Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: A multicenter cohort study

Abstract Background: Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19. Methods: This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge. Results: Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality. Conclusion: The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality.

Chester step test: assessment of functional capacity and magnitude of cardiorespiratory response in patients with COPD and healthy subjects / Teste step Chester: avaliação da capacidade funcional e magnitude da resposta cardiorrespiratória em pacientes com DPOC e indivíduos saudáveis

BACKGROUND: the assessment of functional capacity in patients with chronic obstructive pulmonary disease (COPD) has been performed by simple and easy to apply methods that mimic everyday activities, such as the Chester step test (TChester). OBJECTIVES: to investigate whether TChester is able to differentiate functional capacity and the magnitude of cardiorespiratory response of patients with COPD from healthy subjects; and to compare it with the cardiorespiratory response induced by shuttle test (TShuttle) and six-minute walk test (6MWT). METHOD: 10 patients with COPD (64±10 years, and forced expiratory volume at the first second - FEV1 38.1±11.8% predicted) and 10 healthy subjects (63±7 years, and FEV1 of 95.8±18.0% predicted) underwent evaluation of pulmonary function, functional status and capacity (6MWT, TShuttle and TChester). RESULTS: COPD patients had worst performance in all tests, when compared to healthy subjects (TChester 2,1±0,9 vs. 4,1±1,1 completed levels; TC6min: 435±105,1 vs. 593±87,3 m; TShuttle 251±84,6 vs. 436±55,4 m; p<0.05). TChester correlated with TShuttle and 6MWT (r =0.67 and 0.83, respectively, p<0.05). There were no differences in heart rate and dyspnea in TChester levels between groups (p>0.05). SpO2 was lower in COPD patients since the first TChester level (p<0.05). CONCLUSION: TChester is valid in the assessment of functional capacity of COPD patients, being able to distinguish them from healthy subjects, inducing similar cardiovascular demand and greater desaturation in COPD patients. .

CONTEXTUALIZAÇÃO: A avaliação da capacidade funcional em pacientes com doença pulmonar obstrutiva crônica (DPOC) tem sido realizada por métodos simples, de fácil aplicação e que mimetizam as atividades cotidianas, como o teste step Chester (TChester). OBJETIVOS: Investigar se o TChester é capaz de diferenciar a capacidade funcional e a magnitude da resposta cardiorrespiratória de pacientes com DPOC e de indivíduos saudáveis e comparar com a resposta cardiorrespiratória induzida pelos testes de caminhada de seis minutos (TC6min) e Shuttle (TShuttle). MÉTODO: Participaram dez pacientes com DPOC (64±10 anos, volume expiratório forçado no primeiro segundo - VEF1 de 38,1±11,8% do predito) e dez saudáveis (63±7 anos, IMC de 24,5±3,1 e VEF1 de 95,8±18,0% do predito) que realizaram avaliação da função pulmonar, estado e capacidade funcional. RESULTADOS: O grupo DPOC obteve pior desempenho nos três testes, quando comparado ao controle (TChester 2,1±0,9 vs 4,1±1,1 níveis completos; TC6min: 435±105,1 vs 593±87,3 m; TShuttle 251±84,6 vs 436±55,4 m; p<0,05). O TChester correlacionou-se com o TShuttle e com o TC6min (r=0,67 e 0,83, respectivamente; p<0,05). Não se observaram diferenças na frequência cardíaca (FC) e dispneia nos níveis do TChester entre os grupos (p>0,05). A SpO2 apresentou-se mais reduzida no grupo DPOC já no primeiro nível do TChester (p<0,05). CONCLUSÃO: O TChester é válido na avaliação da capacidade funcional de pacientes com DPOC, sendo capaz de diferenciá-los de indivíduos saudáveis, induzindo similar demanda cardiovascular e maior dessaturação nos pacientes ...