Twelve months after severe COVID-19 pneumonia, most of the patients had a peak V′O 2 considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r 2 = 0.12 p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (D LCO) (r 2 = − 0.15 p = 0.01). Impairments were more pronounced in patients with dyspnea. Peak PetCO 2 was significantly lower in subjects with an abnormal increase of VD/Vt ( p = 0.001). More than half of the patients with a normal peak predicted V′O 2 showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 at anaerobic threshold (AT) and 0.29 at peak) and a widened median peak alveolar-arterial gradient for O 2 (35.2 mmHg. Length of ICU stay remained an independent predictor of V′O 2. The majority of the patients (80%) had a peak O 2 uptake (V′O 2) considered within normal limits (median peak predicted O 2 uptake (V′O 2) of 98% ). Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. Twelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Lung function at rest and chest computed tomography (CT) scan were also performed. In this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae. Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest.
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