• Pierre Jaquet, Camille Legouy, Lucie Le Fevre, Alexandra Grinea, Fabrice Sinnah, Guillaume Franchineau, Juliette Patrier, Mehdi Marzouk, Paul-Henri Wicky, Alexis GeoffroyPierrePDepartment of Psychiatry and Addictive Medicine, AP-HP, Hospital Bichat - Claude Bernard, 75018 Paris, France.Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France.CNRS UPR 3212, Institute for Cellular and Integrative Neur, Florence Arnoult, Serafima Vledouts, Etienne de Montmollin, Lila Bouadma, Jean-François Timsit, Tarek Sharshar, and Romain Sonneville.
• UFR de médecine, Université de Paris, Paris, France.
• Crit. Care Med. 2022 Aug 1; 50 (8): e674e682e674-e682.

ObjectivesTo describe 3-6-month neurologic outcomes of survivors of COVID-19-associated acute respiratory distress syndrome, invasively ventilated in the ICU.DesignA bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020).SettingTwo academic hospital ICUs, Paris, France.PatientsAdult 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.InterventionsFollow-up by face-to-face neurologic consultation.Measures And Main ResultsThe 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.ConclusionsCOVID-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.Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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