One year after hospital discharge, survivors of severe COVID-19 who required mechanical ventilation have twice the prevalence of PTSD symptoms, more difficulty returning to work and other disabilities than those who they had severe forms of less severe disease. .
The findings are from a study published last week in a critical care medicine scientific journal, conducted between March 2020 and March 2022 in 84 hospitals linked to the Covid-19 Coalition, an alliance to conduct research involving several leading institutions. plan such as Albert Einstein, Sírio-Libanês, Hcor, Oswaldo Cruz, Beneficência Portuguesa (in São Paulo) and Moinhos de Vento (in Porto Alegre).
The patients were compared according to the severity of the disease: from those hospitalized who did not need oxygen to those who needed intubation (mechanical ventilation).
Of the 1,508 enrolled in the study, 36 died before completing one year of follow-up. The all-cause mortality rate among those who were intubated was 7.9%. That of people who had the least severe form of Covid was 1.2%.
The study showed that 1 in 4 intubated people needed to be hospitalized in the following 12 months (24% vs 19.6%). The rate of cardiovascular events, such as heart attack, was also more than double that of those not requiring mechanical ventilation (5.6% versus 2.3%).
“The results serve as a warning not only to patients who have had severe Covid and their families, but also to healthcare managers. [O uso de ventilação mecânica] it can be an easily recognizable marker to identify patients at higher risk and to help outline rehabilitation goals,” says intensive care physician Regis Goulart Rosa, researcher at Moinhos de Vento Hospital and lead author of the study.
According to the survey, a high percentage of patients reported new disabilities, such as movement difficulties, one year after admission (40.4% versus 23.5%). They also have a lower rate of return to work (88.1% versus 97.5%) and to education (88.9% versus 96.9%).
“More personalized follow-up and care for these patients can also mean cost-effectiveness for health systems. If the person is rehospitalized less, they are able to return to society, work, everyone benefits.”
The study also reveals that patients undergoing intubation suffer a large impact on mental health. The prevalence of PTSD among them was double that of the less severe group (14% versus 7%). One in four had anxiety symptoms (24.7% versus 17.5%).
The mean age of study participants was 53 years; 60.8% were men. Hypertension (45%), obesity (30%) and diabetes (24%) are among the most common comorbidities. The mean duration of mechanical ventilation during hospitalization was ten days.
Other studies have already shown that patients with Covid-19 who require mechanical ventilation are more likely to have elevated inflammatory markers, more extensive lung involvement, multi-organ dysfunction and higher in-hospital mortality. “Mechanical ventilation is a very effective treatment, it saves lives, but it’s not without its negative effects,” says Regis Rosa.
The scientific literature shows that factors such as heavy sedation, medications (neuromuscular blocking agents and corticosteroids), immobilization and pneumonia are associated with worse long-term outcomes, with ICU-acquired weakness, post-traumatic stress, post-traumatic -discharge and reduced quality of life.
The study authors also point out that overcrowding in intensive care units caused by the COVID-19 pandemic may also have been associated with lower adherence to interventions aimed at preventing long-term disability among mechanically ventilated patients. These include minimization of sedation and use of neuromuscular blocking agents, pain control, early mobilisation, and family attendance.
Since the beginning of the pandemic, Brazil has already recorded more than 36 million cases of Covid and about 695,000 deaths. “We have thousands of people suffering from some degree of Covid involvement. And we already know from other studies that it’s not just severe cases that are affected [pela Covid longa]. We need more research to understand this new condition, the risk factors, as well as recognize and offer rehabilitation to these patients,” says Regis Rosa.
According to intensive care doctor Suzana Lobo, who was head of AMIB (Associação de Medicina Intensiva Brasileira) during the critical period of the pandemic, the long-term impact of the most severe cases of Covid was already a tragedy waiting to happen.
“On countless occasions, we, as scientific societies and scientists, have warned of the risks of long-term complications and the impact on quality of life. We have known this very well for decades due to the bacterial sepsis with which we live daily in our intensive care units. And Covid-19 is nothing more than a viral sepsis,” he explains.
Lobo recalls that in a meeting in April 2021 with former Health Minister Marcelo Queiroga, Amib warned of the need to prepare and invest in rehabilitation for the next five years, in which there would be thousands of sequels of Covid-19.
The survey also warns of the need to monitor patients after discharge, as many die from complications of the disease but appear in surveys as recovered. Another important measure is to prepare professionals to act early in rehabilitation.
The relationship between the severity of Covid-19 and the increased incidence of cardiovascular events is another finding that worries researchers. “This association is not new and exists in other conditions, such as severe sepsis, that cause organ dysfunction. There is a higher risk of organ involvement [músculo] myocardium, arrhythmias. There is great concern about the increase in the incidence of these events in the years following the pandemic,” says Rosa.
The study has some limitations, such as the fact that COVID-19 can have different effects on long-term outcomes in different settings, for example patients with early access to post-discharge rehabilitation services.
Variables that could, in theory, modify the association between acute severity of Covid-19 and long-term outcomes, such as vaccination, infection with different variants of SARS-CoV-2, and treatments were also not evaluated. specific.
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