Intolerância ao exercício em pacientes pós-hospitalização por Covid-19
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Data
2023-09-29
Autores
Lima, Mariana Lafetá [UNIFESP]
Orientadores
Campos, Eloara Vieira Machado Ferreira Alvares da Silva [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
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Resumo
Sobreviventes após hospitalização por lesão pulmonar por Covid-19 podem persistir com dispneia e intolerância ao exercício com menor qualidade de vida. Apesar de recentes avanços, os possíveis preditores de intolerância ao exercício nos pacientes pós-Covid-19 permanecem complexos e não totalmente caracterizados. Objetivos: Avaliar a persistência da intolerância avaliada pelo consumo do oxigênio no pico do exercício (V’O2PICO) em sobreviventes pós-hospitalização por Covid-19 e a correlação com gravidade da internação e alteração em exames funcionais e imagéticos. Materiais e Métodos: Estudo prospectivo e observacional que avaliou consecutivamente pacientes previamente hospitalizados por Covid-19 moderada a grave/crítica. A avaliação foi realizada após 90 ± 10 dias do início dos sintomas agudos da Covid-19 e os pacientes foram submetidos à avaliação cardiopulmonar ampla, incluindo função pulmonar, ecocardiograma, tomografia de tórax e teste de exercício cardiopulmonar com gasometria capilar de sangue arterializado do lóbulo de orelha. Resultados: Dos 87 pacientes avaliados, o V’O2PICO foi de 19,5 ± 5,0 ml/kg/min dividido em três grupos por tercis: ≤ 17,0, 17,1-22,2 e ≥ 22,3 ml/kg/min. A gravidade da hospitalização foi semelhante nos três grupos. No entanto, na consulta de seguimento, pacientes com V’O2PICO ≤ 17,0 ml/kg/min relataram maior sensação de dispneia e apresentaram índices de função pulmonar reduzidos e respostas ventilatórias, gasosas e metabólicas anormais durante o exercício em comparação com pacientes com V’O2PICO > 17,0 ml/kg/min. Por meio da análise de regressão logística multivariada ajustada para idade, sexo e embolia pulmonar, com pontos de corte definidos pela análise da curva ROC, a relação espaço morto por volume corrente ≥ 29 e a capacidade vital forçada em repouso ≤ 80% previsto foram preditores independentes da redução do V’O2PICO. Conclusão: A intolerância ao exercício nos sobreviventes após hospitalização por Covid-19 esteve relacionada à alta relação espaço morto como fração do volume corrente no pico do exercício e redução da capacidade vital forçada em repouso, sugerindo que tanto o possível comprometimento da microcirculação pulmonar quanto o ventilatório podem influenciar a capacidade aeróbia nessa população de pacientes.
Post-Covid-19 survivors frequently have dyspnea that can lead to exercise intolerance and lower quality of life. Despite recent advances, possible predictors of exercise intolerance in the post-Covid-19 patients remain complex and not fully characterized. Objectives: To evaluate the persistence of exercise intolerance analyzed by peak oxygen consumption (PEAKV’O2) in post-Covid-19 survivors after hospitalization and its correlation with the severity of hospitalization and the changes in functional and imaging tests. Materials and Methods: Prospective study evaluated consecutive patients previously hospitalized due to moderate-to-severe/critical Covid-19. Within 90±10 days of Covid-19 acute symptoms onset, patients underwent a comprehensive cardiopulmonary assessment, including a cardiopulmonary exercise testing with earlobe arterialized capillary blood gas analysis. Measurements and Main Results: Eighty-seven patients were evaluated, their peak oxygen consumption was 19.5 ± 5.0 ml/kg/min, and the tertiles were: ≤ 17.0, 17.1-22.2 and ≥ 22.3 ml/kg/min. Hospitalization severity was similar among the three groups. However, at the follow-up visit, patients with PEAKV’O2 ≤ 17.0 ml/kg/min reported a greater sensation of dyspnea, along with indices of impaired pulmonary function, and abnormal ventilatory, gas-exchange and metabolic responses during exercise compared to patients with PEAKV’O2 > 17 ml/kg/min. By multivariate logistic regression analysis (ROC curve analysis) adjusted for age, sex and pulmonary embolism, a peak dead space fraction of tidal volume ≥ 29 and a resting forced vital capacity ≤ 80% predicted were independent predictors of reduced peak oxygen consumption. Conclusions: Exercise intolerance in the post-Covid-19 survivors was related to a high dead space fraction of tidal volume at peak exercise and a decreased resting forced vital capacity, suggesting that both pulmonary microcirculation injury and ventilatory impairment could influence aerobic capacity in this patient population.
Post-Covid-19 survivors frequently have dyspnea that can lead to exercise intolerance and lower quality of life. Despite recent advances, possible predictors of exercise intolerance in the post-Covid-19 patients remain complex and not fully characterized. Objectives: To evaluate the persistence of exercise intolerance analyzed by peak oxygen consumption (PEAKV’O2) in post-Covid-19 survivors after hospitalization and its correlation with the severity of hospitalization and the changes in functional and imaging tests. Materials and Methods: Prospective study evaluated consecutive patients previously hospitalized due to moderate-to-severe/critical Covid-19. Within 90±10 days of Covid-19 acute symptoms onset, patients underwent a comprehensive cardiopulmonary assessment, including a cardiopulmonary exercise testing with earlobe arterialized capillary blood gas analysis. Measurements and Main Results: Eighty-seven patients were evaluated, their peak oxygen consumption was 19.5 ± 5.0 ml/kg/min, and the tertiles were: ≤ 17.0, 17.1-22.2 and ≥ 22.3 ml/kg/min. Hospitalization severity was similar among the three groups. However, at the follow-up visit, patients with PEAKV’O2 ≤ 17.0 ml/kg/min reported a greater sensation of dyspnea, along with indices of impaired pulmonary function, and abnormal ventilatory, gas-exchange and metabolic responses during exercise compared to patients with PEAKV’O2 > 17 ml/kg/min. By multivariate logistic regression analysis (ROC curve analysis) adjusted for age, sex and pulmonary embolism, a peak dead space fraction of tidal volume ≥ 29 and a resting forced vital capacity ≤ 80% predicted were independent predictors of reduced peak oxygen consumption. Conclusions: Exercise intolerance in the post-Covid-19 survivors was related to a high dead space fraction of tidal volume at peak exercise and a decreased resting forced vital capacity, suggesting that both pulmonary microcirculation injury and ventilatory impairment could influence aerobic capacity in this patient population.
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Citação
LAFETA, Mariana Lima. Intolerância ao exercício em pacientes pós-hospitalização por Covid-19. 2023. 131 f. Tese (Doutorado em Pneumologia) - Escola Paulista de Medicina, Universidade de São Paulo (UNIFESP), São Paulo, 2023.