Luca Carenzo1, Alessandro Protti2,3, Francesca Dalla Corte2, Romina Aceto2, Giacomo Iapichino2, Angelo Milani2,3, Alessandro Santini2, Chiara Chiurazzi2, Michele Ferrari2, Enrico Heffler3,4, Claudio Angelini5, Alessio Aghemo3,6, Michele Ciccarelli7, Arturo Chiti3,8, Theodore J Iwashyna9, Margaret S Herridge10, Maurizio Cecconi2,3. 1. Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy. luca.carenzo@hunimed.eu. 2. Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy. 3. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy. 4. Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy. 5. Department of Renal Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy. 6. Department of Internal Medicine and Hepatology, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy. 7. Department of Respiratory Medicine, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy. 8. Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Italy. 9. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, USA. 10. Interdepartmental Division of Critical Care Medicine, Institute of Medical Science, Toronto General Research Institute, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: Survivors of severe COVID-19 are at risk of impaired health-related quality of life (HRQoL) and persistent physical and psychological disability after ICU and hospital discharge. The subsequent social burden is a major concern. We aimed to assess the short-term HRQoL, physical function and prevalence of post-traumatic stress symptoms of invasively mechanically ventilated COVID-19 patients treated in our ICU. METHODS: Prospective, observational cohort study in a follow-up clinic. Patients completed a 6-min walking test (6MWT) to assess their cardio-pulmonary function around 2 months (early follow-up) from hospital discharge, the EQ-5D-5L questionnaire for quality of life assessment around 2 months and at 6 months from hospital discharge and an anonymous web-based Impact of Event Scale-Revised (IES-R) questionnaire for Post-Traumatic Stress symptoms at 2 months. RESULTS: 47 patients attended our follow-up program, mean age 59 ± 10 years, median pre-morbid Clinical Frailty Scale (CFS) 2 [2-3]. The median distance walked in 6 min was 470 [406-516] m, 83 [67-99]% of the predicted value. Overall 1 out 3 patients and 4/18 (22%) among those with a good functional baseline prior to COVID-19 (CFS of 1 or 2) had lower (84%) than predicted 6MWT. EQ-5D-5L quality of life VAS was 80 [70-90] out of 100 at early follow-up with a slight improvement to 85 [77.5-90] at 6 months. Mobility, self-care and usual activities improved between the two timepoints, while pain/discomfort and depression/anxiety did not improve or got worse. The IES-R total score was greater than the threshold for concern of 1.6 in 27/41(66%) respondents. CONCLUSIONS: Patients recovering from severe COVID-19 requiring invasive mechanical ventilation surviving hospital discharge present with early mild to moderate functional impairment, mildly reduced quality of life from hospital discharge with an overall improvement of mobility, self-care and the ability of performing usual activities, while a worsening of pain and depression/anxiety symptoms at 6 months and a large proportion of symptoms of post-traumatic distress soon after hospital discharge.
BACKGROUND: Survivors of severe COVID-19 are at risk of impaired health-related quality of life (HRQoL) and persistent physical and psychological disability after ICU and hospital discharge. The subsequent social burden is a major concern. We aimed to assess the short-term HRQoL, physical function and prevalence of post-traumatic stress symptoms of invasively mechanically ventilated COVID-19patients treated in our ICU. METHODS: Prospective, observational cohort study in a follow-up clinic. Patients completed a 6-min walking test (6MWT) to assess their cardio-pulmonary function around 2 months (early follow-up) from hospital discharge, the EQ-5D-5L questionnaire for quality of life assessment around 2 months and at 6 months from hospital discharge and an anonymous web-based Impact of Event Scale-Revised (IES-R) questionnaire for Post-Traumatic Stress symptoms at 2 months. RESULTS: 47 patients attended our follow-up program, mean age 59 ± 10 years, median pre-morbid Clinical Frailty Scale (CFS) 2 [2-3]. The median distance walked in 6 min was 470 [406-516] m, 83 [67-99]% of the predicted value. Overall 1 out 3 patients and 4/18 (22%) among those with a good functional baseline prior to COVID-19 (CFS of 1 or 2) had lower (84%) than predicted 6MWT. EQ-5D-5L quality of life VAS was 80 [70-90] out of 100 at early follow-up with a slight improvement to 85 [77.5-90] at 6 months. Mobility, self-care and usual activities improved between the two timepoints, while pain/discomfort and depression/anxiety did not improve or got worse. The IES-R total score was greater than the threshold for concern of 1.6 in 27/41(66%) respondents. CONCLUSIONS:Patients recovering from severe COVID-19 requiring invasive mechanical ventilation surviving hospital discharge present with early mild to moderate functional impairment, mildly reduced quality of life from hospital discharge with an overall improvement of mobility, self-care and the ability of performing usual activities, while a worsening of pain and depression/anxiety symptoms at 6 months and a large proportion of symptoms of post-traumatic distress soon after hospital discharge.
Entities:
Keywords:
6-min walking test; COVID-19; Follow-up; Health Related Quality of Life; Post-Traumatic Stress Disorder
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