Analysis of nutrition support in COVID19 critical care patients

The aim of this analysis was to determine route and adequacy of nutrition support in patients with COVID19 during the first 7 days of admission to an intensive care unit (ICU). Nutrition parameters were collected for all patients admitted to ICU with COVID19 and compared to best practice guidelines1. Of the initial 64 patients admitted to ICU for management of COVID19, all patients were assessed by a critical care dietitian. Patients who were tolerating oral diet were commenced on oral nutrition support as appropriate. Forty eight patients (75%) required enteral nutrition (EN) or parenteral nutrition (PN). The feeding route of choice for the majority of patients was EN (89.5%). In patients with gastrointestinal (GI) intolerance where strategies to optimise tolerance were unsuccessful, supplementary or total PN was used (10.5%). Energy and protein intakes during the early and late acute phase are described below. [Formula presented] Energy intakes in the early acute phase were consistent with best practice guidelines while protein provision was a challenge in both phases. GI intolerance was common which compromised nutrition intakes, though proned position did not affect these outcomes. Where strategies to improve GI tolerance are unsuccessful supplementary PN should be considered without delay to optimise nutrition intake. References: 1Singer et al. Clinical Nutrition (2019) 38(1), 48-79. Disclosure of Interest: None Declared

Obesity Is Not Associated With Mortality In COVID-19 Pneumonia

Study Objective: Currently there is conflicting evidence regarding the impact of obesity on patient outcomes in COVID-19 pneumonia. Specifically, obesity may be associated with severe pneumonia, hypoxia, intubation and mortality. The CXR opacity scoring system has been shown to characterize pneumonia severity in COVID-19 patients. The aim of this study is to evaluate the association between obesity, pneumonia severity and mortality. Methods: A retrospective chart review was conducted for April 2020 at an urban ED located in a medically underserved region. Inclusion criteria consisted of adult ED patients who were admitted with COVID-19 pneumonia. An EM attending and senior resident determined the CXR opacity scores in severity ranging from 0 to 6. Scores ≥ 3 indicate a severe pneumonia. Inter-rater agreement was determined based on the kappa coefficient. Demographic information, Pulse Oximetry (PO), Body Mass Index (BMI), intubation requirement and mortality were analyzed using chi-square and student's t-test. Results: 306 patients met inclusion criteria. The mean age was 61.9 ± 14.7 years and there were 40.2% male patients. The mean BMI and PO were 30.1 ± 6.4 and 88.7 ± 3.9, respectively. Pneumonia on CXR was 85.3% bilateral, 6.5% left and 8.2% right. 43.5% of patients were given CXR opacity scores ≥ 3 for severe pneumonia. The kappa coefficient for CXR opacity scoring agreement was 0.47. Patients were categorized as BMI ≤ 25 (63, 20%), > 25-30 (101, 33%), > 30-35 (82, 27%), > 35-40 (32, 10.5%), > 40 (23, 7.5%) and undetermined (5, 2%). There were 84 (27.4%) patients with hypoxia determined with triage PO ≤ 85. We found that 48 (16%) patients were intubated in the ED. The overall in-hospital mortality was 21%. There was no association between BMI and hypoxia (P=0.38), CXR opacity score (P=0.71), intubation (P=0.67) or mortality (P=0.39). Conclusion: In our ED cohort of COVID-19 pneumonia patients, we found that obesity was not associated with severity of pneumonia, hypoxia, intubation or mortality. Further research is therefore needed to fully understand the role of obesity in COVID-19 outcomes.

The use of hyper-polarized 129xe pulmonary mri for study of the lung damage in COVID-19 survivors, preliminary results

RATIONALE: Severe COVID-19 viral infection results in parenchymal pneumonia involving the terminal bronchi and alveolar cells;viral re-production results in damaged and destroyed cells, causing whole lung inflammation resulting in failed gas exchange and respiratory failure that leads to end-stage organ failure. Hyperpolarized 129Xe gas MRI is non-invasive, radioactive-free tool can examine COVID-19 damage to the lungs with spatial-resolution similar to the CT-resolution. We hypothesize, that the high-resolution 129Xe MRI can be used for the assessment of the lung structure and function in COVID-19 survivors (CS). In this pilot study conducting with a small number of CS, we measured the Ventilation-Defect-Percent (VDP) a sensitive indicator of lung function, using highresolution (voxel-size=3x3x3mm3) 129Xe MRI. This should improve our understanding on the effects of COVID-19 on the lungs. METHODS: Three CS with written informed consent provided, underwent spirometry and 1H/129Xe MRI scanning (NCT04584671), performed on a 3.0T scanner. Traditional or low-resolution coronal xenon images (3x3x15mm3), were acquired in a <16 sec breath-hold after inspiration of 1.0L of gas (129Xe/4He-30/70) from functional-residual-capacity using acquisition parameters reported elsewhere.2 Pre- and post-salbutamol data set acquired for each subject. Isotropic-voxel high-resolution-images with 3x3x3mm3 were reconstructed by using the key-hole approach.3 Hyperpolarized 129Xe gas (polarization=35%) was obtained from a turn-key 129Xe polarizer system. Proton MRI was performed as described.1 Image SNR and VDP values were calculated as elsewhere.4 RESULTS: Figure 1 reports CS information and imaging results. The calculated VDPs for the highresolution data were lower than the low-resolution data. The pre- and post-salbutamol values were similar except for CS-1, where the post-salbutamol value was larger. The SNR values are reported on Figure1.DISCUSSION: The good quality of the high-res 129Xe images permitted a precise VDP calculation, which are comparable to those reported elsewhere.5 The North-American xenon consortium expects 129Xe MRI to be FDA approved any moment now, which allow for better diagnoses, treatment planning and treatment assessment of CS. This increases the potential of the 129Xe MRI clinical translation for better treatment of patients with different diseases. CONCLUSION: The preliminary results using 129Xe MR imaging demonstrated accurate lung damage assessment. The results from this pilot study will inform future guidelines on therapies and treatment planning, resulting in improved outcomes for COVID-19 patients.

A critical assessment of canadian earthquake monitoring and alerting practice versus the initial challenges of the 2020 COVID-19 experience

We describe the regular pre-COVID mode of operations for the Canadian National Seismograph Network and the associated monitoring, alerting, and analysis for earthquakes in Canada;we describe how the current operational posture evolved and discuss the ways in which the posture was and was not suitable to respond to the challenges and constraints of the COVID-19 situation in Canada. We find that many of the design and operation decisions that have been taken over the last several decades for earthquake monitoring in Canada, collectively driven largely by considerations of resilience and cost-effectiveness and further refined after the experience of the H1N1 pandemic, resulted in a system that continued to function effectively under lockdown conditions. There were many earthquakes in Canada that required seismologist response during the lockdown, all of which were handled remotely without issue. Specific challenges and lessons learned from the first few months of the pandemic are noted. © Seismological Society of America

Analysis of nutrition support in Covid19 critical care patients

Rationale: The aim of this analysis was to determine route and adequacy of nutrition support in patients with COVID19 during the first 7 days of admission to an intensive care unit (ICU). Methods: Nutrition parameters were collected for all patients admitted to ICU with COVID19 and compared to best practice guidelines1. Results: Of the initial 64 patients admitted to ICU for management of COVID19, all patients were assessed by a critical care dietitian. Patients who were tolerating oral diet were commenced on oral nutrition support as appropriate. Forty eight patients (75%) required enteral nutrition (EN) or parenteral nutrition (PN). The feeding route of choice for the majority of patients was EN (89.5%). In patients with gastrointestinal (GI) intolerance where strategies to optimise tolerance were unsuccessful, supplementary or total PN was used (10.5%). Energy and protein intakes during the early and late acute phase are described below. [Formula presented] The most common reason for suboptimal nutrition intake in the late acute phase was GI intolerance, affecting 27% of patients. Compared with those without GI intolerance, patients who experienced feed regurgitation, vomiting or high gastric residual volumes achieved significantly less energy and protein intakes (p≤0.05). Proned position did not affect GI tolerance in our cohort (p=0.65). Conclusion: Energy intakes in the early acute phase were consistent with best practice guidelines while protein provision was a challenge in both phases. GI intolerance was common which compromised nutrition intakes, though proned position did not affect these outcomes. Where strategies to improve GI tolerance are unsuccessful supplementary PN should be considered without delay to optimise nutrition intake. References: 1Singer et al. Clinical Nutrition (2019) 38(1), 48-79. Disclosure of Interest: None declared.

Weight status of patients admitted to an Intensive Care Unit for management of COVID19

Rationale: Obesity has been proposed as a risk factor for severe illness and invasive ventilation in patients with COVID191. Additionally, malnutrition is highly prevalent in critically unwell patients, regardless of baseline weight status2. The aim of this analysis was to determine the baseline weight status and weight change in patients admitted to an intensive care unit (ICU) for management of COVID19. Methods: Baseline weight on admission to ICU was collected from the records of all patients admitted with COVID19. Weight change during ICU admission was calculated for patients who survived and had an ICU length of stay (LOS) ≥ 5 days. Results: Sixty four patients were admitted to the ICU for management of COVID19 (mean age 60.6yrs (range 21-90yrs), 66% male, mean ICU LOS 16.5 days (range 1-71days)). Weight status in this cohort is presented below. [Formula presented] 69% of patients experienced at least 5% weight loss during ICU admission and 31% had greater than 10% weight loss, despite provision of nutrition support. Conclusion: Overweight and obesity were prevalent in patients admitted to our ICU for management of COVID19. Significant weight loss in this cohort confirms that malnutrition and obesity co-exist in critically unwell patients. These findings are consistent with emerging data from other centres internationally3 and inform appropriate nutritional management of this cohort of critically ill patients. References: 1Simonnet et al. Obesity (2020) 28: 1195-1199, 2Lew et al. JPEN (2017) 41(5):744–58, 3House et al., ICNARC 2020. Disclosure of Interest: None declared.