Aims and objectives:
To describe the longitudinal evolution of pulmonary function, radiological abnormalities, symptoms, quality of life and health care consumption among survivors throughout the 2 years after critical COVID-19 infection.

Methods:
Longitudinal cohort study among patients admitted to the ICUs of the University Hospitals Arnau de Vilanova and Santa Maria of Lleida (Spain) between March and December 2020. Eligible COVID-19 survivors were evaluated 3, 6, 12 and 24 months after hospital discharge.

Results:
A total of 109 patients were evaluated. Over 2 years, patients showed a progressive recovery of lung function and exercise capacity. However, there were still 45.7% and 53.9% with impairment in lung diffusing capacity and radiological abnormalities, respectively. This was pronounced among patients who required mechanical ventilation. At 24 months, patients presented quality of life, anxiety, depression and cognition levels similar to those of the general population. Nevertheless, 35%, 14%, 10.9%, and 7.9% had persistently abnormal scores for fatigue, cognition, anxiety and depression, respectively. A total of 54.3% presented post-COVID syndrome. The consumption of health resources remained high and was related to symptom burden. Most patients returned to work 2 years after hospital discharge.

Conclusions:
Critical COVID-19 showed longitudinal improvements in health outcomes and returned to work within 2 years. There was still a high proportion of patients with functional and radiological abnormalities, especially intubated patients. A high burden of symptoms and post-COVID syndrome was present in the long term, affecting quality of life and implying high levels of health care consumption.