Surviving Critical COVID-19: How Functionality, Physical, Mental and Cognitive Outcomes Evolve?

Ana Teixeira-Vaz ,José Afonso Rocha, Mafalda Oliveira, Tiago Simões-Moreira, David Almeida e Reis, Ana Isabel Silva, José Artur Paiva


To analyze the long-term consequences of critical COVID-19, regarding physical, mental, cognitive and functional impairments, and to describe its evolution through time.


The primary aim of this study was to describe the long-term consequences of critical COVID-19, regarding physical, mental, cognitive and functional impairments, as well as its evolution through time. As a secondary goal, we intended to characterize PRM intervention in this subset of patients.

Materials and Methods

Prospective cohort study with consecutive inclusion of patients admitted to one of four ICU of an Intensive Care Department in a tertiary-care center, between May/2020 and September/2021.Inclusion criteria were age ≥ 18 years old and ICU admission diagnosis of acute respiratory distress syndrome (ARDS) due to SARS-CoV-2, requiring invasive mechanical ventilation (IMV) for ≥ 48 hours (h). Patients who died during ICU stay were excluded.

After hospital discharge, all patients were reached by telephone and asked to attend a specific post-COVID-19 PRM outpatient appointment. When it was not possible to contact the patients through a single telephonic contact, five more attempts, in different days and at different day hours (from 10am to 5pm, on weekdays) were performed. First PRM appointment was scheduled at six months after ICU discharge. A re-evaluation visit was performed at 12 months after ICU discharge. If any of the appointments were missed, the patient was given two opportunities to reschedule in a one-month period.


In the included sample, 66.7% were males with a mean age of 62 years old (standard deviation (SD) = 13.5). All patients were previously independent on ADL. Obesity (57.1%), hypertension (54.8%), and hyperlipidemia (45.2%) were the comorbidities more frequently identified.

The mean SAPS II score was 40.7 (SD = 15.3), with 73.8% (n = 31) of patients scoring over 30 points at ICU admission. Moreover, the median of ICU stay was 31.5 days (interquartile range (IQR) = 15.5–51.3) and the median number of days under IMV was 25 (IQR = 10.0–43.0). During ICU stay, several complications were registered, namely neurological (54.8%), cardiovascular (14.3%), abdominal 


Our study revealed that critical COVID-19 survivors present substantial physical, mental and cognitive impairments 6 and 12 months after ICU discharge, and that these impairments seem to improve through time. Nevertheless, 1 year after ICU discharge, significant disablements in muscle strength, gait ability, balance, psycho-emotional status and cognitive performance persisted. Approximately half of these survivors were fully independent on ADL 6 months after ICU discharge, value that improved by approximately 20% on the subsequent 6 months.


Critical COVID-19 survivors present significative physical, mental and cognitive impairments 6 and 12 months after ICU discharge, despite their positive evolution through time. Accordingly, at least during the first-year post ICU discharge, but probably for a longer period, COVID-19 patients benefit from PRM evaluations and interventions, since clinical and functional impairments persist.

Citation: Teixeira-Vaz A, Rocha JA, Oliveira M, Simões-Moreira T, Reis DAe, Silva AI, et al. (2023) Surviving critical COVID-19: How functionality, physical, mental and cognitive outcomes evolve? PLoS ONE 18(6): e0284597.

Editor: Patricia Rezende do Prado, Federal University of Acre (UFAC), BRAZIL

Received: January 25, 2023; Accepted: April 3, 2023; Published: June 23, 2023

Copyright: © 2023 Teixeira-Vaz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.


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