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Long-Term Morbidity Associated With Non-COVID-19 Pneumonia in Patients Receiving Mechanical Ventilation
Alexander T Clark1, Clark I Strunk1, Matthew W Semler1
1Department of Emergency Medicine (A. T. C., C. I. S., S. D., W. H. S., and J. H. H.), Vanderbilt University Medical Center, Tennessee Valley Healthcare System; the Division of Allergy, Pulmonary, and Critical Care Medicine (M. W. S., J. D. C., J. C. J., E. W. E., A. L. K., P. T. B., and A. L.), the Vanderbilt Institute for Clinical and Translational Research (M. W. S., J. D. C., and W. H. S.), Vanderbilt University Medical Center; the Department of Biostatistics (C. A. J., G. W., and R. R.), the Critical Illness, Brain Dysfunction, and Survivorship Center (J. C. J., E. W. E., A. L. K., P. T. B., A. L., and J. H. H.), the Department of Anesthesiology (R. E. F.), Vanderbilt University Medical Center; and the Geriatric Research, Education, and Clinical Center (J. C. J., E. W. E., and J. H. H.), Tennessee Valley Healthcare System, Nashville, TN.
Background:
The COVID-19 pandemic highlighted the impact of acute respiratory illnesses on long-term morbidity. However, the long-term morbidity associated with non-COVID-19 pneumonia is unclear, particularly in patients who are receiving mechanical ventilation.
Research Question:
What is the burden of 12-month long-term cognitive impairment (LTCI), functional impairment, psychological distress, and quality of life in critically ill patients receiving mechanical ventilation for non-COVID-19 pneumonia?
Study Design And Methods:
This single-site prospective cohort study enrolled patients with non-COVID-19 pneumonia receiving mechanical ventilation in the emergency department and ICUs from June 18, 2018, through August 30, 2021. Global cognition at 12 months was measured by the Montreal Cognitive Assessment for the Blind, with higher scores representing better cognition. Secondary outcomes were basic and instrumental activities of daily living (ADLs), physical function, psychological distress (posttraumatic stress disorder [PTSD], depression, and anxiety), and quality of life.
Results:
Of 408 patients with non-COVID-19 pneumonia (63.4%), 96 patients survived and completed the 12-month follow-up. Among survivors of non-COVID-19 pneumonia, 57.3% met the criteria for LTCI, 13.5% showed executive dysfunction, 17.7% showed impairments in at least 1 basic ADL, 51.0% showed impairments in at least 1 instrumental ADL, 44.0% demonstrated physical disability, 17.8% met the criteria for PTSD, 37.8% met the criteria for depression, 46.7% met the criteria for anxiety, and 19.4% rated their quality of life as poor at 12 months.
Interpretation:
A substantial proportion of patients with non-COVID-19 pneumonia receiving mechanical ventilation met criteria for LTCI. Additionally, many demonstrated difficulty performing ADLs, showed physical disability, and experienced psychological sequelae, leading to poor quality of life at 12 months. Interventions designed to reduce these adverse outcomes are needed.
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