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Published on: July 18, 2025
One-Year Multidisciplinary Follow-Up of Patients With COVID-19 Requiring Invasive Mechanical Ventilation
Alberto Zangrillo1, Alessandro Belletti2, Diego Palumbo3
1Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Insights
One year after hospital discharge, COVID-19 ARDS patients on mechanical ventilation showed good survival and functional recovery. Most survivors experienced no dyspnea and had improved quality of life, with minimal long-term lung damage.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Infectious Diseases
Background:
- COVID-19 frequently causes acute respiratory distress syndrome (ARDS), necessitating intensive care unit (ICU) admission and invasive mechanical ventilation (IMV).
- Long-term outcomes for patients surviving severe COVID-19 ARDS remain incompletely understood.
Purpose of the Study:
- To evaluate 1-year survival rates.
- To assess quality of life and functional recovery in patients with COVID-19 ARDS who required IMV.
Main Methods:
- A prospective observational study was conducted at a tertiary-care university hospital.
- Adult patients with COVID-19 ARDS receiving IMV and discharged alive were followed up for 1 year.
- Assessments included validated questionnaires on functional, cognitive, and psychological status, with optional follow-up chest CT scans.
Main Results:
- Of 116 patients requiring IMV, 61 (52.6%) survived to discharge. All survivors were alive at 1 year.
- >80% reported good functional recovery and no difficulties with usual activities; 93% had no dyspnea at rest.
- Severe anxiety/depression affected 8.9% of patients. Significant improvements were noted in working status and exertional dyspnea from 2 months to 1 year. Only 4 patients showed fibrotic changes on CT scans.
Conclusions:
- Patients surviving severe COVID-19 ARDS requiring IMV demonstrate excellent 1-year survival.
- The majority experience substantial functional recovery and improved quality of life.
- Long-term pulmonary sequelae are uncommon, suggesting good recovery potential for survivors.
Objectives:
Patients with COVID-19 frequently develop acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) admission. Data on long-term survival of these patients are lacking. The authors investigated 1-year survival, quality of life, and functional recovery of patients with COVID-19 ARDS requiring invasive mechanical ventilation.
Design:
Prospective observational study.
Setting:
Tertiary-care university hospital.
Participants:
All patients with COVID-19 ARDS receiving invasive mechanical ventilation and discharged alive from hospital.
Interventions:
Patients were contacted by phone after 1 year. Functional, cognitive, and psychological outcomes were explored through a questionnaire and assessed using validated scales. Patients were offered the possibility to undergo a follow-up chest computed tomography (CT) scan.
Measurements And Main Results:
The study included all adult (age ≥18 years) patients with COVID-19-related ARDS admitted to an ICU of the authors' institution between February 25, 2020, and April 27, 2020, who received at least 1 day of invasive mechanical ventilation (IMV). Of 116 patients who received IMV, 61 (52.6%) survived to hospital discharge. These survivors were assessed 1 year after discharge and 56 completed a battery of tests of cognition, activities of daily living, and interaction with family members. They had overall good functional recovery, with >80% reporting good recovery and no difficulties in usual activities. A total of 52 (93%) of patients had no dyspnea at rest. Severe anxiety/depression was reported by 5 (8.9%) patients. Comparing 2-month and 1-year data, the authors observed the most significant improvements in the areas of working status and exertional dyspnea. One-year chest CT scans were available for 36 patients; fibrotic-like changes were present in 4 patients.
Conclusions:
All patients who survived the acute phase of COVID-19 and were discharged from the hospital were alive at the 1-year follow up, and the vast majority of them had good overall recovery and quality of life.
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