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Nanwani-Nanwani K, López-Pérez L, Giménez-Esparza C, Ruiz-Barranco I, Carrillo E, Arellano MS, Díaz-Díaz D, Hurtado B, García-Muñoz A, Relucio MÁ, Quintana-Díaz M, Úrbez MR, Saravia A, Bonan MV, García-Río F, Testillano ML, Villar J, García de Lorenzo A, Añón JM. Prevalence of post-intensive care syndrome in mechanically ventilated patients with COVID-19. Sci Rep 2022; 12:7977. [PMID: 35562379 PMCID: PMC9105588 DOI: 10.1038/s41598-022-11929-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/29/2022] [Indexed: 01/10/2023] Open
Abstract
Coronavirus disease 19 (COVID-19) patients usually require long periods of mechanical ventilation and sedation, which added to steroid therapy, favours a predisposition to the development of delirium and subsequent mental health disorders, as well as physical and respiratory sequelae. The aim of this study was to determine the prevalence of post-intensive care syndrome (PICS) at 3 months after hospital discharge, in a cohort of mechanically ventilated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An ambispective, observational study was conducted in three hospitals with intensive care unit (ICU) follow-up clinics. We studied adults who survived a critical illness due to SARS-CoV-2 infection requiring invasive mechanical ventilation. A physical (muscle strength and pulmonary function), functional [12-Item Short Form Health Survey (SF-12), and Barthel score], psychological [hospital anxiety and depression (HADS) and posttraumatic stress disorder symptom severity scales], and cognitive [Montreal cognitive assessment (MoCA) test] assessment were performed. A total of 186 patients were evaluated at 88 days (IQR 68-121) after hospital discharge. Mean age was 59 ± 12 years old, 126 (68%) patients were men, and median length of mechanical ventilation was 14 days (IQR 8-31). About 3 out of 4 patients (n = 139, 75%) met PICS criteria. Symptoms of cognitive and psychiatric disorders were found in 59 (32%) and 58 (31%) patients, respectively. Ninety-one (49%) patients had muscle weakness. Pulmonary function tests in patients with no respiratory comorbidities showed a normal pattern in 93 (50%) patients, and a restrictive disorder in 62 (33%) patients. Also, 69 patients (37%) were on sick leave, while 32 (17%) had resumed work at the time of assessment. In conclusion, survivors of critical illness due to SARS-CoV-2 infection requiring mechanical ventilation have a high prevalence of PICS. Physical domain is the most frequently damaged, followed by cognitive and psychiatric disorders. ICU follow-up clinics enable the assistance of this vulnerable population.
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Affiliation(s)
- Kapil Nanwani-Nanwani
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | | | - Inés Ruiz-Barranco
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Elena Carrillo
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - María Soledad Arellano
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Domingo Díaz-Díaz
- Intensive Care Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Beatriz Hurtado
- Intensive Care Unit, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - Andoni García-Muñoz
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Manuel Quintana-Díaz
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - María Rosario Úrbez
- Department of Physical Medicine and Rehabilitation, Hospital Universitario La Paz, Madrid, Spain
| | - Andrés Saravia
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Francisco García-Río
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Jesús Villar
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Abelardo García de Lorenzo
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - José Manuel Añón
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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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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