Dataset Information

Post intensive care syndrome in survivors of COVID-19 who required mechanical ventilation during the third wave of the pandemic: A prospective study.

ABSTRACT:

Background

Post intensive care syndrome is defined as the presence of any impairment affecting the physical, psychiatric, or cognitive domains as a result of critical illnesses.

Objectives

To explore functional, cognitive and psychological outcomes at 30 days post hospital discharge among survivors of COVID-19-associated acute respiratory distress syndrome, who required mechanical ventilation.

Methods

Prospective cohort study. We included adult patients with COVID-19-associated acute respiratory distress syndrome, invasively ventilated in two ICUs in Buenos Aires. We measured functional, cognitive and psychological impairments with Barthel index, Montreal Cognitive Assessment test, Patient Health Questionnaire-9 and General Anxiety Disorder-7. Primary outcome was post-intensive care syndrome. Secondary outcome was mortality at 60 days.

Results

We admitted 40 patients, median age was 69 (60-75) and mostly male (75%). Mortality at 60 days was 37%. Cox regression analysis identified diabetes and Apache II as independent predictors of mortality. Out of 22 patients studied, 14 (64%) developed PICS after discharge. With a physical, cognitive and psychological impairment in 64%, 41% and 32% of patients, respectively. Obesity, days of mechanical ventilation, Apache II, vasopressors use, delirium duration and cumulative midazolam dose were associated with functional dependence.

Conclusions

We identified a high prevalence of functional, cognitive and mental impairment at 30 days after hospital discharge in COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated. The physical domain was the most frequently affected. These findings suggest the need for long-term follow-up of this population.

SUBMITTER: Martinez E

PROVIDER: S-EPMC10277848 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Publications

Post intensive care syndrome in survivors of COVID-19 who required mechanical ventilation during the third wave of the pandemic: A prospective study.

Martínez Ezequiel E Aguilera Cintia C Márquez Diego D Ziegler Gabriela G Plumet Javier J Tschopp Lorena L Cominotti Claudia C Sturzenegger Viviana V Cimino Carlos C Escobar Hernán H Pereyra Cecilia C Hidalgo Eliana E Adanza Santiago Piombi SP Morelli Daniela Moraes DM Masevicius Fabio Daniel FD

Heart & lung : the journal of critical care 20230619

<h4>Background</h4>Post intensive care syndrome is defined as the presence of any impairment affecting the physical, psychiatric, or cognitive domains as a result of critical illnesses.<h4>Objectives</h4>To explore functional, cognitive and psychological outcomes at 30 days post hospital discharge among survivors of COVID-19-associated acute respiratory distress syndrome, who required mechanical ventilation.<h4>Methods</h4>Prospective cohort study. We included adult patients with COVID-19-associ ...[more]

PMID: 37348211

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Project description:BackgroundCritical illness is associated with cognitive, physical, and psychological impairments; however, evidence of the severity and frequency of impairments in Chinese survivors of mechanical ventilation in an intensive care unit (ICU) remains limited. Our aim was to investigate the incidence and severity of impairments in Chinese survivors of mechanical ventilation in ICU and to explore risk factors influencing specific impairments.MethodsPatients discharged alive after mechanical ventilation in a large general ICU for ≥2 days were enrolled in this single-center cross-sectional study. Survivors were evaluated using measures of functional disability (Activity of Daily Living Scale), and post-traumatic stress disorder (PTSD, The Impact of Event Scale-Revised) via telephone interview. Multivariable analysis was conducted.ResultsData were obtained from 130 consenting survivors. At follow-up (mean: 19.64 months), among those in part-time or full-time employment prior to admission, only 45.1% had returned to work. Further, 29.2% of survivors had clear disabilities affecting daily living. Deficits in activities of daily living (ADL) were mainly characterized by impairment of instrumental ADL. Predictors of ADL in mechanically ventilated survivors included age, ICU admission diagnosis, and Acute Physiology And Chronic Health Evaluation II (APACHE II) score, which accounted for 33.5% of total variance. Furthermore, 17.7% of participants had symptoms consistent with PTSD. ICU length of stay was the only predictor of PTSD, and accounted for 7.5% of total variance.ConclusionsICU survivors of mechanical ventilation in China face negative impacts on employment, and commonly have ADL impairment and PTSD. Age, ICU admission diagnosis, and APACHE II score were key factors influencing ADL, while ICU length of stay was the only factor affecting PTSD. These findings suggest that some survivors who have had certain exposures may warrant closer follow-up, and systematic interventions for these high-risk survivors should be developed in China.

Project description:ObjectivesTo assess the reliability of codes relevant to critically ill patients in administrative data.DesignRetrospective cohort study linking data from Acute Physiology and Chronic Health Evaluation Outcomes, a clinical database of ICU patients with data from Medicare Provider Analysis and Review. We linked data based on matching for sex, date of birth, hospital, and date of admission to hospital.SettingForty-six hospitals in the United States participating in Acute Physiology and Chronic Health Evaluation Outcomes.PatientsAll patients in Acute Physiology and Chronic Health Evaluation Outcomes greater than or equal to 65 years old who could be linked with hospitalization records in Medicare Provider Analysis and Review from January 1, 2009, through September 30, 2012.Measurements and main resultsOf 62,451 patients in the Acute Physiology and Chronic Health Evaluation Outcomes dataset, 80.1% were matched with data in Medicare Provider Analysis and Review. All but 2.7% of Acute Physiology and Chronic Health Evaluation Outcomes ICU patients had either an ICU or coronary care unit charge in Medicare Provider Analysis and Review. In Acute Physiology and Chronic Health Evaluation Outcomes, 37.0% received mechanical ventilation during the ICU stay versus 24.1% in Medicare Provider Analysis and Review. The Medicare Provider Analysis and Review procedure codes for mechanical ventilation had high specificity (96.0%; 95% CI, 95.8-96.2), but only moderate sensitivity (58.4%; 95% CI, 57.7-59.1), with a positive predictive value of 89.6% (95% CI, 89.1-90.1) and negative predictive value of 79.7% (95% CI, 79.4-80.1). For patients with mechanical ventilation codes, Medicare Provider Analysis and Review overestimated the percentage with a duration greater than 96 hours (36.6% vs 27.3% in Acute Physiology and Chronic Health Evaluation Outcomes). There was discordance in the hospital discharge status (alive or dead) for only 0.47% of all linked records (κ = 1.00).ConclusionsMedicare Provider Analysis and Review data contain robust information on hospital mortality for patients admitted to the ICU but have limited ability to identify all patients who received mechanical ventilation during a critical illness. Estimates of use of mechanical ventilation in the United States should likely be revised upward.

Dataset Information

Post intensive care syndrome in survivors of COVID-19 who required mechanical ventilation during the third wave of the pandemic: A prospective study.

Background

Objectives

Methods

Results

Conclusions

Publications

Post intensive care syndrome in survivors of COVID-19 who required mechanical ventilation during the third wave of the pandemic: A prospective study.

Similar Datasets

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