Post-intensive care syndrome and pulmonary fibrosis in patients surviving ARDS-pneumonia of COVID-19 and non-COVID-19 etiologies.
Post-intensive care syndrome and pulmonary fibrosis in patients surviving ARDS-pneumonia of COVID-19 and non-COVID-19 etiologies.
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DOI：
10.1038/s41598-023-32699-x
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发表时间：
2023-04-21
影响因子：
4.6
通讯作者：
Morris, Peter E. E.
中科院分区：
文献类型：
--
作者：
Sturgill, Jamie L. L.;Mayer, Kirby P. P.;Kalema, Anna G. G.;Dave, Kinjal;Mora, Stephanie;Kalantar, Alborz;Carter, David J. J.;Montgomery-Yates, Ashley A. A.;Morris, Peter E. E.
目的是检查以患者为中心的结局以及肺炎相关急性呼吸窘迫综合征（ARDS）后胸部计算机断层扫描（CT）成像上肺纤维化变化的发生率。我们试图调查COVID 19相关ARDS和非COVID相关ARDS幸存者的门诊胸部CT成像，以确定组间差异并探索肺纤维化变化与功能结局之间的关系。在一家三级学术医疗中心的ICU恢复诊所，对因COVID-19和非COVID病因而存活的成人ARDS患者进行了电子健康记录的回顾性实践分析。纳入了94例患者，平均年龄为53 ± 13岁，51%为男性（n = 64 COVID-19组和n = 30非COVID组）。两组之间的年龄、性别、住院时间、ICU住院时间、机械通气时间或序贯器官衰竭评估（SOFA）评分无差异。与非COVID组（43%，p < 0.001）相比，COVID-19幸存者（70%）中发生CT成像可见的纤维化变化的比例更高。在两组中，发生纤维化变化的患者（n = 58）年龄较大，BMI较低，住院和ICU LOS较长，平均RASS评分较低，辅助供氧总持续时间较长。虽然没有统计学差异，但纤维化改变的患者确实有呼吸功能降低，6分钟步行试验表现较差，并且无论最初的诊断如何，焦虑，抑郁，情绪困扰和轻度认知障碍的发生率都很高。肺炎-ARDS幸存的患者在与重症监护后综合征相关的身体、情感和认知健康方面存在高风险损害。具有临床重要性的是，COVID-ARDS组胸部CT显示的肺纤维化变化比例较高;然而，ICU随访时肺功能测定或体格评估未测量到功能差异。从这些数据中，COVID感染是否会带来独特的恢复并不明显，但表明对所有ARDS幸存者进行长期随访是必要的。
The purpose was to examine patient-centered outcomes and the occurrence of lung fibrotic changes on Chest computed tomography (CT) imaging following pneumonia-related acute respiratory distress syndrome (ARDS). We sought to investigate outpatient clinic chest CT imaging in survivors of COVID19-related ARDS and non-COVID-related ARDS, to determine group differences and explore relationships between lung fibrotic changes and functional outcomes. A retrospective practice analysis of electronic health records at an ICU Recovery Clinic in a tertiary academic medical center was performed in adult patients surviving ARDS due to COVID-19 and non-COVID etiologies. Ninety-four patients with mean age 53 ± 13 and 51% male were included (n = 64 COVID-19 and n = 30 non-COVID groups). There were no differences for age, sex, hospital length of stay, ICU length of stay, mechanical ventilation duration, or sequential organ failure assessment (SOFA) scores between the two groups. Fibrotic changes visualized on CT imaging occurred in a higher proportion of COVID-19 survivors (70%) compared to the non-COVID group (43%, p < 0.001). Across both groups, patients with fibrotic changes (n = 58) were older, had a lower BMI, longer hospital and ICU LOS, lower mean RASS scores, longer total duration of supplemental oxygen. While not statistically different, patients with fibrotic changes did have reduced respiratory function, worse performance on the six-minute walk test, and had high occurrences of anxiety, depression, emotional distress, and mild cognitive impairment regardless of initial presenting diagnosis. Patients surviving pneumonia-ARDS are at high risk of impairments in physical, emotional, and cognitive health related to Post-Intensive Care Syndrome. Of clinical importance, pulmonary fibrotic changes on chest CT occurred in a higher proportion in COVID-ARDS group; however, no functional differences were measured in spirometry or physical assessments at ICU follow-up. Whether COVID infection imparts a unique recovery is not evident from these data but suggest that long-term follow up is necessary for all survivors of ARDS.
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影响因子：
8.8
作者：
Fan E;Dowdy DW;Colantuoni E;Mendez-Tellez PA;Sevransky JE;Shanholtz C;Himmelfarb CR;Desai SV;Ciesla N;Herridge MS;Pronovost PJ;Needham DM
通讯作者：
Needham DM
DOI：
10.1164/rccm.201103-0503oc
发表时间：
2012-03-01
影响因子：
24.7
作者：
Bienvenu, Oscar J.;Colantuoni, Elizabeth;Needham, Dale M.
通讯作者：
Needham, Dale M.
影响因子：
8.3
作者：
Cardinal-Fernandez, Pablo;Lorente, Jose A.;Matute-Bello, Gustavo
通讯作者：
Matute-Bello, Gustavo
影响因子：
3.7
作者：
Haylett, Rebekah;Gustafson, Owen
通讯作者：
Gustafson, Owen
影响因子：
1
作者：
Mayer, Kirby P.;Sturgill, Jamie L.;Morris, Peter E.
通讯作者：
Morris, Peter E.