Cardiorespiratory abnormalities in ICU survivors of COVID-19 with postacute sequelae of SARS-CoV-2 infection are unrelated to invasive mechanical ventilation.
Igor LongobardiDanilo Marcelo Leite do PradoDanieli Castro de Oliveira AndradeKarla Fabiana GoesslerGersiel Nascimento de Oliveira JúniorRafael de Almeida AzevedoAlice Erwig LeitãoJhonnatan Vasconcelos Pereira SantosAna Lucia de Sá PintoBruno GualanoHamilton RoschelPublished in: American journal of physiology. Heart and circulatory physiology (2024)
Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) often leads to exertional intolerance and reduced exercise capacity, particularly in individuals previously admitted to an intensive care unit (ICU). However, the impact of invasive mechanical ventilation (IMV) on PASC-associated cardiorespiratory abnormalities during exercise remains poorly understood. This single-center, cross-sectional study aimed to gather knowledge on this topic. Fifty-two patients with PASC recruited ∼6 mo after ICU discharge were clustered based on their need for IMV (PASC + IMV, n = 27) or noninvasive support therapy (PASC + NIS, n = 25). Patients underwent pulmonary function and cardiopulmonary exercise testing (CPX) and were compared with a reference group (CONTROL, n = 19) comprising individuals of both sexes with similar age, comorbidities, and physical activity levels but without a history of COVID-19 illness. Individuals with PASC, irrespective of support therapy, presented with higher rates of cardiorespiratory abnormalities than CONTROL, especially dysfunctional breathing patterns, dynamic hyperinflation, reduced oxygen uptake and oxygen pulse, and blunted heart rate recovery (all P < 0.05). Only the rate of abnormal oxygen pulse was greater among PASC + IMV group than PASC + NIS group ( P = 0.05). Mean estimates for all CPX variables were comparable between PASC + IMV and PASC + NIS groups (all P > 0.05). These findings indicate significant involvement of both central and peripheral factors, leading to exertional intolerance in individuals with PASC previously admitted to the ICU, regardless of their need for IMV. NEW & NOTEWORTHY We found cardiorespiratory abnormalities in ICU survivors of severe-to-critical COVID-19 with PASC to be independent of IMV need. Overall, both group of patients experienced dysfunctional breathing patterns, dynamic hyperinflation, lower oxygen uptake and oxygen pulse, and blunted heart rate responses to CPX. PASC seems to impact exertional tolerance and exercise capacity due to ventilatory inefficiency, impaired aerobic metabolism, and potential systolic and autonomic dysfunction, all of these irrespective of support therapy during ICU stay.
Keyphrases
- mechanical ventilation
- intensive care unit
- heart rate
- high intensity
- blood pressure
- respiratory syndrome coronavirus
- acute respiratory distress syndrome
- physical activity
- sars cov
- coronavirus disease
- heart rate variability
- end stage renal disease
- newly diagnosed
- respiratory failure
- body composition
- ejection fraction
- chronic kidney disease
- resistance training
- young adults
- body mass index
- stem cells
- oxidative stress
- mesenchymal stem cells
- early onset
- bone marrow
- patient reported outcomes
- depressive symptoms
- sleep quality