Abstracts Division 2
29. One year outcomes of mechanically ventilated COVID-19 ICU survivors: A prospective cohort study.
Julia L.M. Bels M.D. 1,2, Rob J.J. van Gassel M.D. 1,2,3,
Lieneke Timmerman M.D. 1, Bena Hemmen M.D. 4,5, Marcel
C.G. van de Poll M.D. 1,2,3, Bas C.T. van Bussel M.D. 1,5,
Nicky H.G.M. Peters M.D. 6, Martijn A. Spruit Ph.D. 2, 7,
8, Geertjan Wesseling M.D. 7, Susanne van Santen M.D. 1,
Hester A. Gietema M.D. 5, 9 *,
Rein Posthuma M.D. 2,7,8 *
* HAG and RP are joint senior authors.
1Department of Intensive Care Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands
2NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
3Department of Surgery, Maastricht University Medical Centre, The Netherlands
4Department of Rehabilitation Medicine, Maastricht University Medical Centre, The Netherlands
5Care and Public Health Research Institute (CAPHRI), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
6Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands
7Department of Respiratory Medicine, Maastricht University Medical Centre, The Netherlands
8Ciro+, Centre of expertise for chronic organ failure, Hornerheide 1, 6085 NM Horn, The Netherlands
9GROW School of Oncology and Developmental Biology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
Importance
The Coronavirus Disease-19 (COVID-19) causes numerous post-infectious sequelae. Data on long-term recovery
in patients on the severe end of the disease spectrum is urgently warranted.
Objective
To characterize the respiratory and functional recovery of mechanically ventilated COVID-19 ICU
survivors over twelve months after hospital discharge.
Design
Prospective cohort study including patients admitted between March and June 2020 with assessment of radiological,
respiratory, functional, and patient-reported outcomes at three- and
twelve-months post hospital discharge.
Participants & Setting
Ninety-four ICU patients, admitted for
invasive mechanical ventilation in a university teaching hospital, were
included, of whom 52 patients survived, 48 completed assessment at three
months, and 47 at twelve months following hospital discharge (69% male, median
age 63yr).
Main Outcomes
Pulmonary recovery was assessed using high-resolution computed tomography (CT) and pulmonary function testing,
and functional recovery using 6-minute walking test (6MWT) and handgrip
strength. Patient-reported outcomes were health-related Quality of Life (QoL)
(Euro-QoL-5D-5-level Health Utility Score, EQ-5D-5L HUS), dyspnea (Medical
Research Council dyspnea scale, MRC), fatigue (multi-dimensional fatigue
inventory, MFI), and mental health (Hospital Anxiety and Depression Scale, HADS).
Results
Mean diffusing capacity for carbon monoxide increased from 61% (±14) to 76% (±16) of predicted (P <
0.001). Mean CT severity score improved from 10.9 (±6.3) to 8.8 (±2.6) (P =
0.024). Distance walked in 6MWT increased from 80% (±24) to 95% (±23) of
predicted (P <0.001). QoL, measured by EQ-5D-5L HUS, increased from 0.67
(±0.19) to 0.84 (±0.15) (P <0.001). Fatigue remained high (MFI score 61 (±4)
vs. 60 (±6) (P = 0.482)).
Conclusions and Relevance
Mechanically ventilated COVID-19 ICU survivors showed significant recovery at twelve months regarding respiratory structure and function, skeletal muscle function, and health-related quality of life compared
to three months after hospital discharge. Despite this encouraging degree of
recovery, complaints of fatigue and dyspnea remain largely unchanged.
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