Dusart Cecile, Smet Jelle, Chirumberro Audrey, André Stephanie, Roman Alain, Claus Marc, Bruyneel Anne-Violette, Menez Ophelie, Alard Stephane, De Vos Nathalie, Bruyneel Marie
Department of Pneumology, CHU Saint-Pierre, 1000 Brussels, Belgium.
Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium.
J Clin Med. 2023 May 27;12(11):3712. doi: 10.3390/jcm12113712.
Despite improved management of patients with COVID-19, we still ignore whether pharmacologic treatments and improved respiratory support have modified outcomes for intensive care unit (ICU) surviving patients of the three first consecutive waves (w) of the pandemic. The aim of this study was to evaluate whether developments in the management of ICU COVID-19 patients have positively impacted respiratory functional outcomes, quality of life (QoL), and chest CT scan patterns in ICU COVID-19 surviving patients at 3 months, according to pandemic waves.
We prospectively included all patients admitted to the ICU of two university hospitals with acute respiratory distress syndrome (ARDS) related to COVID-19. Data related to hospitalization (disease severity, complications), demographics, and medical history were collected. Patients were assessed 3 months post-ICU discharge using a 6 min walking distance test (6MWT), a pulmonary function test (PFT), a respiratory muscle strength (RMS) test, a chest CT scan, and a Short Form 36 (SF-36) questionnaire.
We included 84 ARDS COVID-19 surviving patients. Disease severity, complications, demographics, and comorbidities were similar between groups, but there were more women in wave 3 (w3). Length of stay at the hospital was shorter during w3 vs. during wave 1 (w1) (23.4 ± 14.2 days vs. 34.7 ± 20.8 days, = 0.0304). Fewer patients required mechanical ventilation (MV) during the second wave (w2) vs. during w1 (33.3% vs. 63.9%, = 0.0038). Assessment at 3 months after ICU discharge revealed that PFTs and 6MWTs scores were worse for w3 > w2 > w1. QoL (SF-36) deteriorated (vitality and mental health) more for patients in w1 vs. in w3 (64.7 ± 16.3 vs. 49.2 ± 23.2, = 0.0169). Mechanical ventilation was associated with reduced forced expiratory volume (FEV1), total lung capacity (TLC), diffusing capacity for carbon monoxide (DLCO), and respiratory muscle strength (RMS) (w1,2,3, < 0.0500) on linear/logistic regression analysis. The use of glucocorticoids, as well as tocilizumab, was associated with improvements in the number of affected segments in chest CT, FEV1, TLC, and DLCO ( < 0.01).
With better understanding and management of COVID-19, there was an improvement in PFT, 6MWT, and RMS in ICU survivors 3 months after ICU discharge, regardless of the pandemic wave during which they were hospitalized. However, immunomodulation and improved best practices for the management of COVID-19 do not appear to be sufficient to prevent significant morbidity in critically ill patients.
尽管对新冠病毒病（COVID-19）患者的管理有所改善，但我们仍不清楚药物治疗和改善呼吸支持是否改变了疫情前三波连续浪潮中重症监护病房（ICU）存活患者的预后。本研究的目的是评估根据疫情浪潮，ICU中COVID-19患者管理方面的进展是否对ICU中COVID-19存活患者3个月时的呼吸功能结局、生活质量（QoL）和胸部CT扫描模式产生了积极影响。
我们前瞻性纳入了两家大学医院ICU中所有因COVID-19相关急性呼吸窘迫综合征（ARDS）入院的患者。收集了与住院相关的数据（疾病严重程度、并发症）、人口统计学数据和病史。患者在ICU出院3个月后接受6分钟步行距离测试（6MWT）、肺功能测试（PFT）、呼吸肌力量（RMS）测试、胸部CT扫描和简短健康调查问卷（SF-36）评估。
我们纳入了84例ARDS合并COVID-19的存活患者。各组间疾病严重程度、并发症、人口统计学和合并症相似，但第三波（w3）中的女性更多。与第一波（w1）相比，w3期间的住院时间更短（23.4±14.2天 vs. 34.7±20.8天，P = 0.0304）。与w1相比，第二波（w2）期间需要机械通气（MV）的患者更少（33.3% vs. 63.9%，P = 0.0038）。ICU出院3个月后的评估显示，PFT和6MWT评分在w3>w2>w1中更差。与w3相比，w1患者的QoL（SF-36）（活力和心理健康）恶化更明显（64.7±16.3 vs. 49.2±23.2，P = 0.0169）。在线性/逻辑回归分析中，机械通气与第一、二、三波（w1、2、3）中用力呼气量（FEV1）、肺总量（TLC）、一氧化碳弥散量（DLCO）和呼吸肌力量（RMS）降低相关（P<0.0500）。糖皮质激素以及托珠单抗的使用与胸部CT中受累节段数量、FEV1、TLC和DLCO的改善相关（P<0.01）。
随着对COVID-19的更好理解和管理，ICU存活患者在ICU出院3个月后的PFT、6MWT和RMS有所改善，无论他们住院期间处于哪一波疫情。然而，免疫调节和改进的COVID-19管理最佳实践似乎不足以预防危重症患者的显著发病。
