Senior in hospital bed

Understanding the outcomes of patients who survived older acute respiratory diseases may help clinicians address the needs of the many COVID-19 patients discharged from intensive care, investigators say.

An international group of authors analyzed studies of the long-term outcomes in severe COVID-19, acute respiratory distress syndrome (ARDS), and SARS-CoV infection (a precursor to SARS-CoV-2, which causes COVID-19). Certain physical and mental health problems persisted for years in hospitalized survivors of the older diseases, suggesting that some disability may be permanent in COVID-19 as well, they reported in a commentary published in The Lancet. 

In one study of 109 people who recovered from ARDS, for example, fully 25% continued to have weakness and “substantial functional dependency,” up to five years after ICU discharge. Among that study’s additional findings:

  • Lingering functional dependency may include trouble managing activities of daily living, including mobility and self care. 
  • Peripheral nerve injuries are common, from positioning, joint contracture from immobility, and oral or laryngeal injuries from protracted endotracheal intubation during the ICU stay. 
  • Tracheal stenosis — a narrowing of the windpipe that can occur after prolonged use of a breathing tube — might be more frequent than was previously thought.
  • Patients and family caregivers may develop debilitating mental health challenges that last months to years and are exacerbated in settings of isolation and stigmatization, as with ethnic minorities.
  • Inpatient visiting restrictions to reduce disease transmission risks can result in a lack of personal contact and dehumanisation of health care, “adding to patients’ and family members’ longer-term health burden.”

Similar trajectories have been found in the few available studies of discharged COVID-19 ICU patients.

In an investigation that followed 1,700 COVID-19 patients in China’s Wuhan province, those who had mechanical ventilation reported at least one symptom at six months, most commonly fatigue or muscle weakness, sleep difficulties, and anxiety or depression.

Similarly, among 94 patients admitted to the ICU in a study of more than 470 hospitalized COVID-19 patients, anxiety (23%), depression (18%) and post-traumatic stress disorder (7%) were reported at four months. And muscular weakness was reported by 27% of the 51 patients who had been intubated. In yet another investigation of nearly 47,000 COVID-19 patients, nearly a third of individuals who were discharged from the hospital after acute COVID-19 were readmitted.

While the range of persistent symptoms may turn out to be different from these early COVID-19 reports, a universal definition of long-term COVID-19 is urgently needed, said the authors of the research review. The findings also highlight the need for standardized core outcome measures for long-term COVID-19 follow-up, they wrote.

“As more data emerge and the features and course of post-COVID-19-associated critical illness become clearer, [a] continuum of care will need to be refined and optimised to meet the long-term needs of patients and their families,” they concluded.

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Three new studies shed more light on ‘long COVID’