Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19: A 3-Month Prospective Cohort.
Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19: A 3-Month Prospective Cohort.
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DOI：
10.1016/j.chest.2021.02.062
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发表时间：
2021-07
期刊：
影响因子：
9.6
通讯作者：
CIBERESUCICOVID Project (COV20/00110, ISCIII)
中科院分区：
文献类型：
--
作者：
González J;Benítez ID;Carmona P;Santisteve S;Monge A;Moncusí-Moix A;Gort-Paniello C;Pinilla L;Carratalá A;Zuil M;Ferrer R;Ceccato A;Fernández L;Motos A;Riera J;Menéndez R;Garcia-Gasulla D;Peñuelas O;Bermejo-Martin JF;Labarca G;Caballero J;Torres G;de Gonzalo-Calvo D;Torres A;Barbé F;CIBERESUCICOVID Project (COV20/00110, ISCIII)
超过20%的COVID-19住院患者表现为ARDS，需要入住ICU。此类患者的长期呼吸系统后遗症仍不清楚。COVID-19幸存的危重患者的主要长期肺部后遗症是什么？招募了需要入住ICU的COVID-19患者，并在出院后3个月进行了评估。随访包括症状和生活质量、焦虑和抑郁问卷、肺功能检查、运动试验（6分钟步行试验[6 MWT]）和胸部CT成像。于2020年3月至6月期间，招募了125名因COVID-19继发性ARDS而入住ICU的患者。在3个月随访时，62例患者可用于肺部评价。最常见的症状是呼吸困难（46.7%）和咳嗽（34.4%）。82%的患者显示肺弥散量低于80%。6 MWT的中位距离为400 m（四分位距，362-440 m）。CT扫描显示70.2%的患者异常，其中49.1%为网状病变，21.1%为纤维化。胸部CT改变越严重的患者，肺功能越差，6 MWT中的去饱和程度越高。与胸部CT扫描肺损伤严重程度相关的因素是年龄和ICU住院期间有创机械通气的时间。出院后三个月，需要入住ICU的COVID-19继发性ARDS患者的肺结构异常和功能障碍非常普遍。对于所有危重COVID-19幸存者，应在出院后3个月考虑进行肺部评估。
More than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear. What are the major long-term pulmonary sequelae in critical patients who survive COVID-19? Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging. One hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay. Three months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.
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