Postacute Sequelae of COVID-19 Critical Illness

Abstract

With an ever-increasing number of COVID-19 survivors, providers are tasked with addressing the longer lasting symptoms of COVID-19, or postacute sequelae of SARS-CoV-2 infection (PASC). For critically ill patients, existing knowledge about postintensive care syndrome (PICS) represents a useful structure for understanding PASC. Post-ICU clinics leverage a multidisciplinary team to evaluate and treat the physical, cognitive, and psychological sequelae central to both PICS and PASC in critically ill patients. While management through both pharmacologic and nonpharmacologic modalities can be used, further research into both the optimal treatment and prevention of PASC represents a key public health imperative.

Keywords: Long COVID; Post-COVID-19 programs; Postacute sequelae of SARS-CoV-2; Postintensive care syndrome; Post–acute COVID-19 syndrome.

Fig. 1

Common sequelae of critical illness in both COVID-19 and non–COVID-19 survivors.

Fig. 2

Risk factors associated with PICS. Each circle represents the PICS domain associated with each risk factor. Those in italics represent potentially modifiable risk factors; others are pre-existing.

Fig. 3

Outpatient evaluation of PASC in survivors of critical illness. HADS, Hospital Anxiety and Depression Scale; MoCA, Montreal Cognitive Assessment; IESR, Impact of Event Scale-Revised; EQ-5D, EuroQol-5D; mMRC, Modified Medical Research Council; BBS, Borg Balance Scale; 5XSTS, Five Times Sit-to-Stand; MMT, Manual Muscle Testing; 6MWT, Six-Minute Walk Test

Fig. 4

Role of PICS clinics in improving ICU care. Multidisciplinary evaluation in post-ICU clinics can provide a basis for long-term research, which in turn can inform future preventative interventions in the ICU. PICS, Post-Intensive Care Syndrome; SAT, Spontaneous Awakening Trial; SBT, Spontaneous Breathing Trial.