Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19: A 3-Month Prospective Cohort

Chest. 2021 Jul;160(1):187-198. doi: 10.1016/j.chest.2021.02.062. Epub 2021 Mar 4.


Background: More than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear.

Research question: What are the major long-term pulmonary sequelae in critical patients who survive COVID-19?

Study design and methods: Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging.

Results: One hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay.

Interpretation: Three months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.

Keywords: COVID-19; CT abnormalities; ICU; SARS; SARS-CoV-2; lung function; sequelae.

Publication types

  • Observational Study

MeSH terms

  • Aftercare / methods
  • Aftercare / statistics & numerical data
  • COVID-19* / complications
  • COVID-19* / epidemiology
  • COVID-19* / therapy
  • Female
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Long Term Adverse Effects* / diagnosis
  • Long Term Adverse Effects* / epidemiology
  • Long Term Adverse Effects* / etiology
  • Long Term Adverse Effects* / psychology
  • Lung / diagnostic imaging*
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Discharge / statistics & numerical data
  • Prevalence
  • Quality of Life*
  • Respiratory Function Tests / methods*
  • SARS-CoV-2
  • Spain / epidemiology
  • Survivors* / psychology
  • Survivors* / statistics & numerical data
  • Tomography, X-Ray Computed / methods*
  • Walk Test / methods
  • Walk Test / statistics & numerical data