Long-term impact of COVID-19 requiring elevated oxygen support and safety of prolonged positive pressure ventilation

In this study, we analyzed long-term sequelae in patients hospitalized at Montichiari Hospital (Brescia, Italy) during the COVID-19 acute phase, who needed a high-flow oxygen treatment. The follow-up evaluation has been performed after more than one year from discharge through a quality-of-life phone interview, standard laboratory tests, chest computed tomography, and global spirometry with an evaluation of the diffusing capacity of the lungs for carbon monoxide (DLCO). In our analysis, we found that patients who needed high FiO2 support during the acute phase, independently from the device used to administer it, showed a long-term heavy burden of pulmonary consequences: more than half of patients presented radiological alterations and persistent dyspnea or DLCO alterations; about 17% of them had alterations compatible with pulmonary fibrosis. Further analysis included a comparison of long-term consequences in patients treated with different devices. An interesting result was that prolonged positive pressure ventilation treatment didn’t seem to cause persistent pulmonary damage and thus could be considered a safe approach. In conclusion, this study confirms the heavy quality-of-life impact of moderate to severe COVID-19 and highlights the importance of recognizing patients who will benefit from rehabilitative programs and customized follow-up depending on the acute phase disease severity.