OBJECTIVES: 

To describe 3–6-month neurologic outcomes of survivors of COVID-19–associated acute respiratory distress syndrome, invasively ventilated in the ICU.

DESIGN: 

A bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020).

SETTING: 

Two academic hospital ICUs, Paris, France.

PATIENTS: 

Adult COVID-19–associated acute respiratory distress syndrome survivors, invasively ventilated in the ICU, were eligible for a neurologic consultation between 3 and 6 months post ICU discharge.

INTERVENTIONS: 

Follow-up by face-to-face neurologic consultation.

MEASURES AND MAIN RESULTS: 

The primary endpoint was favorable functional outcome defined by a modified Rankin scale score less than 2, indicating survival with no significant disability. Secondary endpoints included mild cognitive impairment (Montreal Cognitive Assessment score < 26), ICU-acquired weakness (Medical Research Council score < 48), anxiety and depression (Hospital Anxiety and Depression score > 7), and posttraumatic stress disorder (posttraumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders 5 score > 30). Of 54 eligible survivors, four non-French-speaking patients were excluded, eight patients were lost-to-follow-up, and one died during follow-up. Forty-one patients were included. Time between ICU discharge and neurologic consultation was 3.8 months (3.6–5.9 mo). A favorable functional outcome was observed in 16 patients (39%) and mild cognitive impairment in 17 of 33 patients tested (52%). ICU-acquired weakness, depression or anxiety, and posttraumatic stress disorder were reported in six of 37 cases (16%), eight of 31 cases (26%), and two of 27 cases (7%), respectively. Twenty-nine patients (74%) required rehabilitation (motor, cognitive, or psychologic). ICU and hospital lengths of stay, tracheostomy, and corticosteroids were negatively associated with favorable outcome. By contrast, use of alpha-2 agonists during ICU stay was associated with favorable outcome.

CONCLUSIONS: 

COVID-19–associated acute respiratory distress syndrome requiring intubation led to slight-to-severe functional disability in about 60% of survivors 4 months after ICU discharge. Cognitive impairment, muscle weakness, and psychologic symptoms were frequent. A large multicenter study is warranted to allow identification of modifiable factors for improving long-term outcome.

中文翻译：

---

需要插管的 COVID-19 相关急性呼吸窘迫综合征幸存者的神经系统结果

目标： 

描述在 ICU 接受有创通气的 COVID-19 相关急性呼吸窘迫综合征幸存者 3-6 个月的神经系统结果。

设计： 

在大流行的第一波两波（2020 年 3 月至 5 月和 9 月至 12 月）期间进行的双中心前瞻性研究。

环境： 

法国巴黎的两家学术医院 ICU。

患者： 

在 ICU 接受有创通气的成人 COVID-19 相关急性呼吸窘迫综合征幸存者有资格在 ICU 出院后 3 至 6 个月内接受神经科会诊。

干预措施： 

通过面对面的神经科咨询进行随访。

措施及主要成果： 

主要终点是良好的功能结果，由小于 2 的改良 Rankin 量表评分定义，表明存活且无明显残疾。次要终点包括轻度认知障碍（蒙特利尔认知评估评分<26）、ICU获得性无力（医学研究委员会评分<48）、焦虑和抑郁（医院焦虑和抑郁评分>7）以及创伤后应激障碍（创伤后应激障碍检查表）精神障碍诊断和统计手册5分数 > 30）。在 54 名符合条件的幸存者中，4 名非法语患者被排除在外，8 名患者失访，1 名患者在随访期间死亡。其中包括四十一名患者。从 ICU 出院到神经科会诊之间的时间为 3.8 个月（3.6-5.9 个月）。16 名患者 (39%) 观察到良好的功能结果，33 名患者中有 17 名 (52%) 出现轻度认知障碍。37 例中的 6 例（16%）、31 例中的 8 例（26%）和 27 例中的 2 例（7%）分别报告了 ICU 获得性虚弱、抑郁或焦虑以及创伤后应激障碍。二十九名患者 (74%) 需要康复（运动、认知或心理）。ICU 和住院时间、气管切开术和皮质类固醇与良好的结果呈负相关。相比之下，在 ICU 住院期间使用 α-2 激动剂与良好的结果相关。

结论： 

需要插管的 COVID-19 相关急性呼吸窘迫综合征导致约 60% 的幸存者在 ICU 出院 4 个月后出现轻度至重度功能障碍。认知障碍、肌肉无力和心理症状很常见。有必要进行大型多中心研究，以确定可改变的因素，以改善长期结果。