Evaluation of long-term sequelae by cardiopulmonary exercise testing 12 months after hospitalization for severe COVID-19

BMC Pulmonary Medicine

Research

Sofia Noureddine¹  Frédéric Claudé¹  Ophélie Ritter¹  Lucie Laurent¹  Pauline Roux-Claudé¹  Pauline Dolla¹  Sinan Karaer¹  Guillaume Eberst²  Virginie Westeel²  Cindy Barnig³ 

[1] Department of Chest Disease, University Hospital Besançon, 25000, Besançon, France;Department of Chest Disease, University Hospital Besançon, 25000, Besançon, France;Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France and UMR 1098, University of Franche-Comté, Besançon, France;Department of Chest Disease, University Hospital Besançon, 25000, Besançon, France;UMR1098, University of Franche-Comté, INSERM, EFS BFC, F-25000, Besançon, France;

关键词: COVID-19;    SARS-CoV-2;    Acute respiratory distress syndrome;    Cardiopulmonary exercise testing;    Peak oxygen consumption;    Pulmonary vascular disease;   

DOI  :  10.1186/s12890-023-02313-x

 received in 2022-09-21, accepted in 2023-01-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundCardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae.MethodsIn this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed.ResultsTwelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O2 uptake (V′O2) considered within normal limits (median peak predicted O2 uptake (V′O2) of 98% [87.2–106.3]). Length of ICU stay remained an independent predictor of V′O2. More than half of the patients with a normal peak predicted V′O2 showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21–0.32] at anaerobic threshold (AT) and 0.29 [0.25–0.34] at peak) and a widened median peak alveolar-arterial gradient for O2 (35.2 mmHg [31.2–44.8]. Peak PetCO2 was significantly lower in subjects with an abnormal increase of VD/Vt (p = 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r2 = 0.12; p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (DLCO) (r2 =  − 0.15; p = 0.01).ConclusionsTwelve months after severe COVID-19 pneumonia, most of the patients had a peak V′O2 considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea.Trial registration: NCT04519320 (19/08/2020).

【 授权许可】

CC BY   
© The Author(s) 2023

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