Longitudinal recovery trajectories and ventilatory modalities in COVID-19 acute respiratory distress syndrome survivors.

Summary

In a 52-ICU prospective cohort of 1,854 severe COVID-19 survivors, late intubation was associated with significantly worse percentage-predicted pulmonary function during follow-up, and patients managed with noninvasive mechanical ventilation (NIMV) showed slower lung recovery. Modalities were distributed as HFNC 19.4%, NIMV 15.6%, and IMV 64.9% (early IMV 966 vs late IMV 238).

Key Findings

• Among 1,854 ICU patients, HFNC, NIMV, and IMV were used in 19.4%, 15.6%, and 64.9%, respectively.
• Late intubation (n=238) was associated with significantly worse percentage-predicted pulmonary function during follow-up compared with early intubation (n=966).
• Patients initially treated with NIMV exhibited slower lung recovery over time.

Clinical Implications

Consider avoiding delayed intubation in decompensating COVID-19 ARDS and exercise caution with prolonged NIMV when lung recovery is a priority. Plan structured pulmonary follow-up (e.g., DLCO) at 3–12 months.

Limitations

• Observational design with potential confounding by indication for ventilatory modality and intubation timing
• Study period limited to early pandemic waves; practice patterns and variants may have evolved

Future Directions

Pragmatic trials and causal inference analyses on intubation timing; standardized NIMV protocols with early failure criteria; integration of pulmonary rehabilitation pathways and biomarker-guided recovery.