Post-Intensive Care Unit Multidisciplinary Approach in Patients with Severe Bilateral SARS-CoV-2 Pneumonia.

Background: Short and long-term sequelae after admission to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) are to be expected, which makes multidisciplinary care key in the support of physical and cognitive recovery. Objective: To describe, from a multidisciplinary perspective, the sequelae one month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia. Design: Prospective cohort study. Environment: Multidisciplinary outpatient clinic. Population: Patients with severe COVID-19 pneumonia, post- ICU admission. Methods: A total of 104 patients completed the study in the multidisciplinary outpatient clinic. The tests performed included spirometry, measurement of respiratory muscle pressure, loss of body cell mass (BCM) and BCM index (BCMI), general joint and muscular mobility, the short physical performance battery (SPPB or Guralnik test), grip strength with hand dynamometer, the six-minute walk test (6-MWT), the functional assessment of chronic illness therapy-fatigue scale (FACIT-F), the European quality of life-5 dimensions (EQ-5D), the Barthel index and the Montreal cognitive assessment test (MoCA). While rehabilitation was not necessary for 23 patients, 38 patients attended group rehabilitation sessions and other 43 patients received home rehabilitation. Endpoints: The main sequelae detected in patients were fatigue (75.96%), dyspnoea (64.42%) and oxygen therapy on discharge (37.5%). The MoCA showed a mean score compatible with mild cognitive decline. The main impairment of joint mobility was limited shoulder (11.54%) and shoulder girdle (2.88%) mobility; whereas for muscle mobility, lower limb limitations (16.35%) were the main dysfunction. Distal neuropathy was present in 23.08% of patients, most frequently located in lower limbs (15.38%). Finally, 50% of patients reported moderate limitation in the EQ-5D, with a mean score of 60.62 points (SD 20.15) in perceived quality of life. Conclusions: Our findings support the need for a multidisciplinary and comprehensive evaluation of patients after ICU admission for COVID-19 because of the wide range of sequelae, which also mean that these patients need a long-term follow-up. Impact on clinical rehabilitation: This study provides data supporting the key role of rehabilitation during the follow-up of severe patients, thus facilitating their reintegration in society and a suitable adaptation to daily living.

“Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID 19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos?” "Multidisciplinary Approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to Intensive Care?”

Objetivo: Describir las secuelas al mes del alta hospitalaria en pacientes que precisaron ingreso en Cuidados Intensivos por neumonía grave COVID 19 y analizar las diferencias entre los que recibieron terapia exclusivamente con oxigenoterapia con alto flujo con respecto a los que precisaron ventilación mecánica invasiva. Diseño: Estudio de cohorte, prospectivo y observacional Ámbito: Consulta multidisciplinar post cuidados intensivos Pacientes o participantes: Pacientes que superaron el ingreso en la unidad de cuidados intensivos (UCI) por neumonía grave COVID 19 desde abril 2020 hasta octubre 2021 Intervenciones: Inclusión en el programa multidisciplinar post UCI Variables de interés principales: Secuelas motoras, sensitivas, psicológicas/psiquiátricas, respiratorias y nutricionales tras el ingreso hospitalario. Resultados: Se incluyeron 104 pacientes. 48 pacientes recibieron oxigenoterapia nasal de alto flujo (ONAF) y 56 ventilación mecánica invasiva (VMI). Las principales secuelas encontradas fueron la neuropatía distal (33,9% VMI vs 10,4% ONAF);plexopatía braquial (10,7% VMI vs 0% ONAF);disminución de fuerza de agarre: mano derecha 20,67kg (+/- 8,27) en VMI vs 31,8 kg (+/- 11,59) en ONAF y mano izquierda 19,39kg (+/- 8,45) en VMI vs 30,26kg (+/- 12,74) en ONAF;y balance muscular limitado en miembros inferiores (28,6% VMI vs 8,6% ONAF). Las diferencias observadas entre ambos grupos no alcanzaron significación estadística en el estudio multivariable. Conclusiones: Los resultados obtenidos tras el estudio multivariable sugieren no existir diferencias en cuanto a las secuelas físicas percibidas al mes del alta hospitalaria en función de la terapia respiratoria empleada, ya fuera oxigenoterapia nasal de alto flujo o ventilación mecánica prolongada, si bien son precisos más estudios para poder obtener conclusiones al respecto.

Effects on Health of Passive Smoking and Vape on Terraces in the COVID-19 Pandemic: A Review

The health damage caused by passive smoking is well known in closed public spaces such as workplaces, inside homes and restaurants. However, at present, the number of smokers in open public spaces such as terraces has increased and consequently a loss of the quality of the air breathed, increasing the concentration of particles and other contaminating agents, affecting the health of workers and customers, of these spaces. Multiple studies show that high exposure to tobacco smoke in these environments augments the risk of developing cardiorespiratory diseases, especially in the vulnerable population, but also respiratory infections. Tobacco smoke can be an excellent vehicle for transmitting viral particles, favoring coronavirus disease 2019 (COVID-19).

Importance of Vaccination against SARS-CoV-2 in Patients with Interstitial Lung Disease Associated with Systemic Autoimmune Disease.

OBJECTIVES: To describe the frequency of COVID-19 and the effect of vaccination in patients with interstitial lung disease and systemic autoimmune disease (ILD-SAD) and to identify factors associated with infection and severity of COVID-19. METHODS: We performed a cross-sectional multicenter study of patients with ILD-SAD followed between June and October 2021. The main variable was COVID-19 infection confirmed by a positive polymerase chain reaction (PCR) result for SARS-CoV-2. The secondary variables included severity of COVID-19, if the patient had to be admitted to hospital or died of the disease, and vaccination status. Other variables included clinical and treatment characteristics, pulmonary function and high-resolution computed tomography. Two logistic regression was performed to explore factors associated with "COVID-19" and "severe COVID-19". RESULTS: We included 176 patients with ILD-SAD: 105 (59.7%) had rheumatoid arthritis, 49 (27.8%) systemic sclerosis, and 22 (12.54%) inflammatory myopathies. We recorded 22/179 (12.5%) SARS-CoV-2 infections, 7/22 (31.8%) of them were severe and 3/22 (13.22%) died. As to the vaccination, 163/176 (92.6%) patients received the complete doses. The factors associated with SARS-CoV-2 infection were FVC (OR (95% CI), 0.971 (0.946-0.989); p = 0.040), vaccination (OR (95% CI), 0.169 (0.030-0.570); p = 0.004), and rituximab (OR (95% CI), 3.490 (1.129-6.100); p = 0.029). The factors associated with severe COVID-19 were the protective effect of the vaccine (OR (95% CI), 0.024 (0.004-0.170); p < 0.001) and diabetes mellitus (OR (95% CI), 4.923 (1.508-19.097); p = 0.018). CONCLUSIONS: Around 13% of patients with ILD-SAD had SARS-CoV-2 infection, which was severe in approximately one-third. Most patients with severe infection were not fully vaccinated.

Acute Lung Injury Biomarkers in the Prediction of COVID-19 Severity: Total Thiol, Ferritin and Lactate Dehydrogenase.

SARS-CoV-2 (COVID-19) patients who develop acute respiratory distress syndrome (ARDS) can suffer acute lung injury, or even death. Early identification of severe disease is essential in order to control COVID-19 and improve prognosis. Oxidative stress (OS) appears to play an important role in COVID-19 pathogenesis; we therefore conceived a study of the potential discriminative ability of serum biomarkers in patients with ARDS and those with mild to moderate disease (non-ARDS). 60 subjects were enrolled in a single-centre, prospective cohort study of consecutively admitted patients: 29 ARDS/31 non-ARDS. Blood samples were drawn and marker levels analysed by spectrophotometry and immunoassay techniques. C-reactive protein (CRP), lactate dehydrogenase (LDH), and ferritin were significantly higher in ARDS versus non-ARDS cases at hospital admission. Leukocytes, LDH, ferritin, interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) were also significantly elevated in ARDS compared to non-ARDS patients during the hospital stay. Total thiol (TT) was found to be significantly lower in ARDS. Conversely, D-dimer, matrix metalloproteinase-9 (MMP-9) and advanced glycosylated end products (AGE) were elevated. Leukocytes, LDH, CRP, ferritin and IL-6 were found to be significantly higher in non-survivors. However, lymphocyte, tumour necrosis factor beta (TGF-ß), and TT were lower. In summary, our results support the potential value of TT, ferritin and LDH as prognostic biomarkers for ARDS development in COVID-19 patients, distinguishing non-ARDS from ARDS (AUCs = 0.92; 0.91; 0.89) in a fast and cost-effective manner. These oxidative/inflammatory parameters appear to play an important role in COVID-19 monitoring and can be used in the clinical management of patients.