Neuroleptics used in critical COVID associated with moderate-severe dyspnea after hospital discharge.

Summary

In a prospective cohort of 100 severe COVID-19 survivors, limiting dyspnea (mMRC >1) affected 57% at 1 month and 34% at 12 months. The total inpatient neuroleptic dose and baseline comorbidities independently predicted 1-month dyspnea; dyspnea at 1 month predicted persistence at 12 months, which correlated with worse mental health, frailty, and quality of life.

Key Findings

• Limiting dyspnea (mMRC >1) occurred in 56.6% at 1 month and 33.9% at 12 months post-discharge.
• Total inpatient neuroleptic dose and pre-existing comorbidities independently predicted 1-month dyspnea.
• Dyspnea at 1 month predicted persistent dyspnea at 12 months, associated with higher depression, anxiety, frailty, and lower quality of life.

Clinical Implications

Minimize neuroleptic exposure when feasible in critically ill COVID-19 patients; screen those with early dyspnea for targeted rehabilitation and mental health support.

Limitations

• Single-center study with modest sample size and 37% loss to 12-month follow-up
• Potential confounding by indication regarding neuroleptic use

Future Directions

Interventional studies to reduce neuroleptic exposure in ICU and randomized rehabilitation strategies for patients with early post-discharge dyspnea.