Longitudinal Recovery Trajectories and Ventilatory Modalities in Covid-19 ARDS Survivors
Authors: González Jessica , Benítez Iván D. , Santisteve Sally , Vila Anna , Aguilà Maria , Torres Gerard , Sánchez-Cucó Anna , Malla-Bañeres Mar , Moncusí-Moix Anna , de Batlle Jordi , Gracia-Lavedan Esther , Ceccato Adrián , Ferrer Ricard , Motos Anna , Riera Jordi , Fernández Laia , Menéndez Rosario , Lorente José Ángel , Peñuelas Oscar , García Dario , Roca Oriol , Peñasco Yhivian , Ricart Pilar , Martin Delgado Maria Cruz , Aguilera Luciano , Rodríguez Alejandro , Boado Varela Maria Victoria , Pérez-García Felipe , Pozo-Laderas Juan Carlos , Solé-Violan Jordi , Adell-Serrano Berta , Novo Mariana Andrea , Barberán José , Amaya Villar Rosario , de Gonzalo-Calvo David , Torres Antoni , Barbé Ferran , Roche-Campo Ferran ,   on behalf of the CIBERESUCICOVID Group
Published: January 2025

Introduction

The impact of the different ventilatory support modalities and the timing of intubation on longitudinal lung recovery trajectories in patients with severe COVID-19 is unknown.

Methods

A multicenter, prospective observational study conducted in 52 Spanish intensive care units (ICUs) involving critically ill COVID-19 patients admitted between February 25th, 2020, to February 28th, 2021. 1854 COVID-19 patients were followed after hospital discharge at 3, 6 and 12 months with lung diffusing capacity (DLCO) and a chest imaging. Patients were classified regarding the ventilatory support received during the ICU stay: noninvasive mechanical ventilation (NIMV), high-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV) divided into early IMV (intubation <24 h) and late IMV (intubation >24 h). The primary objective is to evaluate the impact of the different respiratory support modalities during the ICU stay and time of intubation on DLCOmeasurements and their recovery trajectories over a one-year follow-up. Secondary outcomes include other pulmonary function parameters and chest imaging findings.

Results

A total of 360 (19.4%) and 290 (15.6%) patients received HFNC and NIMV, respectively. 1204 (64.9%) patients underwent IMV; 966 received early IMV and 238 late IMV. The latter exhibited a significantly worse percentage of predicted DLCOduring the one-year follow-up with adjusted differences (95%CI; p-value) of 6.9 (3.9 to 10; p<0.001), 4.2 (1.1 to 7.2; p=0.007) and 4.9 (1.7 to 8.2; p=0.003) at 3, 6 and 12 months compared with early IMV. NIMV patients exhibited greater lung damage at follow-up than those under HFNC with an adjusted difference of DLCOvalues of 5.2 (1.7 to 8.7; p=0.003) at 6 months and greater presence of radiological abnormalities during the follow-up. Matched and sensitivity analysis showed results consistent with those reported.

Conclusions

Delay in intubation implies the worst outcomes; however, patients with NIMV exhibited a slower lung recovery in terms of DLCOmeasurements and more radiological abnormalities compared with HFNC patients. These results should be used to optimize follow-up protocols for COVID-19 ARDS survivors. These findings may serve as a valuable consideration for optimizing follow-up protocols for survivors of COVID-19 ARDS.