Função pulmonar em sobreviventes pós-covid 19: uma revisão integrativa
Lung function in post-covid 19 survivors: an integrative review
Agnes Cristy de Mesquita, Adriana Ferreira London Mendes, Brenda Lee Silva Rocha, Andressa Lagoa Nascimento França
Resumo
Introdução: O Coronavírus é uma infecção viral sistêmica que causa lesão nas vias aéreas e têm amplo poder de transmissão. Devido à sua severa destruição do parênquima pulmonar faz-se necessário realizar acompanhamento ambulatorial e testes de função pulmonar através da espirometria, capacidade de difusão e volumes pulmonares para avaliar as possíveis alterações. Objetivo: Sintetizar as evidências científicas com relação aos efeitos deletérios na função pulmonar dos pacientes pós-covid 19. Métodos: Este estudo é uma revisão de literatura integrativa. Realizou-se a busca de artigos nas bases de dados no período de 2020 a 2022, incluídos nos idiomas portugues e inglês, e com pacientes maiores de 18 anos. Foram excluídos artigos duplicados, relatos de casos, revisão de literatura, estudos de reabilitação/tratamento e que não responderam à pergunta norteadora. Resultados: Foram encontrados por meio da estratégia de busca 548 artigos, sendo incluídos 23 estudos, com total de 4.421 participantes, e 2.834 realizaram os testes de função pulmonar. Houve predominância na avaliação pela espirometria, tendo como principais alterações a diminuição na capacidade de difusão do monóxido de carbono e padrão ventilatório restritivo. Conclusão: Os estudos incluídos apontam que pacientes sintomáticos apresentaram maiores alterações na função pulmonar em comparação com assintomáticos. Os principais déficits são as alterações ventilatórias restritivas e a redução da capacidade de difusão dos gases, sendo esta a que apresentou a maior sensibilidade para as disfunções pulmonares, no momento da alta hospitalar em até 12 meses.
Palavras-chave
Abstract
Background: Coronavirus is a systemic viral infection that affects the airways and has a high transmission potential. Due to its severe damage to the lung parenchyma, it is necessary to perform outpatient follow-up and lung function tests, including spirometry, diffusion capacity, and lung volumes, to assess possible changes. Aim: To synthesize the scientific evidence regarding the deleterious effects on lung function post-COVID-19. Methods: This study is an integrative literature review. A search was conducted for articles in databases from 2020 to 2022, including studies in Portuguese and English, and involving patients over 18 years old. Duplicate articles, case reports, literature reviews, rehabilitation/treatment studies, and those that did not answer the guiding question were excluded. Results: Through the search strategy, 548 articles were found, of which 23 studies were included, with a total of 4,421 participants, 2,834 of whom underwent pulmonary function tests. There was a predominance of spirometry evaluations, with the main alterations being a decrease in carbon monoxide diffusion capacity and a restrictive ventilatory pattern. Conclusion: The present studies reveal that symptomatic patients exhibited greater changes in lung function compared to asymptomatic patients. The main deficits were reduced diffusion capacity and restrictive ventilatory changes from hospital discharge up to 12 months. Diffusion capacity showed greater sensitivity for detecting pulmonary alterations.
DOI da versão traduzida: https://doi.org/10.47066/2966-4837.2024.0005en
Keywords
Referências
1. WHO: Word Health Organization. Weekly epidemiological update on COVID-19 [Internet]. 2022 [citado em 2022 Out 30]. Disponível em: https://www.who.int/publications/m/ item/weekly-epidemiological-update-on-covid-19---26- october-2022.
2. Mendes BS, Tessaro LM, Farinaci VM, Moreira VA, Sardenberg RAS. COVID-19 & SARS. Ulakes J Med. 2020;1:41-9.
3. Fabbri L, Moss S, Khan FA, Chi W, Xia J, Robinson K, et al. Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis. Thorax. 2023;78(2):191-201. http://doi. org/10.1136/thoraxjnl-2021-218275. PMid:35338102.
4. George PM, Barratt SL, Condliffe R, Desai SR, Devaraj A, Forrest I, et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax. 2020;75(11):1009-16. http:// doi.org/10.1136/thoraxjnl-2020-215314. PMid:32839287.
5. Sibila O, Molina-Molina M, Valenzuela C, Ríos-Cortés A, Arbillaga-Etxarri A, Torralba García Y, et al. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) consensus for post-COVID-19 clinical follow-up. Open Respir Arch. 2020;2(4):278-83. http://doi.org/10.1016/j. opresp.2020.09.002. PMid:38620714.
6. Araújo WCO. Recuperação da informação em saúde: construção, modelos e estratégias. Conci, Conv Ciênc Inform. 2018;3(2):100–134.
7. Galvão MC. Níveis de evidência. Acta paul enferm. 2006;19(2):v–vii
8. Ahmed H, Patel K, Greenwood D, Halpin S, Lewthwaite P, Salawu A, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: a systematic review and meta-analysis. J Rehabil Med. 2020;52(5):jrm00063. http:// doi.org/10.2340/16501977-2694. PMid:32449782.
9. Cortés-Telles A, López-Romero S, Figueroa-Hurtado E, Pou- Aguilar YN, Wong AW, Milne KM, et al. Pulmonary function and functional capacity in COVID-19 survivors with persistent dyspnoea. Respir Physiol Neurobiol. 2021;288:103644. http://doi.org/10.1016/j.resp.2021.103644. PMid:33647535.
10. Trinkmann F, Müller M, Reif A, Kahn N, Kreuter M, Trudzinski F, et al. Residual symptoms and lower lung function in patients recovering from SARS-CoV-2 infection. Eur Respir J. 2021;57(2):2003002. http://doi. org/10.1183/13993003.03002-2020. PMid:33479105.
11. Eroglu SE, Ademoglu E, Baslilar S, Aksel G, Eker A, Algın A, et al. Can 1st and 6th month pulmonary function test follow-ups give an idea about the long-term respiratory effects of COVID-19 pneumonia? Rev Assoc Med Bras. 2022;68(2):183-90. http://doi.org/10.1590/1806- 9282.20210890. PMid:35239879.
12. Lehmann A, Gysan M, Bernitzky D, Bal C, Prosch H, Zehetmayer S, et al. Comparison of pulmonary function test, diffusion capacity, blood gas analysis and CT scan in patients with and without persistent respiratory symptoms doi.org/10.1186/s12890-022-01987-z. PMid:35578190.
13. Albu S, Zozaya NR, Murillo N, García-Molina A, Chacón CAF, Kumru H. What’s going on following acute covid-19? Clinical characteristics of patients in an out-patient rehabilitation program. NeuroRehabilitation. 2021;48(4):469-80. http:// doi.org/10.3233/NRE-210025. PMid:33998551.
14. Shah AS, Wong AW, Hague CJ, Murphy DT, Johnston JC, Ryerson CJ, et al. A prospective study of 12-week respiratory outcomes in COVID-19-related hospitalisations. Thorax. 2021;76(4):402-4. http://doi.org/10.1136/ thoraxjnl-2020-216308. PMid:33273023.
15. González J, Benítez ID, Carmona P, Santisteve S, Monge A, Moncusí-Moix A, et al. Pulmonary function and radiologic features in survivors of critical COVID-19: a 3-month prospective cohort. Chest. 2021;160(1):187-98. http://doi. org/10.1016/j.chest.2021.02.062. PMid:33676998.
16. Huang L, Yao Q, Gu X, Wang Q, Ren L, Wang Y, et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021;398(10302):747-58. http://doi. org/10.1016/S0140-6736(21)01755-4. PMid:34454673.
17. Guler SA, Ebner L, Aubry-Beigelman C, Bridevaux PO, Brutsche M, Clarenbach C, et al. Pulmonary function and radiological features 4 months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study. Eur Respir J. 2021;57(4):2003690. http://doi. org/10.1183/13993003.03690-2020. PMid:33419891.
18. Bardakci MI, Ozturk EN, Ozkarafakili MA, Ozkurt H, Yanc U, Yildiz Sevgi D. Evaluation of long‐term radiological findings, pulmonary functions, and health‐related quality of life in survivors of severe COVID‐19. J Med Virol. 2021;93(9):5574- 81. http://doi.org/10.1002/jmv.27101. PMid:34032292.
19. Miwa M, Nakajima M, Kaszynski RH, Hamada S, Ando H, Nakano T, et al. Abnormal pulmonary function and imaging studies in critical COVID-19 survivors at 100 days after the onset of symptoms. Respir Investig. 2021;59(5):614-21. http://doi.org/10.1016/j.resinv.2021.05.005. PMid:34148855.
20. Mancuzo EV, Marinho CC, Machado-Coelho GLL, Batista AP, Oliveira JF, Andrade BH, et al. Lung function of patients hospitalized with COVID-19 at 45 days after hospital discharge: first report of a prospective multicenter study in Brazil. J Bras Pneumol. 2021;47(6):e20210162. http://doi. org/10.36416/1806-3756/e20210162. PMid:34932718.
21. Baldini M, Chiapella MN, Fernández A, Guardia S, Sala H. Evaluation of the pulmonary function of patients with severe coronavirus 2019 disease three months after diagnosis. Medicina (B Aires). 2021;81(5):715-21. PMid:34633943.
22. Stockley JA, Alhuthail EA, Coney AM, Parekh D, Geberhiwot T, Gautum N, et al. Lung function and breathing patterns in hospitalised COVID-19 survivors: a review of post-COVID-19 Clinics. Respir Res. 2021;22(1):255. http://doi.org/10.1186/ s12931-021-01834-5. PMid:34579722.
23. Ordinola Navarro A, Cervantes-Bojalil J, Cobos Quevedo OJ, Avila Martínez A, Hernández-Jiménez CA, Pérez Álvarez E, et al. Decreased quality of life and spirometric alterations even after mild-moderate COVID-19. Respir Med. 2021;181:106391. http://doi.org/10.1016/j. rmed.2021.106391. PMid:33865161.
24. Compagnone N, Palumbo D, Cremona G, Vitali G, De Lorenzo R, Calvi MR, et al. Residual lung damage following ARDS in COVID-19 ICU survivors. Acta Anaesthesiol Scand. 2022;66(2):223-31. http://doi.org/10.1111/aas.13996. PMid:34758108.
25. Faverio P, Luppi F, Rebora P, D’Andrea G, Stainer A, Busnelli S, et al. One-year pulmonary impairment after severe COVID-19: a prospective, multicenter follow-up study. Respir Res. 2022;23(1):65. http://doi.org/10.1186/s12931- 022-01994-y. PMid:35313890.
26. Smet J, Stylemans D, Hanon S, Ilsen B, Verbanck S, Vanderhelst E. Clinical status and lung function 10 weeks after severe SARS-CoV-2 infection. Respir Med. 2021;176:106276. http:// doi.org/10.1016/j.rmed.2020.106276. PMid:33278758.
27. Stylemans D, Smet J, Hanon S, Schuermans D, Ilsen B, Vandemeulebroucke J, et al. Evolution of lung function and chest CT 6 months after COVID-19 pneumonia: real-life data from a Belgian University Hospital. Respir Med. 2021;182:106421. http://doi.org/10.1016/j. rmed.2021.106421. PMid:33901788.
28. Salem AM, Al Khathlan N, Alharbi AF, Alghamdi T, AlDuilej S, Alghamdi M, et al. The long-term impact of COVID-19 pneumonia on the pulmonary function of survivors. Int J Gen Med. 2021;14:3271-80. http://doi.org/10.2147/IJGM. S319436. PMid:34267545.
29. Torres-Castro R, Vasconcello-Castillo L, Alsina-Restoy X, Solis- Navarro L, Burgos F, Puppo H, et al. Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis. Pulmonology. 2021;27(4):328-37. http:// doi.org/10.1016/j.pulmoe.2020.10.013. PMid:33262076.
30. Froidure A, Mahsouli A, Liistro G, De Greef J, Belkhir L, Gérard L, et al. Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae. Respir Med. 2021;181:106383. http://doi.org/10.1016/j. rmed.2021.106383. PMid:33839588.
Steinbeis F, Thibeault C, Doellinger F, Ring RM, Mittermaier M, Ruwwe-Glösenkamp C, et al. Severity of respiratory failure and computed chest tomography in acute COVID-19 correlates with pulmonary function and respiratory symptoms after infection with SARS-CoV-2: an observational longitudinal study over 12 months. Respir Med. 2022;191:106709. http:// doi.org/10.1016/j.rmed.2021.106709. PMid:34871947.
32. Bellan M, Baricich A, Patrucco F, Zeppegno P, Gramaglia C, Balbo PE, et al. Long-term sequelae are highly prevalent one year after hospitalization for severe COVID-19. Sci Rep. 2021;11(1):22666. http://doi.org/10.1038/s41598-021- 01215-4. PMid:34811387.
33. Van Gassel RJJ, Bels JLM, Raafs A, Van Bussel BCT, Van de Poll MCG, Simons SO, et al. High prevalence of pulmonary sequelae at 3 months after hospital discharge in mechanically ventilated survivors of COVID-19. Am J Respir Crit Care Med. 2021;203(3):371-4. http://doi.org/10.1164/ rccm.202010-3823LE. PMid:33326353.
34. Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020;55(6):2001217. http://doi. org/10.1183/13993003.01217-2020. PMid:32381497.
35. Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Mäkelä MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237. http://doi.org/10.1186/s12931- 021-01830-9. PMid:34446020.
Submetido em:
01/12/2023
Aceito em:
31/10/2024
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