COVID-19 in patients with Pulmonary Alveolar Proteinosis A European multicenter study

Background: Interruption of GM-CSF signaling leads to Pulmonary Alveolar Proteinosis (PAP), occasionally to lung infections and relates to the impaired ability of lung macrophages to catabolize phagocytized surfactant and handle microbes. COVID-19 is associated with worse prognosis in lung disorders. We hypothesized that PAP patients would be at increased risk for COVID-19 and poor outcome. Aim and objectives: This multi-center, retrospective, European study aimed to investigate prevalence and clinical consequences of COVID-19 in PAP and the impact of iGM-CSF treatment on hospitalization or death. Method(s): All patients with PAP and COVID-19 diagnosed and followed-up in 11 referral European centers from January 24th 2020 to August 31st 2021 were included. Prevalence, clinical course and outcome were investigated. Result(s): COVID-19 developed in 34/255 (13.3%) of patients, mostly adults (91.2%), all with autoimmune (a)PAP;all patients were infected before the preventive option of vaccination was available;11 (35.5%) were hospitalized, of whom almost half were in the ICU;3 (27%) of hospitalized patients either died or underwent lung-transplant;these three patients had worse DLCO% predicted (p=0.019) and had more often arterial hypertension (AH) (p=0.012), and a smoking history (p=0.002). All patients with mild disease treated at home survived. Among children, 3 developed COVID-19 with good outcome. Conclusion(s): PAP patients experienced similar rates of COVID-19 with the general population but increased rates of hospitalizations and deaths, underscoring the vulnerability of this population and the necessity of preventive measures to avoid infection. If infected, secondary prophylaxis with monoclonal antibodies and the impact of iGM-CSF must be considered.

Effects of early physical therapy in acute severe COVID-19 pneumonia

Introduction: Rehabilitation in subjects with severe coronavirus disease 2019 (COVID-19) pneumonia has been widely recommended. However, data regarding the starting time of rehabilitation, subjects and healthcare workers safety are limited. We aimed to assess the safety and characterize the effect of early and non-early physiotherapy on severe COVID-19 pneumonia subjects. Method(s): Retrospective cohort study including a consecutive sample of surviving subjects admitted to an acute care hospital due to severe COVID-19 pneumonia from March 13th to May 15th of 2020. Subjects were separated into three groups: non-physical therapy, early physiotherapy (onset <7 days of admission), and non-early physiotherapy. Subject and therapist safety, and length of hospital stay were the main evaluated outcomes. Result(s): A total of 159 subjects were included (72% male;median age 62 years). Rehabilitation was performed on 108 subjects (32 early and 76 non-early physiotherapy). The length of hospital stay was 19 (IQR 36.25) and 34 days (IQR 27.25) (p=0.001) for early and non-early physiotherapy groups, respectively. No physiotherapist was infected and no subject adverse effect was identified. Multivariate analysis of subjects receiving physiotherapy during admission identified obesity (Odds ratio [OR] 3.21;p-value 0.028), invasive mechanical ventilation (OR 6.25;p-value <0.001) and non-early physiotherapy (OR 3.54;p-value 0.017) as independent factors associated with a higher risk of prolonged hospital stay. Conclusion(s): Rehabilitation in acute severe COVID-19 pneumonia is safe for subjects and healthcare workers, and could reduce the length of hospitalization stay, especially in those that may start early.

Respiratory consequences after COVID-19: outcome and treatment.

The SARS-CoV-2 (COVID-19) pandemic represents the infection with the highest lethality, but also the one that has caused the most sequelae and multi-organ consequences, especially respiratory, in the last century. Several actions have been required in the field of respiratory and intensive care medicine to reduce mortality and chronicity. The consequences of COVID-19 are multiple and encompass different physical, emotional, organizing, and economic aspects, which will require a multidisciplinary, transversal, and collaborative approach. This review includes the observations and results of published retrospective and prospective studies on post-COVID19 respiratory sequelae, especially after severe pneumonia with associated adult respiratory distress syndrome (ARDS).

Late Breaking Abstract - Lung ultrasound for severity assessment and outcome prediction of COVID-IQ patients

Introduction: Coronavirus disease 2019 (COVID-19) patients can develop severe bilateral pneumonia leading to acute respiratory failure. Lung ultrasound (LU) might be a useful tool for the evaluation of these patients. LU Score (LUS) is a twelve-zone examination method for the assessment of lung parenchyma. Aim: To evaluate LUS as a tool for severity assessment and outcome prediction of COVID-19 patients. Methods: Observational and prospective pilot study, including patients admitted to the Intermediate Respiratory Care Unit (IMCU) of Bellvitge University Hospital (Barcelona, Spain). LUS scored from 0-36 points using a convex transducer. Patient data was collected at inclusion. A composite outcome of death or Intensive Care Unit (ICU) admission was used. Patients were followed-up until composite outcome was observed or hospital discharge. Patients were stratified in two groups using LUS>24 as the cut-off point. Results: Thirty-six patients were included. Of them, 69.4% were male. Mean age was 60.2±12.8 years. Median LUS was 23.5 points. A cut-off point for LUS>24 showed 100% sensitivity, 69.2% specificity and AUROC 0.846 for identifying patients with worse prognosis. The composite outcome was observed in 10 (55.6%) patients of the LUS>24 group but not in the LUS<24 group (p<.001). Survival at 7 days from LU was 50% (95%CI 31.5-79.4%) among patients with LUS>24 points. Significant correlations were observed between LUS and Sp02/Fi02 ratio, serum D-Dimer, C-Reactive protein, lactate dehydrogenase and lymphocyte count. Conclusion: LU is a useful tool for the assessment of COVID-19 severity in patients admitted to an IMCU. A LUS>24 points is related to worse prognosis defined as ICU admission requirement or death.

Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) Consensus for post-COVID-19 Clinical Follow-up

SARS-CoV-2 infection can cause a range of respiratory sequelae, especially in patients who have had severe Covid-19 pneumonia. Given the high number of patients who have developed this infection over a short period of time, numerous post-Covid-19 follow-up visits are being carried out, but no clinical follow-up protocol has been established to advise on the complementary tests to be performed and the frequency of these procedures. This consensus document was drawn up by professionals from different areas of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) in order to assist the clinician in identifying possible respiratory complications that may occur during the months following the acute disease, and to protocolize their follow-up and additional tests to be performed. It recommends examinations and interventions to be carried out at various stages in the post-Covid-19 period, and details the specific objectives of these procedures. Primarily, we aim to ensure that patients receive timely clinical follow-up, following a pre-established schedule that takes into account the severity of the disease and the likelihood of long-term sequelae. Another objective is to avoid overloading the health system by eschewing examinations and/or consultations that are, in many cases, unnecessary. Finally, we define criteria for referring patients with specific established sequelae (interstitial lung disease, pulmonary vascular disease, bronchiectasis) to the corresponding specialized units.