Respiratory viruses lead to airway dysbiosis in exacerbations of chronic obstructive pulmonary disease

P18 Figure 1The percentage of exacerbations with bacteria detected in sputum by qPCR, according to respiratory virus identified at exacerbation, at a) exacerbation onset (n=30) and at b) two weeks (n=11). HI = H. influenzae, SP = S. pneumoniae, MC = M. catarrhalis. RV = rhinovirus, HCV = human coronaviruses, FluA = influenza A, Other = a combination of the other viral exacerbations[Figure omitted. See PDF]ConclusionsSecondary bacterial outgrowth occurs in COPD exacerbations caused by a range of respiratory viruses suggesting that viral infection results in microbiome dysbiosis. Bacterial qPCR detected several bacteria that were not identified using standard microbiological culture with a high bacterial load and Moraxella detection at two weeks Bacterial overgrowth may explain why some exacerbations show prolonged recovery.

Upper Limb Function in Survivors of COVID-19 Requiring Mechanical Ventilation

Rationale Upper limb dysfunction is well recognised in survivors of intensive care (Gustafson et al Crit Care Med 2018;46:1769-1774). A mainstay of respiratory support through the COVID-19 pandemic has been use of repeated patient prone positioning to improve ventilation. Potential complications reported with prone positioning of sedated patients include brachial plexopathy, shoulder subluxation and peripheral nerve injury. We hypothesised that there would be a high prevalence of upper limb dysfunction, disability and pain in survivors of COVID-19 requiring mechanical ventilation, particularly in those who were prone positioned. Methods Eligible patients were laboratory-confirmed swab positive for SARS-CoV-2, mechanically ventilated for a minimum of 72 hours on the Royal Brompton Hospital Adult Intensive Care Units. We measured handgrip strength (HGS), normalised for age and sex, the Disability of Arm Shoulder Hand (DASH) questionnaire (Beaton et al J Hand Ther 2001;14:128-146) and Upper limb Pain Numerical Rating Scale (from 0-10). Health related quality of life was measured using the EuroQol-5 dimensions 5-level (EQ5D5L Utility Index (UI) and Visual Analogue Score (VAS)). Patients were stratified according to whether they received prone positioning or not. Results Twenty-seven consecutive patients were assessed at mean 45 days after hospital discharge. Baseline demographics, admission characteristics, and follow-up upper limb assessment data are shown in Table 1. There was evidence of upper limb weakness (mean (SD) right HGS: 44.77(19.31) %predicted;left HGS 47.69 (18.41) %predicted), with 63% showing upper limb dysfunction (DASH ≥ 16) and 33% showing severe upper limb dysfunction (DASH ≥40). Median (IQR) pain scores were 4 (0.75-6.25) with 53% reporting severe pain (≥ 5). DASH correlated significantly with EQ5D5L UI and VAS (r=-0.69 and r=-0.73 respectively;both p<0.001). No significant differences in upper limb parameters were seen between patients who did or did not receive prone positioning.