to prevent patients from experiencing severe energy deficit and muscle loss. Rehabilitation may be extremely prolonged and therefore, nutrition is mandatory to decrease this recondition period. This review also comments on the European Society of Parenteral and Enteral Nutrition (ESPEN) nutritional statements.
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22
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Kotani T, Sugiyama M, Matsuzaki F, Kubodera K, Saito J, Kaneki M, Shono A, Maruo H, Mori M, Ohta S, Kasai F. Roles of Early Mobilization Program in Preventing Muscle Weakness and Decreasing Psychiatric Disorders in Patients with Coronavirus Disease 2019 Pneumonia: A Retrospective Observational Cohort Study. J Clin Med 2021; 10:jcm10132941. [PMID: 34209010 PMCID: PMC8267911 DOI: 10.3390/jcm10132941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Although many coronavirus 2019 patients have experienced persistent symptoms and a long-term decline in quality of life after discharge, the details of these persistent symptoms and the effect of early rehabilitation are still unclear. We conducted a single-center, retrospective observational study to investigate the prevalence of persistent symptoms three months after discharge from the intensive care unit by checking the medical records. All patients received an early mobilization program. Four out of 13 patients (31%) had postintensive care syndrome. No patients had muscle weakness, and 11 patients (85%) returned to their previous work. However, psychiatric disorder, such as anxiety (23%) and posttraumatic stress disorder (15%), were observed. Eleven patients claimed persistent symptoms, including fatigue and numbness in the extremities. Our results suggest that the implementation of an early rehabilitation program plays some role in preventing muscle weakness and that decreasing psychiatric disorders should be a next target of patient care in the intensive care unit.
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Affiliation(s)
- Toru Kotani
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
- Correspondence: ; Tel.: +81-3-3784-8575
| | - Mizuki Sugiyama
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (M.S.); (F.K.)
| | - Fumika Matsuzaki
- Rehabilitation Center, Showa University Hospital, Tokyo 142-8666, Japan; (F.M.); (K.K.)
| | - Kota Kubodera
- Rehabilitation Center, Showa University Hospital, Tokyo 142-8666, Japan; (F.M.); (K.K.)
| | - Jin Saito
- Graduate School of Nursing and Rehabilitation Sciences, Showa University, Yokohama 226-8555, Japan;
| | - Mika Kaneki
- Department of Nutrition, Showa University Hospital, Tokyo 142-8666, Japan;
| | - Atsuko Shono
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
| | - Hiroko Maruo
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
| | - Maiko Mori
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
| | - Shin Ohta
- Department of Internal Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan;
| | - Fumihito Kasai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (M.S.); (F.K.)
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23
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Sigfrid L, Cevik M, Jesudason E, Lim WS, Rello J, Amuasi J, Bozza F, Palmieri C, Munblit D, Holter JC, Kildal AB, Reyes LF, Russell CD, Ho A, Turtle L, Drake TM, Beltrame A, Hann K, Bangura IR, Fowler R, Lakoh S, Berry C, Lowe DJ, McPeake J, Hashmi M, Dyrhol-Riise AM, Donohue C, Plotkin D, Hardwick H, Elkheir N, Lone NI, Docherty A, Harrison E, Baille JK, Carson G, Semple MG, Scott JT. What is the recovery rate and risk of long-term consequences following a diagnosis of COVID-19? A harmonised, global longitudinal observational study protocol. BMJ Open 2021; 11:e043887. [PMID: 33692181 PMCID: PMC7948153 DOI: 10.1136/bmjopen-2020-043887] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Very little is known about possible clinical sequelae that may persist after resolution of acute COVID-19. A recent longitudinal cohort from Italy including 143 patients followed up after hospitalisation with COVID-19 reported that 87% had at least one ongoing symptom at 60-day follow-up. Early indications suggest that patients with COVID-19 may need even more psychological support than typical intensive care unit patients. The assessment of risk factors for longer term consequences requires a longitudinal study linked to data on pre-existing conditions and care received during the acute phase of illness. The primary aim of this study is to characterise physical and psychosocial sequelae in patients post-COVID-19 hospital discharge. METHODS AND ANALYSIS This is an international open-access prospective, observational multisite study. This protocol is linked with the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) and the WHO's Clinical Characterisation Protocol, which includes patients with suspected or confirmed COVID-19 during hospitalisation. This protocol will follow-up a subset of patients with confirmed COVID-19 using standardised surveys to measure longer term physical and psychosocial sequelae. The data will be linked with the acute phase data. Statistical analyses will be undertaken to characterise groups most likely to be affected by sequelae of COVID-19. The open-access follow-up survey can be used as a data collection tool by other follow-up studies, to facilitate data harmonisation and to identify subsets of patients for further in-depth follow-up. The outcomes of this study will inform strategies to prevent long-term consequences; inform clinical management, interventional studies, rehabilitation and public health management to reduce overall morbidity; and improve long-term outcomes of COVID-19. ETHICS AND DISSEMINATION The protocol and survey are open access to enable low-resourced sites to join the study to facilitate global standardised, longitudinal data collection. Ethical approval has been given by sites in Colombia, Ghana, Italy, Norway, Russia, the UK and South Africa. New sites are welcome to join this collaborative study at any time. Sites interested in adopting the protocol as it is or in an adapted version are responsible for ensuring that local sponsorship and ethical approvals in place as appropriate. The tools are available on the ISARIC website (www.isaric.org). PROTOCOL REGISTRATION NUMBER: osf.io/c5rw3/ PROTOCOL VERSION: 3 August 2020 EUROQOL ID: 37035.
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Affiliation(s)
- Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Heatlh, University of Oxford, Oxford, UK
| | - Muge Cevik
- Infection and Global Health Division, School of Medicine, University of St Andrews, St Andrews, UK
| | - Edwin Jesudason
- Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jordi Rello
- Centro de Investigación Biomédica en Red - Enfermedades Respiratorias (CIBERES), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Research Department, CHU Nîmes, Université Nîmes-Montpellier, Nîmes, France
| | - John Amuasi
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Carlo Palmieri
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Clatterbridge Cancer Centre NHS Foundation Trust, Livepool, UK
| | - Daniel Munblit
- Department of Paediatrics, I M Sechenov First Moscow State Medical University, Moskva, Russia
- IInflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College London Faculty of Medicine, London, UK
| | - Jan Cato Holter
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anders Benjamin Kildal
- Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromso, Norway
| | | | - Clark D Russell
- The University of Edinburgh Centre for Inflammation Research, Edinburgh, UK
| | | | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Thomas M Drake
- Centre for Medical Informatics, The University of Edinburgh, Edinburgh, UK
| | - Anna Beltrame
- Department of Infectious Diseases, Tropical and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Katrina Hann
- Sustainable Health Systems, Freetown, Sierra Leone
| | | | - Robert Fowler
- Sunnybrook Health Sciences Institute, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - David J Lowe
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - Joanne McPeake
- NHS Greater Glasgow and Clyde, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | | | - Chloe Donohue
- National Institute of Health Research (NIHR) Health Protection research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Daniel Plotkin
- Nuffield Department of Medicine, ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Hayley Hardwick
- National Institute of Health Research (NIHR) Health Protection research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Nazir I Lone
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Annemarie Docherty
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Ewen Harrison
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - J Kenneth Baille
- Division of Genetics and Genomics, The University of Edinburgh The Roslin Institute, Roslin, UK
| | - Gail Carson
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Heatlh, University of Oxford, Oxford, UK
| | - Malcolm G Semple
- Health Protection Research Unit In Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Janet T Scott
- MRC, University of Glasgow Centre for Virus Research, Glasgow, UK
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