Journal Article Annotations
2023, 3rd Quarter

Critical care

Annotations by Jon Sole, MD, MSc and O. Joseph Bienvenu, MD, PhD
October, 2023

A systematic review and meta-analysis of long term physical and mental sequelae of COVID-19 pandemic: call for research priority and action.
PTSD Symptoms Among Family Members of Patients With ARDS Caused by COVID-19 After 12 Months.

Of interest:

- Post-intensive care syndrome (PICS): recent updates.
- Delirium in the NICU.

PUBLICATION #1 — Critical care

A systematic review and meta-analysis of long term physical and mental sequelae of COVID-19 pandemic: call for research priority and action.

Na Zeng, Yi-Miao Zhao, Wei Yan, Chao Li, Qing-Dong Lu, Lin Liu, Shu-Yu Ni, Huan Mei, Kai Yuan, Le Shi, Peng Li, Teng-Teng Fan, Jun-Liang Yuan, Michael V,Vitiello, Thomas Kosten, Alexandra L Kondratiuk, Hong-Qiang Sun, Xiang-Dong Tang, Mei-Yan Liu, Ajit Lalvani, Jie Shi, Yan-Ping Bao, Lin Lu.

Abstract: Mol Psychiatry. 2023 Jan;28(1):423-433. doi: 10.1038/s41380-022-01614-7. Epub 2022 Jun 6.

The long-term physical and mental sequelae of COVID-19 are a growing public health concern, yet there is considerable uncertainty about their prevalence, persistence and predictors. We conducted a comprehensive, up-to-date meta-analysis of survivors’ health consequences and sequelae for COVID-19. PubMed, Embase and the Cochrane Library were searched through Sep 30th, 2021. Observational studies that reported the prevalence of sequelae of COVID-19 were included. Two reviewers independently undertook the data extraction and quality assessment. Of the 36,625 records identified, a total of 151 studies were included involving 1,285,407 participants from thirty-two countries. At least one sequelae symptom occurred in 50.1% (95% CI 45.4-54.8) of COVID-19 survivors for up to 12 months after infection. The most common investigation findings included abnormalities on lung CT (56.9%, 95% CI 46.2–67.3) and abnormal pulmonary function tests (45.6%, 95% CI 36.3–55.0), followed by generalized symptoms, such as fatigue (28.7%, 95% CI 21.0–37.0), psychiatric symptoms (19.7%, 95% CI 16.1–23.6) mainly depression (18.3%, 95% CI 13.3–23.8) and PTSD (17.9%, 95% CI 11.6–25.3), and neurological symptoms (18.7%, 95% CI 16.2–21.4), such as cognitive deficits (19.7%, 95% CI 8.8–33.4) and memory impairment (17.5%, 95% CI 8.1–29.6). Subgroup analysis showed that participants with a higher risk of long-term sequelae were older, mostly male, living in a high-income country, with more severe status at acute infection. Individuals with severe infection suffered more from PTSD, sleep disturbance, cognitive deficits, concentration impairment, and gustatory dysfunction. Survivors with mild infection had high burden of anxiety and memory impairment after recovery. Our findings suggest that after recovery from acute COVID-19, half of survivors still have a high burden of either physical or mental sequelae up to at least 12 months. It is important to provide urgent and appropriate prevention and intervention management to preclude persistent or emerging long-term sequelae and to promote the physical and psychiatric wellbeing of COVID-19 survivors.

Annotation

The finding:
This systematic meta-analysis of 151 studies, encompassing 1.2 million patients, suggests 50% of survivors experience persistent symptoms after COVID infection, the most common including abnormal PFTs, fatigue, depression, cognitive deficits, and memory impairment. Risk factors included age, male sex, severity of acute infection, and living in a high-income country.

Strength and weaknesses:
This study is one of the largest to explore the prevalence of mental health disorders in patients with COVID-19. It included over 1 million patients across 32 countries, evaluation of seven organ systems, and 102 specific symptoms related to COVID-19. The study’s quality assessment indicated a mixed quality level of included studies, with a majority being classified as medium quality.

Relevance:
While the study is not specific to critical care, findings suggest patients with more severe infection (such as those requiring ICU admission) are more likely to experience PTSD, sleep disturbances, cognitive deficits, concentration impairment, and gustatory dysfunction, highlighting the need for further evaluation of these domains in this sub-population.

PUBLICATION #2 — Critical care

PTSD Symptoms Among Family Members of Patients With ARDS Caused by COVID-19 After 12 Months.

Nancy Kentish-Barnes, Matthieu Resche-Rigon, Antoine Lafarge, Virginie Souppart, Anne Renet, Frédéric Pochard, Elie Azoulay.

Abstract: JAMA. 2023 Oct 10;330(14):1383-1385. doi: 10.1001/jama.2023.15879.

Abstract:

Twelve months after patient ICU hospitalization, having ARDS caused by COVID-19 compared with other causes was not significantly associated with increased symptoms of PTSD, anxiety, or depression in family members in contrast with results after 3 months. Family members’ psychological symptoms may have eased over time as patients recovered. Death caused by COVID-19 was not associated with a higher risk of family members developing complicated grief, contrary to expectations.

Annotation

The finding:
This is a prospective cohort study of family members of patients hospitalized in 23 ICUs in France with a primary diagnosis of ARDs due to COVID-19 versus other causes. Family members were assessed for PTSD-related symptoms, anxiety, depression, and complex grief at 3 and 12 months after hospitalization. Results suggest no significant difference in prevalence of these factors between family members of patients with COVID-19 ARDs and those with non-COVID-19 ARDs at 12 months.

Strength and weaknesses:
The study includes a large sample size (602 family members), prospective design, assessment of multiple psychiatric outcomes, and two assessment time points over one year. Generalizability may be limited to France, and there is a possible lack of power due to loss of follow up at 12 months. Additionally, there is a lack of information regarding family members’ mental health interventions throughout the study period.

Relevance:
The study suggests that family members of patients with COVID-19 ARDS may not be at increased risk for developing long-term mental health concerns compared to family members of patients with other causes of ARDS. Current standard of care interventions for family members of patients with non-COVID-19 ARDS may not require modifications for COVID-19 related ARDS in a family member.

PUBLICATION #3 — Critical care

Post-intensive care syndrome (PICS): recent updates.

Stephanie L Hiser, Arooj Fatima, Mazin Ali, Dale M Needham.

Abstract: J Intensive Care. 2023 May 23;11(1):23. doi: 10.1186/s40560-023-00670-7.

An increasing number of patients are surviving critical illness, but some experience new or worsening long-lasting impairments in physical, cognitive and/or mental health, commonly known as post-intensive care syndrome (PICS). The need to better understand and improve PICS has resulted in a growing body of literature exploring its various facets. This narrative review will focus on recent studies evaluating various aspects of PICS, including co-occurrence of specific impairments, subtypes/phenotypes, risk factors/mechanisms, and interventions. In addition, we highlight new aspects of PICS, including long-term fatigue, pain, and unemployment.

Annotation

The authors searched PubMed for articles published in the last 5 years on PICS, evaluating included studies for PICS incidence, subtypes, risk factors, and interventions via narrative review. Findings include that PICS is common for ICU survivors, with up to 80% of patients experiencing at least one symptom at 12 months post-discharge. They identified four subtypes based on severity of impairment to physical and/or mental health status and broadened associated risk factors, including female sex and delirium. Early mobilization and physical rehabilitation appear to improve long term outcomes for ICU survivors. PICS is a growing consideration as the number of ICU survivors increases. This narrative review assists in remaining current on evolving understanding for the vulnerable ICU survivor population.

PUBLICATION #4 — Critical care

Delirium in the NICU.

Ariel Tarrell, Lisa Giles, Brian Smith, Chani Traube, Kevin Watt.

Abstract: J Perinatol. 2023 Sep 8. doi: 10.1038/s41372-023-01767-5. Online ahead of print.

Delirium in the NICU is an underrecognized phenomenon in infants who are often complex and critically ill. The current understanding of NICU delirium is developing and can be informed by adult and pediatric literature. The NICU population faces many potential risk factors for delirium, including young age, developmental delay, mechanical ventilation, severe illness, and surgery. There are no diagnostic tools specific to infants. The mainstay of delirium treatment is to treat the underlying cause, address modifiable risk factors, and supportive care. This review will summarise current knowledge and areas where more research is needed.

Annotation

Annotation (unstructured):
The review provides a comprehensive overview of the prevalence, risk factors, diagnosis, and management of delirium in infants admitted to the NICU. Risk factors include young age, developmental delay, invasive ventilation, and exposure to neuro-sedative drugs. Delirium is associated with higher mortality, longer time on mechanical ventilation, and increased hospitalization costs in children. There are unique non-pharmacologic and pharmacologic considerations with limited diagnostic tools for delirium in neonate populations.