Background Post-Intensive Care Syndrome (PICS) includes cognitive, psychological, and physical impairments following critical illness. The long-term impact of COVID-19-related ARDS on PICS domains remains under-explored, particularly in resource-limited settings.

Objective To assess the prevalence and trajectory of cognitive, mental, and physical impairments among COVID-19 ARDS survivors at ICU discharge and at 6 months, and to explore associated risk factors.

Methods This was an observational cohort study of 30 mechanically ventilated COVID-19 patients admitted to a tertiary ICU in South India during the second wave (Delta variant). Patients were assessed at ICU discharge (or first follow-up) and at 6 months using the Montreal Cognitive Assessment (MoCA), SF-36 health survey, modified MRC dyspnea scale, 6-minute walk test (6MWT), and physical examination. Risk factors were analyzed using multivariable linear regression.

Results At discharge, mild cognitive impairment was prevalent (MoCA: 25.17±3.63), with significant improvement at 6 months (27.07±2.72, p<0.001). SF-36 domains showed persistent deficits in emotional well-being (36.31→50.83), fatigue (33.28→45.91), and pain (51.38→71.47) (all p<0.01). Functional capacity improved on 6MWT, with >350m walked increasing from 23% to 53%. Risk factors included steroid duration, SOFA score, antifungal exposure, and fasting hypoglycemia. Other parameters like Muscle wasting, dyspnea, and gastrointestinal symptoms also showed partial recovery.

Conclusion COVID-19 ARDS survivors experience significant but partially reversible PICS across multiple domains. Structured post-ICU rehabilitation and early identification of modifiable risk factors may improve recovery trajectories. Findings highlight the need for integrated post-ICU care pathways in similar settings.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Kovai Medical Center and Hospital (KMCH), KMCH Ethics committee, approval granted. Ref: EC/AP/885/03/2022

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↵# Co- Authors

Email id: parvathynarayanan82gmail.com, Phone Number: 9500753889, Email id: docgopi79gmail.com, Phone number: 9790832509, Email id: vijayss87pmgmail.com, Phone number: 807295265

All data produced in the present study are available upon reasonable request to the authors