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Severe COVID-19 effects on lungs after 1 year

Severe COVID-19 effects on lungs after 1 year

 


Short-term lung injury has been reported in patients hospitalized for pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but there are few data on the more chronic sequelae of this condition. .. The new research paper summarizes data from patients seen one year after discharge.

Study: 1 year of pulmonary dysfunction after severe COVID-19: Prospective multicenter follow-up study. Image Credit: SvetaZi / Shutterstockstudy: 1 year of pulmonary dysfunction after severe COVID-19: Prospective multicenter follow-up.. Image credit: SvetaZi / Shutterstock

Preface

Both pneumonia and acute respiratory distress syndrome (ARDS) are frequently found in COVID-19 and can cause lung damage, including fibrosis. This is associated with short-term complications and can be observed 3-6 months after discharge, depending on the range of severity. For example, some patients have mild disability, while others have exertional shortness of breath.

The severity of respiratory failure during the development of pneumonia and the need for higher levels of respiratory support in terms of intubation and mechanical ventilation are factors that regulate the risk of sequelae, including the lungs. Although short-term sequelae have been recorded, early studies have shown that radiation abnormalities that remain on computed tomography (CT) of the lungs appear one year after pneumonia.

Findings included ground-glass opacification and fibrotic interstitial pulmonary abnormalities (ILA), and traction bronchiectasis, but non-fibrotic ILA healed at least partially. In addition, lung diffusion studies showed disability in more than half of critically ill patients, and one-third remained short of breath after a year.

Current studies published in the journal Respiratory researchWe investigated the pulmonary sequelae of a patient one year after the discharge of COVID-19, who was hospitalized for pneumonia.

What did the study show?

More than 300 patients with SARS-CoV-2 pneumonia were included in the study, of which more than 90% continued to be followed up to 1 year. Approximately 60, 140, and 90 patients received oxygen supplementation only, continuous positive airway pressure (CPAP) ventilation, and invasive ventilation (IMV), respectively. None of the patients died later in the study, but five had to be hospitalized repeatedly for a variety of reasons.

Almost 70% of patients had no history of smoking and about 80% had no or only one underlying illness.Incidence of pulmonary thromboembolism and Deep vein thrombosis Both groups were low and comparable.

The lowest diffusion capacity of carbon monoxide (DLCO) was in the oxygen-only group, with the least change in the CPAP group. DLCO improved by approximately 2.5% in all groups during the 6-12 months of CPAP and IMV groups. Very few patients had restrictive lung changes or obstruction, but the latter four patients had a history of smoking or are currently smoking, and one had asthma.

Other features showed no difference between groups, with 1 in 5 patients exhibiting shorter walking distances than expected. No group showed hypoxic saturation or needed oxygen supplementation.

Approximately 40% reported shortness of breath with mild exertion, and 34 patients reported that they had to walk slowly or stop to hold their breath. Comparing the 6-month and 12-month follow-ups, all groups reported increased shortness of breath, but it was not significant. No patient participated in the rehabilitation program.

A summary of the major radiation abnormalities and their enlargement depending on the lung lobes involved. LUL upper left lobe, LLL lower left lobe, RUL upper right lobe, RLL right lower lobe, RML right middle lobe

A summary of the major radiation abnormalities and their enlargement depending on the lung lobes involved. LUL upper left lobe, LLL lower left lobe, RUL upper right lobe, RLL right lower lobe, RML right middle lobe

Radiological abnormalities were found in 80% of IMV patients, 65% of CPAP, and 46% of the oxygen-only group. The risk was more than 8 times higher in the first group and almost 3 times higher in the second group compared to the last group.

Most high-resolution CT (HRCT) scans showed changes in the interstitial lung. More than half showed frosted glass opacity, more than one-third showed reticular anomalies, and less than 5% each showed consolidation and honeycomb. In 44%, frosted glass opacity was associated with traction bronchiectasis or bronchiectasis.

Almost 60% of patients with normal DLCO had HRCT abnormalities, but when DLCO was compromised, the rate of radiation abnormalities increased to 77%. The same applies to the opacity of frosted glass, 45% and 61%, respectively. Reticulated abnormalities occurred in 28% and almost 50%, respectively.

What is the impact?

Findings show that pulmonary fibrosis is a rare finding after SARS-CoV-2 pneumonia requiring hospitalization, with only 1% of patients showing this complication 12 months after discharge. increase. Most cases showed other mild interstitial results. It was mainly ground glass-like turbidity and reticular anomalies, mainly within a single leaf and had a limited range.

This supports previous reports, but even if the cystic changes and pneumatocele formation seen in the latter case are not identified here, it does not help track down the cause of the damage to viral damage. ..

Age is a clear risk factor for persistent radiological sequelae. DLCO disorders more commonly occur between oxygen-only and IMV patients, which may be due to selection bias. “Despite the mild substance of functional sequelae, a consistent proportion of patients 1 year after SARS-CoV-2 pneumonia tended to worsen compared to 6-month visits, resulting in exertional dyspnea (35%). Report.. “

The fact that this was independent of the severity of lung symptoms during hospitalization indicates a general mechanism of lung injury rather than being entirely dependent on the severity of pneumonia. Such patients deserve psychological support and rehabilitation given the debilitating effects of long Covid.

In fact, to summarize these results and the results of previous researchers, careful follow-up of elderly patients with SARS-CoV-2 pneumonia who require IMV to identify long-term lung sequelae without ignoring other pneumonia. Seems to need to provide up. group. Both DLCO and HRCT help pick up the sequelae of the lungs. Sequelae usually improve in 6 to 12 months.

Sources

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2/ https://www.news-medical.net/news/20220327/The-effects-of-severe-COVID-19-on-the-lungs-after-one-year.aspx

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