Background: Investigating the health-related quality of life (HRQoL) after intensive care unit (ICU) discharge is necessary to identify possible modifiable risk factors. The primary aim of this study was to investigate the HRQoL in COVID-19 critically ill patients one year after ICU discharge. Methods: In this multicenter prospective observational study, COVID-19 patients admitted to nine ICUs from 1 March 2020 to 28 February 2021 in Italy were enrolled. One year after ICU discharge, patients were required to fill in short-form health survey 36 (SF-36) and impact of event-revised (IES-R) questionnaire. A multivariate linear or logistic regression analysis to search for factors associated with a lower HRQoL and post-traumatic stress disorded (PTSD) were carried out, respectively. Results: Among 1003 patients screened, 343 (median age 63 years [57–70]) were enrolled. Mechanical ventilation lasted for a median of 10 days [2–20]. Physical functioning (PF 85 [60–95]), physical role (PR 75 [0–100]), emotional role (RE 100 [33–100]), bodily pain (BP 77.5 [45–100]), social functioning (SF 75 [50–100]), general health (GH 55 [35–72]), vitality (VT 55 [40–70]), mental health (MH 68 [52–84]) and health change (HC 50 [25–75]) describe the SF-36 items. A median physical component summary (PCS) and mental component summary (MCS) scores were 45.9 (36.5–53.5) and 51.7 (48.8–54.3), respectively, considering 50 as the normal value of the healthy general population. In all, 109 patients (31.8%) tested positive for post-traumatic stress disorder, also reporting a significantly worse HRQoL in all SF-36 domains. The female gender, history of cardiovascular disease, liver disease and length of hospital stay negatively affected the HRQoL. Weight at follow-up was a risk factor for PTSD (OR 1.02, p = 0.03). Conclusions: The HRQoL in COVID-19 ARDS (C-ARDS) patients was reduced regarding the PCS, while the median MCS value was slightly above normal. Some risk factors for a lower HRQoL have been identified, the presence of PTSD is one of them. Further research is warranted to better identify the possible factors affecting the HRQoL in C-ARDS.

Purpose: To assess the prevalence of symptoms of Post-Traumatic Stress Disorder (PTSD) in survivors of COVID-19 Acute Respiratory Distress Syndrome that needed ICU care; to investigate risk factors and their impact on the Health-Related Quality of life (HR-QoL). Materials and Methods: This multicenter, prospective, observational study included all patients who were discharged from the ICU. Patients were administered the European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L) questionnaire, the Short-Form Health Survey 36Version 2 (SF-36v2), a socioeconomic question set and the Impact of Event Scale—Revised (IES-R) to assess PTSD. Results: The multivariate logistic regression model found that an International Standard Classification of Education Score (ISCED) higher than 2 (OR 3.42 (95% CI 1.28–9.85)), monthly income less than EUR 1500 (OR 0.36 (95% CI 0.13–0.97)), and more than two comorbidities (OR 4.62 (95% CI 1.33–16.88)) are risk factors for developing PTSD symptoms. Patients with PTSD symptoms are more likely to present a worsening in their quality of life as assessed by EQ-5D-5L and SF-36 scales. Conclusion: The main factors associated with the development of PTSD-related symptoms were a higher education level, a lower monthly income, and more than two comorbidities. Patients who developed symptoms of PTSD reported a significantly lower Health-Related Quality of life as compared to patients without PTSD. Future research areas should be oriented toward recognizing potential psychosocial and psychopathological variables capable of influencing the quality of life of patients discharged from the intensive care unit to better recognize the prognosis and longtime effects of diseases.

Purpose: Assess long-term quality of life (HR-QoL) and socio-economic impact in COVID-19-related ARDS (C-ARDS) survivors.Methods: C-ARDS survivors were followed up at 6 months in this prospective, cohort study. HR-QoL was assessed using SF-36 and EQ-5D-5L, and the socio-economic burden of COVID-19 was evaluated with a dedicated questionnaire. Clinical data were prospectively recorded.Results: Seventy-nine survivors, age 63 [57-71], 84% male, were enrolled. The frequency of EQ-5D-5L reported problems was significantly higher among survivors compared to normal, in mobility, usual activities, and self-care; anxiety and depression and pain were not different. SF-36 scores were lower than the reference population, and physical and mental summary scores were below normal in 52% and 33% of the subjects, respectively. In the multivariable analysis, prolonged hospital length of stay (OR1.45;p0.02) and two or more comorbidities on admission (OR7.42;p0.002) were significant predictors of impaired “physical” and “mental” HR-QoL, respectively. A total of 38% subjects worsened social relations, 42% changed their employment status, and 23% required personal care support.Conclusions: C-ARDS survivors have long-term impairment in HR-QoL and socio-economic problems. Prolonged hospital stay and previous comorbidities are risk factors for developing health-related issues.

Some patients with moderate to severe traumatic brain injury (TBI) make a full recovery, while others remain severely disabled. Accurate prognostication is important, because withdrawal of life-sustaining therapy based on perceived poor prognosis is the leading cause of death after TBI. Synchronized activity between brain regions, measurable with resting-state functional MRI (rs-fMRI), may underlie neurological recovery. However, which functional connections are critical for recovery, and whether functional connectivity measured shortly after brain injury predicts long-term recovery, is unknown. Here, we analyzed data from three prospective cohorts of patients with moderate or severe TBI (N = 116 patients; 134 controls) who underwent rs-fMRI shortly after injury. The strongest predictor of 6-mo functional outcomes in the Training Cohort (mean cross validation AUC 0.94) and independent Testing Cohort (AUC 0.78; P = 0.001) was functional connectivity between three pairs of brain regions from functionally distinct networks, two of which were anticorrelated. Results were robust to controlling for sedation ( P = 0.02) and level of consciousness at time of MRI ( P = 0.02). Finally, preserved anticorrelations improved the leave-one-out outcome prediction accuracy of an established prognostic score (AUC 0.90 vs. 0.80; P = 0.02). Preserved functional anticorrelations in acutely traumatized brains identify patients with the neurological substrate required for recovery. This biomarker can inform prognostic decisions in patients at high risk for death from withdrawal of life-sustaining therapy.

Purpose: Secondary brain injury is a common cause of poor outcome after trauma, subarachnoid hemorrhage, and intracerebral hemorrhage, and optimizing treatment requires real-time insight into cerebral metabolism. Cerebral microdialysis (CMD) uniquely provides key related information, yet consensus on its use has not been updated since publication of the consensus statement from the 2014 International Microdialysis Forum. We aimed to assess expert consensus on the use of CMD in critical care and provide contemporary guidance to standardize practice and advance clinical implementation. Methods: We conducted a 3-round modified Delphi study with international experts in CMD and neurocritical care. Consensus was defined as ≥ 75% agreement among non-abstaining respondents, with a minimum of 30 non-abstaining respondents required per statement. Statements not reaching consensus were iteratively revised based on panelist feedback. Results: Forty of 67 invited experts (60%) from 9 countries participated. Sixty of 62 individual items achieved consensus (97%) across 9 domains: indications and patient selection, technical and procedural considerations, detecting deterioration and secondary injury, metabolic interpretation, treatment algorithms, glucose management, sampling frequency, core reporting items, and barriers to clinical implementation. Conclusion: This consensus statement provides updated, evidence-informed recommendations for the use of CMD in critical care. The panel reaffirmed many core recommendations from the 2014 consensus while making targeted advances: cautious extension of guidance to intracerebral hemorrhage, comprehensive reporting guidance addressing frequently omitted elements (19 items vs. 6 in 2014), and identification of 10 key barriers to routine clinical adoption.

IntroductionLimited evidence exists on the health-related quality of life and the socio-economic impact of disease in critically-ill, COVID-19 survivors. Aims of this study were to: assess the quality of life of survivors after ICU discharge; identify social and disease-related risk factors for long-term health consequences; recognize changes in relational, work and economic skills.MethodsCritically ill ARDS survivors were followed up 6 months after ICU discharge. Quality of life was assessed using validated tools (SF-36 and EuroQol EQ-5D-5L), and the socio-economic burden of COVID-19 was evaluated with a specifically-translated questionnaire. Independent sample analysis and regression analysis were performed to evaluate the associations between the evaluated factor and the quality of life.Results79 survivors were enrolled (age 63 [57-71], 84% male). 38.4% report worsened social relations after ICU discharge; 15.4% required health support, 42% had a change in their employment status and 18% had an income reduction. The average physical and mental SF-36 summary scores were 43.6 [34.4-50.2] and 52.1 [44.5-57.0]. The average EQ VAS quality of life score was 80 [60-89]. Reduced quality of life was found in patients with more than one comorbidity, decreased PaO₂/FiO₂ (≤ 150) and increased SAPS II score (>25) on ICU admission, and prolonged hospital length of stay (LOS) > 4 weeks. The univariate analysis identified hospital LOS, SAPS II, age and two or more comorbidities as factors associated with reduced quality of life.ConclusionsCOVID-19 survivors have a reduced quality of life, due to an impaired physical and cognitive functioning, while anxiety and depression are less frequent. A significant proportion of patients report worsened social relations, employment changes and income reduction, and require health and financial support. People with previous comorbidities, most severe respiratory failure and prolonged hospital and ICU stay are at higher risk of health-related problems, while the level of education and the premorbid income have no impact in this cohort.