The emotional impact caused by COVID-19 is worse in patients who weren’t hospitalized at ICU

The clinical profiles of the post-COVID syndrome, that is, of the sequelae left by this disease after suffering it, are different depending on whether the patients have required hospital admission, if they have been in the ICU or if they have had the disease at home .

According to the results of a study led by Dr. Rosa Güell, a researcher at the Research Institute of the Hospital de la Santa Creu i Sant Pau – IIB Sant Pau and an expert in pulmonary rehabilitation, the patients who presented a more severe disease, that is, those who needed to go through the Intensive Care Unit, have a greater loss of muscle strength -especially of the lungs- and their effort capacity is lower compared to less severe patients. On the other hand, patients who were not admitted to the ICU presented more emotional sequelae and anxiety.

“Surprisingly, we have found that non-admitted patients, and even those admitted to the hospital but nor at the ICU, are worse from an emotional point of view. In other words, they have much more anxiety and depression compared to those admitted to the ICU”, details Dr. Güell.

“We do not know the explanation. Our hypothesis is that ICU patients received a lot of support from the beginning: from the physical therapist, from the medical team, from the nursing staff. Everyone was very attentive to them. So, it is very likely that they have had the feeling of accompaniment, in addition to the psychological effect of having overcome something very serious. This fact may have helped them reduce anxiety while those who have been in the room or at home may have felt more alone”, adds Dr. Güell.

Retrospective study

The article, published in the prestigious journal PLoS One, retrospectively compares the different symptom patterns in relation to the severity of acute COVID-19 in patients seen in the Post-COVID Rehabilitation Unit of the Hospital de Sant Pau.

The researchers studied different measures of respiratory, muscular, cognitive, emotional, and health-related quality of life in three groups of post-COVID patients: those who had not required hospitalization for the acute illness, those who had been admitted to a general hospital, and those who had been admitted to the ICU.

Specifically, the data of 178 post-COVID patients (91 admitted to the ICU, 60 on the ward and 27 who had not required admission) on their first visit to the Post-COVID Rehabilitation Unit were analyzed. The most frequent symptoms in all groups were fatigue (78.2%) and dyspnea or respiratory distress (75.4%). Muscle strength and exercise capacity were lower than the ICU group. The mental component and the level of anxiety were worse in patients not admitted to the ICU. No differences were found between groups in respiratory pressure, but 30 of 57 patients with a decrease in peak inspiratory pressure had not required mechanical ventilation.

Dr. Güell explains that it’s common for patients to lose muscle strength after being treated with mechanical ventilation for any reason. However, in this case, it has been found that many patients with COVID-19 who had not required mechanical ventilation had respiratory muscle weakness. “This finding makes us think that, possibly, this effect is not only due to muscle rest that favors mechanical ventilation and that there is surely a direct effect of the virus on the lung muscles.”

Reference article

Perrot JC, Segura M, Beranuy M, Gich I, Nadal MJ, Pintor A, Terra J, Ramirez E, Paz LD, Bascuñana H, Plaza V, Güell-Rous MR. Comparison of post-COVID symptoms in patients with different severity profiles of the acute disease visited at a rehabilitation unit. PLoS One. 2022 Sep 16;17(9):e0274520. doi: 10.1371/journal.pone.0274520. PMID: 36112577; PMCID: PMC9481013.

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