ABSTRACT
Aims: ENO Breathe is an online breathing and wellbeing programme for people with Long COVID focusing on breathing re-training using singing techniques. Aim(s): to assess whether ENO Breathe improves health related quality-of-life (HRQoL) in people with persistent breathlessness following COVID-19. Method(s): A parallel-group, single-blind, RCT, comparing ENO Breathe(6 weeks) with usual care in adults, with persisting breathlessness +/- anxiety, following assessment at an NHS Long COVID clinic. Primary Outcome: change in HRQoL using the RAND SF-36 Mental(MHC) and Physical(PHC) Health Composite Scores. Secondary Outcomes: CAT, VAS for breathlessness (rest, walking, stairs, and running), Dysp-12, GAD-7. Participant experience was assessed using focus groups and free-text responses. Result(s): 150 participants (mean(SD) 49(12)years, 81% female, 320(127) days symptomatic;ENO Breathe(n=74), Control(n=76). ENO Breathe was associated with improvement in MHC of 2.42 points (95%CI 0.03 to 4.80, p=0.045), but not PHC 0.6 (-1.33 to 2.52, p=0.541). VAS breathlessness (running) favoured ENO Breathe -10.48(-17.23 to -3.73, p=0.003). Three participant experience themes were identified 1) improvements in symptoms;2) feeling that the programme was complementary to standard care;3) the particular suitability of singing and music to address their needs. Conclusion(s): An online breathing and wellbeing programme can improve the mental component of HRQoL and elements of breathlessness in people with persisting symptoms after COVID-19. Mind-body and music-based approaches, including practical, enjoyable symptom-management techniques may have a role supporting recovery.
ABSTRACT
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is used to provide life-sustaining support to patients with severe acute respiratory distress syndrome (ARDS). Its use has dramatically increased during the current COVID-19 pandemic. Delayed resolution is associated with poorer patient outcomes and current prediction scores focus on mortality. This study aimed to identify pre-ECMO clinical characteristics that determine early ARDS resolution, to assist clinicians in planning appropriate treatment. METHODS: In this retrospective observational study, point of referral data from patients treated with veno-venous ECMO at a regional centre (2017-2019) were analysed. Patients aged 18 years and above with ARDS, defined by the Berlin criteria, were included. The primary outcome was early ARDS resolution, defined as liberation from ECMO within 14 days, or non-early ARDS resolution, defined as ECMO run longer than 14 days (survivors and non-survivors). Multiple logistic and backwards step-wise logistic regression were used to identify independent predictors. Multiple imputation was used for missing values. RESULTS: Of the 159 patients included in the study, 86 (54.1%) had early ARDS resolution. Following univariate analysis and exclusion of colinear variables, multiple logistic regression showed aspiration pneumonia to be a significant predictor of early resolution. Plateau pressure, social alcohol use and prophylactic heparin were significant predictors of non-early resolution. Backwards step-wise regression retained plateau pressure (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.06-1.24, p=0.001), social alcohol use (OR 2.73, 95% CI 1.17-6.34, p=0.020), prophylactic heparin (OR 3.24, 95% CI 1.46-7.21, p=0.004), aspiration pneumonia (OR 0.19, 95% CI 0.06-0.62, p=0.006) and log (FiO2) (OR 0.06, 95% CI 0.005-0.64, p=0.02) as independent significant predictors. CONCLUSIONS: This study identified important clinical characteristics at the point of referral, in particular the aetiology of ARDS, that predict disease dynamics in ARDS patients receiving ECMO. These can help better prepare families, inform clinicians, plan resource utilization and guide future research into severe ARDS.