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Madahar P, Capaccione KM, Salvatore MM, Short B, Wahab R, Abrams D, Parekh M, Geleris JD, Furfaro D, Anderson MR, Zucker J, Brodie D, Cummings MJ, O’Donnell M, McGroder CF, Wei Y, Garcia CK, Baldwin MR. Fibrotic-Like Pulmonary Radiographic Patterns Are Not Associated With Adverse Outcomes in COVID-19 Chronic Critical Illness. Crit Care Med 2023; 51:e209-e220. [PMID: 37294143 PMCID: PMC10615871 DOI: 10.1097/ccm.0000000000005954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Pulmonary fibrosis is a feared complication of COVID-19. To characterize the risks and outcomes associated with fibrotic-like radiographic abnormalities in patients with COVID-19-related acute respiratory distress syndrome (ARDS) and chronic critical illness. DESIGN Single-center prospective cohort study. SETTING We examined chest CT scans performed between ICU discharge and 30 days after hospital discharge using established methods to quantify nonfibrotic and fibrotic-like patterns. PATIENTS Adults hospitalized with COVID-19-related ARDS and chronic critical illness (> 21 d of mechanical ventilation, tracheostomy, and survival to ICU discharge) between March 2020 and May 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We tested associations of fibrotic-like patterns with clinical characteristics and biomarkers, and with time to mechanical ventilator liberation and 6-month survival, controlling for demographics, comorbidities, and COVID-19 therapies. A total of 141 of 616 adults (23%) with COVID-19-related ARDS developed chronic critical illness, and 64 of 141 (46%) had a chest CT a median (interquartile range) 66 days (42-82 d) after intubation. Fifty-five percent had fibrotic-like patterns characterized by reticulations and/or traction bronchiectasis. In adjusted analyses, interleukin-6 level on the day of intubation was associated with fibrotic-like patterns (odds ratio, 4.40 per quartile change; 95% CI, 1.90-10.1 per quartile change). Other inflammatory biomarkers, Sequential Organ Failure Assessment score, age, tidal volume, driving pressure, and ventilator days were not. Fibrotic-like patterns were not associated with longer time to mechanical ventilator liberation or worse 6-month survival. CONCLUSIONS Approximately half of adults with COVID-19-associated chronic critical illness have fibrotic-like patterns that are associated with higher interleukin-6 levels at intubation. Fibrotic-like patterns are not associated with longer time to liberation from mechanical ventilation or worse 6-month survival.
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Affiliation(s)
- Purnema Madahar
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Kathleen M. Capaccione
- Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Mary M. Salvatore
- Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Briana Short
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Romina Wahab
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Madhavi Parekh
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Joshua D. Geleris
- Division of General Medicine, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - David Furfaro
- Division of Pulmonary, Allergy, and Critical Care, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michaela R Anderson
- Division of Pulmonary and Critical Care, University of Pennsylvania Medical School, Philadelphia, PA, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Matthew J. Cummings
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Max O’Donnell
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Claire F. McGroder
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Christine K. Garcia
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Matthew R. Baldwin
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
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Gephine S, Lemyze M, Pauquet P, Rouzic OL, Fry S, Chenivesse C, Grosbois JM. Effectiveness of a home-based pulmonary rehabilitation programme in people recovering from a severe and critically COVID-19 infection. Respir Med Res 2023; 83:100991. [PMID: 37043972 PMCID: PMC9827746 DOI: 10.1016/j.resmer.2023.100991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/18/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Sarah Gephine
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, EA 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France.,FormAction Santé, F-59840 Pérenchies, France
| | - Malcolm Lemyze
- CH Arras, Service de réanimation et Unité de Sevrage Intensif et Réhabilitation Post-Réanimation, F-62000 Arras
| | - Philippe Pauquet
- CH Arras, Service de réanimation et Unité de Sevrage Intensif et Réhabilitation Post-Réanimation, F-62000 Arras
| | - Olivier Le Rouzic
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, F-59000 Lille
| | - Stéphanie Fry
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, F-59000 Lille
| | - Cécile Chenivesse
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, F-59000 Lille
| | - Jean-Marie Grosbois
- FormAction Santé, F-59840 Pérenchies, France.,Corresponding author: Jean-Marie Grosbois, Zone d'Activité du Bois, Rue de Pietralunga, Pérenchies F-59840, France
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