Hazarika Amarjyoti, Mahajan Varun, Kajal Kamal, Ray Ananya, Singla Karan, Sehgal Inderpaul S, Bhalla Ashish, Singh Shubh M, Naik Naveen B, Kaloria Narender, Saini Kulbhushan, Singh Ajay, Kumar Ganesh, Biswas Indranil, Soni Shiv L, Bhagat Hemant, Singh Yadvender, Puri Goverdhan D
Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.
Anesthesia and Intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.
Cureus. 2021 Sep 6;13(9):e17756. doi: 10.7759/cureus.17756. eCollection 2021 Sep.
Background Survivors of COVID-19 pneumonia may have residual lung injury and poor physical and mental health even after discharge. We hypothesized that COVID-19 severe acute respiratory distress syndrome (ARDS) patients needing mechanical ventilation may be at a greater risk of deterioration in pulmonary function, mental health, and quality of life (QOL). This study analyses the differences in pulmonary function, mental health, and QOL after recovery, in patients having received non-invasive oxygen therapy versus invasive mechanical ventilation during ICU stay. Methods Patients aged >18 years, who had completed 3 months post ICU discharge, with moderate to severe COVID-19 ARDS, were consecutively enrolled from May 1 to July 31, 2021. Patients were allocated into Group A - having required high flow nasal cannula (HFNC)/non-invasive ventilation (NIV) and Group B - having received invasive mechanical ventilation. Pulmonary function tests, 6-minute walk test (6-MWT), and health-related quality of life were compared. Results Of the 145 eligible patients, 31 were lost to follow-up and 21 died. Seventy-four patients were allocated into Groups A (57 patients) and B (17 patients). In Group A, abnormal forced expiratory volume in first second (FEV), forced vital capacity (FVC), forced expiratory flow in mid-half of FVC (FEF), and peak expiratory flow rate (PEFR) values were obtained in 27 (47.37%), 43 (75.44%), 11 (19.3%), and 25 (43.86%) patients, and in Group B, in 13 (76.47%), 17 (100%), 1 (5.88%), and 8 (47%) patients, respectively. No patient had abnormal FEV/FVC. All Group B patients had a restrictive pattern in spirometry as compared to 77% in Group A. Group B had a lower arterial partial pressure of oxygen (PaO) (p=0.0019), % predicted FVC (p<0.0001), % predicted FEV (p=0.001), and 6-MWT distance (p<0.001). The physical component score in the short-form survey 12 questionnaire was higher in group A, p<0.001, whereas the mental component score was comparable. Conclusions Patients requiring invasive mechanical ventilation (MV) have a greater risk of impaired pulmonary function and reduced QOL post-ICU discharge. This warrants a greater need for following these patients for better rehabilitation.
新型冠状病毒肺炎（COVID-19）幸存者即使出院后仍可能存在肺部残余损伤以及身心健康问题。我们推测，需要机械通气的COVID-19重症急性呼吸窘迫综合征（ARDS）患者肺功能、心理健康和生活质量（QOL）恶化的风险可能更高。本研究分析了在重症监护病房（ICU）住院期间接受无创氧疗与有创机械通气的患者康复后肺功能、心理健康和QOL的差异。方法：连续纳入2021年5月1日至7月31日年龄>18岁、在ICU出院后已度过3个月、患有中度至重度COVID-19 ARDS的患者。患者被分为A组——需要高流量鼻导管（HFNC）/无创通气（NIV），以及B组——接受有创机械通气。比较了肺功能测试、6分钟步行试验（6-MWT）和健康相关生活质量。结果：145例符合条件的患者中，31例失访，21例死亡。74例患者被分为A组（57例）和B组（17例）。在A组中，27例（47.37%）、43例（75.44%）、11例（19.3%）和25例（43.86%）患者的第1秒用力呼气量（FEV）、用力肺活量（FVC）、FVC中值的用力呼气流量（FEF）和呼气峰值流速（PEFR）值异常，在B组中，分别有13例（76.47%）、17例（100%）、1例（5.88%）和8例（47%）患者异常。没有患者FEV/FVC异常。与A组的77%相比，B组所有患者的肺量计检查均呈现限制性模式。B组的动脉血氧分压（PaO）较低（p=0.0019）、预测FVC百分比（p<0.0001）、预测FEV百分比（p=0.001）和6-MWT距离较短（p<0.001）。简式健康调查12问卷中的身体成分得分在A组中较高，p<0.001，而心理成分得分相当。结论：需要有创机械通气（MV）的患者在ICU出院后肺功能受损和QOL降低的风险更大。这就更有必要对这些患者进行随访以实现更好的康复。
