Two-year outcome of extracorporeal membrane oxygenation in COVID-19 related severe respiratory failure

Objectives: We sought to evaluate 2-year outcome of V-V ECMO support for COVID-19 related severe respiratory failure in our center. Method(s): Retrospective analysis of 41 consecutive patients (73% male, mean age 51.6+/-14.2 years, mean BMI 35.1+/-12.5 kg/m2) with critical hypoxemic and/or hypercapnic refractory respiratory failure (mean P/F ratio 67.9+/-14.3 mmHg, mean pCO2 77.6.0+/-185.7 mmHg, Murray Score 3.71+/-0.4) on V-V ECMO support from October 2020 to January 2022 Results: With mean support duration of 234.4+/-63.2 hours, 29 patients (70.7%) were successfully weaned off. Finally, 19 of them (46.3%) were discharged home with good neurological outcome (CPC 1,2). During followup, 30-day, 6-, 12-, and 24 -month survival rate was 61.3%, 46.2%, 41.9%, and 41,9% respectively. In survivor group shorter symptoms onset to respiratory failure time (4+/-4.7 vs. 7+/-6.7 days, p=0.04), higher P/F ration (86+/-41.5 vs. 65+/-37.5 mmHg, p=0.04) and norepinephrine support (0.03+/-0.06 vs. 0.09+/-0.12 ug/kg/min, p=0.04), and lower IL-6 level (12.3+/-7.5 vs. 25.9+/-8.8 ng/l, p=0.03) p=0.01) were analysed before cannulation. Mean in-ICU stay and in-hospital stay in survivors;groups reached 32.5+/-27.7 days and 42.6+/-35.8 days, respectively. All long-term survivors (17 patients) complained about slight functional health limitation only with normal 6MWT (542.6+/- 89.2 min), near to normal spirometry parameters (FEV/VC 87+/-7.4%, DLCO 63.1+/-13.7%, KCO 82.,1+/-19.4%) and minimal neurological disability (CPC 1-2) Conclusion(s): 2-year outcome of V-V ECMO support in COVID-19 severe respiratory failure is acceptable even in the scope of low-volume ECMO centre. Reported functional status of long-term survivors was good despite the complicated and prolonged in-hospital stay. (Table Presented).

Respiratory manifestations of post-COVID syndrome

Overcoming infection with coronavirus disease 2019 (COVID-19) can lead to the persistence of various symptoms in some patients. The complex of symptoms causally related to severe acute respiratory coronavirus 2 infection is called post-COVID syndrome. One of the most common respiratory complications is pulmonary fibrosis, especially after critical course of the disease. In some patients, ho-wever, only the peripheral airways are affected by the air-trapping seen on high-resolution computed tomography scans. Less common respiratory complications include sarcoidosis and pneumatoceles. This narrative review summarizes current knowledge about pulmonary involvement as part of post-COVID syndrome.

The influence of the course of the COVID-19 on anxiety levels in patients with post-COVID syndrome.

The COVID-19 is associated not only with symptoms of the acute phase, but in some patients some symptoms persist even after overcoming it, we are talking about the so-called post-COVID syndrome. The aim of our work was to identify factors influencing the level of anxiety in patients with this syn-drome. In total, data were obtained from 404 patients, anxiety levels were assessed using the Beck Anxiety Inventory (BAI). The file con-tained 143 men and 261 women, in the age range of 19-90 years. The average BAI value was 13.2 Most often, patients experienced a mild course of covid-19 infection. According to our results, the severity of the COVID-19 infection itself and the presence of comorbid somatic disease have not effect on the BAI value, on the contrary, hospitalization turned out to be a significant factor. Hospitalized patients had a statistically significantly lower level of anxiety than those who experienced this disease at home. Patients with a pathological level of anxiety were significantly younger and, when comparing gender, there were significantly more anxiety in women. The con-nection between the presence of pulmonary post-inflammatory changes on the chest X-ray and the degree of anxiety was not proven, but a statistically significant trend was found.Copyright © 2023, Czech Medical Association J.E. Purkyne. All rights reserved.

Pulmonary complications following COVID-19 infection.

In the relatively short period of time since December 2019, hundreds of millions of people globally have been infected with SARS-CoV-2, irrespective of their age, gender or ethnicity. Over that time, numerous mutations of various degrees of virulence and patho-genicity have occurred. The course of COVID-19 infection, an acute disease caused by the virus, is rather varied, ranging from asym-ptomatic or symptoms of common viral respiratory diseases to critical, with multiorgan failure and high mortality in high-risk patients. The overall mortality of the disease is 1-2 %. Unlike other viral respiratory diseases, this infection is often associated with frequent and rather diverse clinical manifestations developing after the acute phase of the infection, that is, more than 28 days after its onset. These complications are observed in both individuals with mild illness treated at home and inpatients with severe to critical illness. They develop both early after acute infection and some time after recovering from the disease. This rather heterogeneous group of pathologies may affect various organs and organ systems, with respiratory tract involvement being the most common and one of the most serious complications. Severe respiratory post-COVID-19 complications often include respiratory tract infections, in particular pneumonia.Copyright © 2022, Trios spol. s.r.o.. All rights reserved.

The use of extracorporeal membrane oxygenation in the treatment of critical course of pneumonia

Extracorporeal membrane oxygenation is the highest form of resuscitation care in management of patients with respiratory failure. In the case of acute respiratory distress syndrome, the veno-venous setting is more often used. ECMO support enables, in case of lung function failure, to obtain the necessary time for the onset of the causal treatment effect or is used as a bridge to transplantation Mortality of the patients varies according to the underlying cause and presence of risk factors (e.g., age, complications or comorbid diseases). The onset of the COVID-19 pandemic has led to a significant increase in the need for ECMO. The quality of life of patients after ECMO is significantly reduced, but most patients do not experience permanent disability. © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.

Network analysis uncovers relationship between immune profiles and severity of COVID-19

Introduction: Despite the growing number of studies on COVID-19, interpreting the data and extracting meaning from these data is challenging. Method(s): We used a multivariate patient similarity network (PSN) approach to analyse ~85 immune (cellular and humoral) and ~70 clinical features in 250 prospectively recruited patients 4-8 weeks after a SARS-CoV-2 diagnostic PCR. Result(s): Our multivariate analysis identified a minimal immune signature (CD69+CD4+ T-lymphocytes, CTLA-4+ Tlymphocytes and immature B-lymphocytes) that was strongly associated with disease severity and manifested even 4-8 weeks after COVID-19. Visualisation of clinical and laboratory parameters in patient clusters detected by PSN showed that a history of severe COVID-19 was associated with less frequent anosmia/ageusia and higher levels of IgM and IgG 4-8 weeks after COVID-19 compared with mild disease. Conclusion(s): Ours study reveals the relationship between immune profiles and severity of COVID-19, showing that more severe COVID-19 is typical lower proportion on immature B cells and cytotoxic T- lymphocytes. Our study demonstrates the benefits of implementing multivariate data-mining approaches for interpreting complex datasets, not only relating to COVID-19.

[Pulmonary complications following COVID-19 infection]

In the relatively short period of time since December 2019, hundreds of millions of people globally have been infected with SARS-CoV-2, irrespective of their age, gender or ethnicity. Over that time, numerous mutations of various degrees of virulence and pathogenicity have occurred. The course of COVID-19 infection, an acute disease caused by the virus, is rather varied, ranging from asymptomatic or symptoms of common viral respiratory diseases to critical, with multiorgan failure and high mortality in high-risk patients. The overall mortality of the disease is 1-2 %. Unlike other viral respiratory diseases, this infection is often associated with frequent and rather diverse clinical manifestations developing after the acute phase of the infection, that is, more than 28 days after its onset. These complications are observed in both individuals with mild illness treated at home and inpatients with severe to critical illness. They develop both early after acute infection and some time after recovering from the disease. This rather heterogeneous group of pathologies may affect various organs and organ systems, with respiratory tract involvement being the most common and one of the most serious complications. Severe respiratory post-COVID-19 complications often include respiratory tract infections, in particular pneumonia.

COVID-19 and post-COVID – Jekyll and Hyde of modern medicine

COVID-19 pandemic has massive impact on the whole world, lead to the death of milions of people and required excessive restrictions with large economical, psychological and other impacts. Post-COVID syndrome is defined according to the Czech pneumological and phtizeological society as a complex of symptoms persisting for more than 12 weeks from the acute stage of COVID-19 and which is not possible to explain by other causes. Exact pathopysiological mechanisms and its frequency are still not known, and the data from the literature are not consisent. We present case reports of 2 patients with very different disease and convalescence course. COVID-19 and post-COVID syndrome represent large space for the further research. The prediction of the persisting limitations and other consequencies of the diseases is still not possible. Even though there is usualy higher incidence of post-COVID symptoms in patients surviving severe COVID-19 course, the presented case reports show paradoxically exactly the oposite situation.

Bilateral multiple pneumatocele as a rare late complication of COVID-19 pneumonia

Pneumatocele is a cavity, which may develop rarely as a complication of pneumonia. It is more common in patients requiring ventilation support. After COVID-19 pneumonia, there are only several case reports described. Our case report is about a male patient without any serious commorbities. The patient had bilateral multiple pneumatocele which have formed in postacute phase of moderate course of COVID-19. Other possible causes have been exluded by a complex examination. During the follow-up there was a clear gradual spontaneous resorption of the finding. The patient is still in very good clinical condition. © 2021, SOLEN s.r.o.. All rights reserved.

Covid-19 related olfactory impairment – diagnostics, significance and treatment

Aim: Smell disorders are frequent symptoms of COVID-19 disease. This systematic review covers the pathophysiology, diagnostics, prognostic significance, and treatment of COVID-19 related smell disorders. Methods: The articles were selected in accordance with the PRISMA guidelines. The inclusion criteria were: 1. peer-reviewed publications;2. studies on human subjects;3. studies published in English or Czech;and 4. used filters: meta-analysis/systematic review/randomized controlled trial. The exclusion criteria were: 1. abstracts from conferences;2. commentaries;and 3. inclusion of subjects younger than 18 years. The databases PubMed and Web of Science were searched. Using the search term “anosmia OR smell loss OR smell disorders OR dysosmia OR parosmia AND COVID-19”, 157 papers were selected for analysis, with 109 being ruled out based on the exclusion criteria. The full texts and their references were obtained and studied, and the references meeting the inclusion criteria were also included in this review, leading to a total of 68 papers selected for the review. Results: Approximately 60% of patients with COVID-19 disease present with smell disorders. Most studies agree anosmia appears more frequently in the mild course of the disease. The inflammation and demyelination of the olfactory nerve fibres probably play a key role in the pathogenesis. Damage to the supporting cells of the olfactory epithelium may also play an important role. Olfactory disorder may persist over a varying period of time after the resolution of the acute phase of COVID-19. Olfactory training seems to be beneficial in the treatment. The data regarding the efficacy of topical corticosteroids are inconsistent. No other drugs have yet demonstrated a clinical effect. Conclusion: Loss of smell is a common accompanying symptom in mostly mild forms of COVID-19. Olfactory training seems to be effective in treating this dysfunction. Pharmacotherapy (including local and systemic corticosteroids) has not yet proven effective.

Impact of the COVID-19 pandemic on sleep medicine in the Czech Republic and Slovakia

Aim: The COVID-19 pandemic affected all parts of the healthcare system. The aim of this study was to assess the pandemics effect on sleep medicine in the Czech Republic (CZE) and Slovakia (SVK). Methods: A questionnaire based study, in which where 23 sleep departments (SD) (16 CZE;7 SVK) were included between May 5, 2020 and May 17, 2020. Results: The service was completely interrupted in 43.5% SD. The sum of estimated missed sleep studies in responding SD was 1,100 and the sum of missed positive airway pressure titrations was 580. When considering the response rate of the questionnaire through extrapolation, it is estimated that about 1,900 sleep studies and 1,000 positive airway pressure titrations were not performed in the region of the CZE and SVK because of COVID-19. The situation is unlikely to improve soon, as 59.1% of SD do not expect to meet the same number of diagnosed/treated patients as in 2019 (53.3% CZE;71.4% SVK) and about 34.8% of SD will not restart their activity by the end of May 2020 or will run with a very limited capacity (23.5% CZE;57.1% SVK). Conclusion: Sleep medicine in the CZE and SVK was heavily affected by COVID-19 and the loss of diagnostic and therapeutic procedures may be considered as one of pandemic “collateral damages”.