Journal Article Annotations
2023, 3rd Quarter
Annotations by Jon Sole, MD, MSc and O. Joseph Bienvenu, MD, PhD
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.
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.
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.
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.
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.
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.