Six-Month Impairment in Cognition, Mental Health, and Physical Function Following COVID-19–Associated Respiratory Failure

Jason H. Maley, MD, MS; Danielle K. Sandsmark, MD, PhD; Alison Trainor, MD; Geoffrey D. Bass, MD, MBA; Cian L. Dabrowski, MS; Brigid A. Magdamo, MSEd; Bridget Durkin, MD; Margaret M. Hayes, MD; Richard M. Schwartzstein, MD; Jennifer P. Stevens, MD, MS; Lewis J. Kaplan, MD; Mark E. Mikkelsen, MD, MSCE; Meghan B. Lane-Fall, MD, MSHP

doi:10.1097/CCE.0000000000000673

Critical Care Explorations (Apr 2022)

Six-Month Impairment in Cognition, Mental Health, and Physical Function Following COVID-19–Associated Respiratory Failure

Jason H. Maley, MD, MS,
Danielle K. Sandsmark, MD, PhD,
Alison Trainor, MD,
Geoffrey D. Bass, MD, MBA,
Cian L. Dabrowski, MS,
Brigid A. Magdamo, MSEd,
Bridget Durkin, MD,
Margaret M. Hayes, MD,
Richard M. Schwartzstein, MD,
Jennifer P. Stevens, MD, MS,
Lewis J. Kaplan, MD,
Mark E. Mikkelsen, MD, MSCE,
Meghan B. Lane-Fall, MD, MSHP

Affiliations

Jason H. Maley, MD, MS: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Danielle K. Sandsmark, MD, PhD: 3 Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Alison Trainor, MD: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Geoffrey D. Bass, MD, MBA: 4 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Cian L. Dabrowski, MS: 3 Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Brigid A. Magdamo, MSEd: 3 Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Bridget Durkin, MD: 5 Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Margaret M. Hayes, MD: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Richard M. Schwartzstein, MD: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Jennifer P. Stevens, MD, MS: 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Lewis J. Kaplan, MD: 6 Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Mark E. Mikkelsen, MD, MSCE: 4 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Meghan B. Lane-Fall, MD, MSHP: 7 Department of Anesthesiology and Critical Care and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

DOI: https://doi.org/10.1097/CCE.0000000000000673
Journal volume & issue: Vol. 4, no. 4
p. e0673

Abstract

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OBJECTIVES:. To determine the prevalence and extent of impairments impacting health-related quality of life among survivors of COVID-19 who required mechanical ventilation, 6 months after hospital discharge. DESIGN:. Multicenter, prospective cohort study, enrolling adults 18 years old or older with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who received mechanical ventilation for 48 hours or more and survived to hospital discharge. Eligible patients were contacted 6 months after discharge for telephone-based interviews from March 2020 to December 2020. Assessments included: Montreal Cognitive Assessment-Blind, Hospital Anxiety and Depression Scale, Impact of Event Scale-6, EuroQOL 5 domain quality-of-life questionnaire, and components of the Multidimensional Dyspnea Profile. SETTING:. Two tertiary academic health systems. PATIENTS:. Of 173 eligible survivors, a random sample of 63 were contacted and 60 consented and completed interviews. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Mean age was 57 + 13 years and mean duration of invasive mechanical ventilation was 14 + 8.2 days. Six months post-discharge, 48 patients (80%; 95% CI, 68–88%) met criteria for post-intensive care syndrome (PICS), with one or more domains impaired. Among patients with PICS, 28 (47%; 95% CI, 35–59%) were impaired in at least 2 domains, and 12 (20%; 95% CI, 12–32%) impaired in all three domains. Significant symptoms of post-traumatic stress were present in 20 patients (33%; 95% CI, 23–46%), anxiety in 23 (38%; 95% CI, 27–51%), and depression in 25 (42%; 95% CI, 30–54%). Thirty-three patients (55%; 95% CI, 42–67%) had impairments in physical activity; 25 patients (42%; 95% CI, 30–54%) demonstrated cognitive impairment. CONCLUSIONS:. Eighty percent of COVID-19 survivors who required mechanical ventilation demonstrated PICS 6 months after hospital discharge. Patients were commonly impaired in multiple PICS domains as well as coexisting mental health domains.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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