Post-Intensive Care Unit Syndrome in a Cohort of COVID-19 Survivors in New York City

Abstract

Rationale: The coronavirus disease (COVID-19) pandemic has led to a dramatic increase in the number of survivors of critical illness. These survivors are at increased risk for physical, psychological, and cognitive impairments known collectively as post-intensive care syndrome (PICS). Little is known about the prevalence of PICS in COVID-19 survivors. Objectives: To report the prevalence of physical, psychological, and cognitive impairment among COVID-19 intensive care unit (ICU) survivors receiving follow-up care in an ICU recovery clinic, to assess for associations between PICS and ICU-related factors, and to compare the cohort of ICU survivors who attended a post-ICU clinic with a cohort of ICU survivors who did not. Methods: We performed a retrospective cohort study of COVID-19 ICU survivors admitted from March to May 2020 who were subsequently seen in a post-ICU recovery clinic in New York City. We abstracted medical chart data on available clinical screening instruments for physical, psychological, and cognitive impairment. Associations between these outcomes and care-related variables were tested. Baseline characteristics and in-hospital treatments of the post-ICU clinic cohort were compared with those of COVID-19 ICU survivors from the same institution who were not seen in the post-ICU clinic. Results: Eighty-seven COVID-19 ICU survivors were seen in our post-ICU recovery clinic. The median age was 62 years, and 74% were male. The median length of hospitalization was 51 days, and the median length of ICU stay was 22 days. At the post-ICU follow-up visit, 29%, 21%, and 13% of patients reported clinically significant levels of depressive symptoms, anxiety, and post-traumatic stress disorder symptoms, respectively. Twenty-five percent had cognitive impairment. The overall prevalence of PICS was 90%. There were no associations between length of ICU stay, delirium, and exposure to benzodiazepines, steroids, or systemic paralytics with positive screening results for physical, psychological, or cognitive impairment. Baseline characteristics and ICU-related factors were similar in the cohort of COVID-19 ICU survivors who attended the ICU recovery clinic and those who did not. Conclusions: PICS is common in COVID-19 survivors. We did not find any association with length of ICU stay or the use of benzodiazepines, steroids, or paralytics.

Keywords: COVID-19; acute respiratory distress syndrome; intensive care; physical impairment; post-traumatic stress disorder.

Figure 1.

(A) Flowchart of the patients included in the post–intensive care unit recovery clinic cohort. (B) Flowchart of patients included in the comparison cohort of coronavirus disease intubated survivors. COVID-19 = coronavirus disease; ICU = intensive care unit.

Figure 2.

(A–F) Scatterplots illustrating the associations between length of intensive care unit (ICU) stay in days and the surveys completed in the post-ICU recovery clinic. EQ-5D = EuroQol-5D; HADS = Hospital Anxiety and Depression Scale–Total; MOCA = Montreal Cognitive Assessment; PCL = PTSD Checklist for the DSM-5; PTSD = post-traumatic stress disorder; PTSS = Post-Traumatic Symptom Scale–10.