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Introduction: Despite improved management of patients with COVID-19, we still ignore whether pharmacologic treatments and improved respiratory support have modified outcomes for intensive care unit (ICU) surviving patients of the three first consecutive waves (w) of the pandemic. The aim of this study was to evaluate whether developments in the management of ICU COVID-19 patients have positively impacted respiratory functional outcomes, quality of life (QoL), and chest CT scan patterns in ICU COVID-19 surviving patients at 3 months, according to pandemic waves. Methods: We prospectively included all patients admitted to the ICU of two university hospitals with acute respiratory distress syndrome (ARDS) related to COVID-19. Data related to hospitalization (disease severity, complications), demographics, and medical history were collected. Patients were assessed 3 months post-ICU discharge using a 6 min walking distance test (6MWT), a pulmonary function test (PFT), a respiratory muscle strength (RMS) test, a chest CT scan, and a Short Form 36 (SF-36) questionnaire. Results: We included 84 ARDS COVID-19 surviving patients. Disease severity, complications, demographics, and comorbidities were similar between groups, but there were more women in wave 3 (w3). Length of stay at the hospital was shorter during w3 vs. during wave 1 (w1) (23.4 ± 14.2 days vs. 34.7 ± 20.8 days, p = 0.0304). Fewer patients required mechanical ventilation (MV) during the second wave (w2) vs. during w1 (33.3% vs. 63.9%, p = 0.0038). Assessment at 3 months after ICU discharge revealed that PFTs and 6MWTs scores were worse for w3 > w2 > w1. QoL (SF-36) deteriorated (vitality and mental health) more for patients in w1 vs. in w3 (64.7 ± 16.3 vs. 49.2 ± 23.2, p = 0.0169). Mechanical ventilation was associated with reduced forced expiratory volume (FEV1), total lung capacity (TLC), diffusing capacity for carbon monoxide (DLCO), and respiratory muscle strength (RMS) (w1,2,3, p < 0.0500) on linear/logistic regression analysis. The use of glucocorticoids, as well as tocilizumab, was associated with improvements in the number of affected segments in chest CT, FEV1, TLC, and DLCO (p < 0.01). Conclusions: With better understanding and management of COVID-19, there was an improvement in PFT, 6MWT, and RMS in ICU survivors 3 months after ICU discharge, regardless of the pandemic wave during which they were hospitalized. However, immunomodulation and improved best practices for the management of COVID-19 do not appear to be sufficient to prevent significant morbidity in critically ill patients.

Introduction Despite improvements in the management of COVID-19 patients, we still don’t know whether pharmacological treatments and improvements in ventilatory support have changed outcomes for intensive care unit (ICU) survivors of the three consecutive waves (w) of the pandemic. The objective of this study was to assess pulmonary functional outcomes, radiologic pattern, and quality of life (QoL) in ICU COVID-19 survivors at 3 months, according to pandemic wave. Methods All patients admitted to the ICU for COVID-19 acute respiratory distress syndrome (ARDS) at two university hospitals were prospectively included and assessed 3 months post-ICU discharge by chest CT, pulmonary function test (PFT), 6-minute walking distance test (6MWDT), respiratory muscle strength (RMS) test, and Short Form 36 (SF-36) questionnaire. Results Eighty-four ARDS COVID-19 survivors were included. Hospital length of stay was shorter during w3 vs w1 (23.4 ± 14.2 days vs 34.7 ± 20.8 days, p = 0.03). Fewer patients required mechanical ventilation (MV) during w2 vs w1 (33.3% vs 63.9%, p = 0.0038). Three months after ICU discharge, PFT, 6MWDT, and RMS were similar, regardless of wave (p > 0.05). QoL (SF-36) was worse for patients in w1 vs w3 (64.7 ± 16.3 vs 49.2 ± 23.2, p = 0.0169). On linear/logistic regression analysis, MV was associated with decreased TLC, FEV1, DLCO, and RMS (w1,2,3, p