ABSTRACT
Introduction The Six Minute Walk Test (6MWT) is a practical and simple test that requires no exercise equipment or advanced training. While it serves as an evaluation tool for assessing baseline functional status and response to treatments, it is also well documented as a predictor of morbidity and mortality for patients being evaluated for pulmonary hypertension and lung transplantation. Due to the ongoing COVID-19 pandemic, CDC guidelines recommend face coverings or masks in all healthcare settings. Prior small studies have shown that both n95 respirators and surgical masks worn during the 6MWT do not affect physiologic parameters during the test (heart rate, oxygen saturation), however, subjects did report an increase in dyspnea. During the pandemic, cloth masks are frequently worn in lieu of medical masks. No studies to date have looked at how cloth masks affect parameters measured during the 6MWT. We set out to explore how cloth masks specifically might affect 6MWT data. Methods We enrolled 25 healthy adult (18+) volunteers and had them undergo three 6-minute walk test trials, with 4-minute rest intervals in between each trial. The first two trials were without masks, and the third was with a cloth mask of the subject's choosing. As these were healthy volunteers with no prior 6-minute test trials, we anticipated an improvement between the first and second trials due to a possible learning effect. We recorded baseline data (gender, age, weight) prior to any trial. We then recorded each subject's heart-rate, oxygen saturation and perceived dyspnea (utilizing the modified Borg dyspnea scale) prior to the first trial and after each consecutive trial. We also measured distance walked in each trial. Data from the second (no-mask) trials were compared with the third (masked) trials. ResultsNo differences were noted in mean modified Borg scale scores when the subjects walked without a mask versus with a cloth mask (0.64 vs. 1.14;p=0.157). Similarly, no differences were noted in mean heart rate (99.7 beats/min vs. 101.3 beats/min;p=0.824), oxygen saturation (98.3% vs. 96.1%, p=0.317) or distance walked (1842.8 vs. 1793.9;p=0.552).ConclusionIn healthy subjects, cloth masks did not affect perception of dyspnea, heart rate, oxygen saturation or walk distance when undergoing the 6-minute walk test. Further studies with a larger sample size are required to better identify how cloth masks impact 6MWT data, as well as how these results can be applied to those with lung disease undergoing the test.
ABSTRACT
Cocaine use has a significant public health impact, causing over 1.2 million ER visits annually. Cocaine can cause a wide range of pulmonary pathology, including diffuse alveolar hemorrhage (“Crack Lung”), barotrauma, bronchiectasis, granulomatous disease, and pulmonary vascular disease. Acute eosinophilic pneumonia (AEP) is a rare and potentially life-threatening complication of cocaine use that can be successfully treated if identified. We describe a case of persistent fevers, hypoxemia, and air space opacities due to AEP related to cocaine use.A 34-year-old male with a history of polysubstance abuse was found unresponsive, apneic, and surrounded by vomitus at a party, where he had smoked marijuana and cocaine and injected heroin. Upon hospital arrival, he was hypotensive and severely hypoxic and was intubated. He had severe rhabdomyolysis, lactic acidosis, acute kidney injury, and acute liver injury. His chest radiograph demonstrated diffuse bilateral alveolar infiltrates. COVID-19 was ruled out. Sputum cultures grew Klebsiella and E. Coli;Streptococcus Pneumoniae urine antigen was positive. He received IV fluids, vasopressors, and broad spectrum antibiotics for septic shock and aspiration pneumonia in the setting of drug overdose. His septic shock and hypoxemia improved, allowing tracheostomy and gastrostomy to be performed. Despite prolonged courses of antibiotics, he had persistent fevers, worsening infiltrates on chest radiograph, and persistent hypoxemia. CT imaging demonstrated diffuse, bilateral ground glass opacities and consolidations, with reticulation and interlobular septal thickening. Viral, bacterial, and fungal cultures collected via bronchoscopy were negative, however, cell count revealed 315 WBC / mm3, with 27% eosinophils. He was started on methylprednisolone 80mg IV every eight hours and had resolution of fevers and improvement in oxygenation and infiltrates. 1 month after discharge, he was decannulated and did not require supplemental oxygen. DiscussionThis case highlights an important aspect of assessing fever in the ICU despite broad spectrum antibiotics in patient with drug overdose. In the above , bronchoscopy unmasked an eosinophilic pneumonia allowing a rapid transition to trach collar and prevention of progression to pulmonary fibrosis. (Figure Presented).