Patients´ Mental and Physical Health After Being Treated for Covid-19 in an Intensive Care Unit in Sweden, a National Register Study

Introduction During 2020, an infection disease caused by the new coronavirus Sars-Cov2, Covid-19 were globally spread in the world. Covid-19 caused extensive consequences to the society, economy, and health care. In some of the patients the symptoms progressed to a life-threatening respiratory failure whit a need for intensive care. The intensive care was complicated then the progress of the disease was not followed the usual care for patients with difficult respiratory disease. Many of the patients with Covid-19 required deeper sedation with high-doses of anaesthesia and muscle relaxants and long time in ventilator. This is not in line with the current evidence regarding ventilator treatment and sedation in intensive care and for considered to constitute risk-factors for intensive care related residuals symptoms and worsened long-time results as well as increased mortality. In addition, the hospitals had restrictions regarding visitors and the relatives were not allowed to visit patients at the Intensive Care Unit (ICU). The presence of relatives is estimated in intensive care patients as one of the most important factors contributing to their recovery.

Today we know that intensive care patients had a risk to get physical, mental, and cognitive problems long time after hospital discharge. Other common residual problems as anxiety, depression, and post-traumatic stress (PTSD) can also occurred after intensive care. However, there are an increased risk that ICU patients with Covid-19 experience physical, and mental problems and decreased health related quality of life (HRQoL), then the environment at ICU during the Covid-19 pandemic, could predispose for cognitive failure and PTSD. The knowledge about this is limited. Today, data indicate that fatigue and dyspnoea are common residual symptoms which affect the HRQoL in multiple dimensions long time after hospital discharge.

Since 2005 the Swedish Intensive Care Registry (SIR) recommend to follow-up former ICU patients HRQoL (RAND-36), BMI, ADL and working capacity. We have now a unique chance to describe how patients taken care for Covid-19 in ICU experience their HRQoL with physical, mental, and cognitive problems compared to patients who were cared for in ICU for reasons other than Covid-19, and if they changed over time in relation to changed treatment conditions. It is important to map which risk factors that affect patients HRQoL. International studies show that factors important to HRQoL after intensive care are: age, comorbidity, the severity of the illness, length of stay, diagnose, PTSD, and symptoms of depression. It is likely that other factors also play a decisive role, such as socioeconomics factors. The purpose of this study is to deepen the analyse and identify other factors that are important for the patients HRQoL.

Aim The aim is to increase the knowledge about adult patient's whit Covid-19 taken care of at ICUs in Sweden estimate their HRQoL during the first year after ICU discharge and compare their HRQoL with patients taken care at ICU for other reasons than Covid-19 and which risk-factors affect the HRQoL and if there are any discrepancy between the groups.

Research-questions Are there differences in self-estimated HRQoL between patients care for Covid-19 and patients cared for other reasons at ICU, at 3, 6 and 12 months after ICU discharge? Method Design: National quality register study. Participants/sample size: All adult patients ≥18 year who have been treated at ICUs in Sweden and have a registered follow-up in SIR. (Covid-19 and non-Covid-19).