Long-term physical impairments in survivors of COVID-19-associated ARDS compared with classic ARDS: A two-center study

Simone Piva; Matteo Pozzi; Giacomo Bellani; Elena Peli; Nicola Gitti; Alberto Lucchini; Michele Bertoni; Alberto Goffi; John C Marshall; Stefano Calza; Francesco A Rasulo; Giuseppe Foti; Nicola Latronico; LOTO Investigators

doi:10.1016/j.jcrc.2023.154285

Long-term physical impairments in survivors of COVID-19-associated ARDS compared with classic ARDS: A two-center study

J Crit Care. 2023 Aug:76:154285. doi: 10.1016/j.jcrc.2023.154285. Epub 2023 Mar 6.

Authors

Affiliations

¹ 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. Electronic address: simone.piva@unibs.it.
² Department of Emergency and Intensive Care, ASST Monza, Monza, Italy.
³ Department of Emergency and Intensive Care, ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
⁴ Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.
⁵ 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.
⁶ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
⁷ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, University of Toronto, Toronto, ON, Canada.
⁸ Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
⁹ 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" University Research Center on LOng Term Outcome (LOTO) in Survivors of Critical Illness, University of Brescia, Italy.

PMID: 36889040
DOI: 10.1016/j.jcrc.2023.154285

Abstract

Purpose: This work aimed to compare physical impairment in survivors of classic ARDS compared with COVID-19-associated ARDS (CARDS) survivors.

Material and methods: This is a prospective observational cohort study on 248 patients with CARDS and compared them with a historical cohort of 48 patients with classic ARDS. Physical performance was evaluated at 6 and 12 months after ICU discharge, using the Medical Research Council Scale (MRCss), 6-min walk test (6MWT), handgrip dynamometry (HGD), and fatigue severity score (FSS). We also assessed activities of daily living (ADLs) using the Barthel index.

Results: At 6 months, patients with classic ARDS had lower HGD (estimated difference [ED]: 11.71 kg, p < 0.001; ED 31.9% of predicted value, p < 0.001), 6MWT distance (ED: 89.11 m, p < 0.001; ED 12.96% of predicted value, p = 0.032), and more frequent significant fatigue (OR 0.35, p = 0.046). At 12 months, patients with classic ARDS had lower HGD (ED: 9.08 kg, p = 0.0014; ED 25.9% of predicted value, p < 0.001) and no difference in terms of 6MWT and fatigue. At 12 months, patients with classic ARDS improved their MRCss (ED 2.50, p = 0.006) and HGD (ED: 4.13 kg, p = 0.002; ED 9.45% of predicted value, p = 0.005), while those with CARDS did not. Most patients in both groups regained independence in ADLs at 6 months. COVID-19 diagnosis was a significant independent predictor of better HGD (p < 0.0001) and 6MWT performance (p = 0.001), and lower prevalence of fatigue (p = 0.018).

Conclusions: Both classic ARDS and CARDS survivors experienced long-term impairments in physical functioning, confirming that post-intensive care syndrome remains a major legacy of critical illness. Surprisingly, however, persisting disability was more common in survivors of classic ARDS than in CARDS survivors. In fact, muscle strength measured with HGD was reduced in survivors of classic ARDS compared to CARDS patients at both 6 and 12 months. The 6MWT was reduced and fatigue was more common in classic ARDS compared to CARDS at 6 months but differences were no longer significant at 12 months. Most patients in both groups regained independent function in ADLs at 6 months.

Keywords: Acute respiratory distress syndrome; COVID-19; Long-term survivors; Severe acute respiratory syndrome coronavirus 2.

Publication types

Observational Study

MeSH terms

Activities of Daily Living
COVID-19 Testing
COVID-19* / complications
Cohort Studies
Hand Strength
Humans
Quality of Life
Respiratory Distress Syndrome* / complications
Survivors