OLFACTORY FUNCTION AND BRAIN STRUCTURAL EFFECTS FOLLOWING SARS-CoV-2 INFECTION

Background: SARS-CoV-2 infection is accompanied by acute olfactory disturbance in as high as 70% of cases. This loss is associated with decreased olfactory bulb volume. As time passes, the anosmia tends to subside, but the OB volume decrease does not. Volume reductions in primary and secondary olfactory cortex are also seen following SARS-CoV-2 infection. Nevertheless, concurrent SARS-CoV-2 infection effects on olfactory discrimination, olfactory bulb volume, primary olfactory cortex and its targets have not been investigated. To explore this possibility, we measured olfactory discrimination, olfactory bulb volume, primary olfactory cortex and basal ganglia volume in patients who had SARS-CoV-2 infection more than 12 weeks previously, who were then divided into COVID and long-COVID groups on the basis of selfreported fatigue and concentration complaints. Method(s): This cross-sectional study included 25 post-infection and 19 demographically-matched, no-COVID control participants, we investigated effects on olfaction using NIH Toolbox Odor Identification Test and the Monell Smell Questionnaire. GM structure was assessed with voxel-based morphometry and manual delineation of high resolution (1mm3), T1- and T2-weighted MRI data. Linear regression was used to model group effects on GM structure, adjusting for age, sex, education and total intracranial volume. CAT12/SPM12 and R were used for image processing and statistical modeling. Result(s): Results. The NIH Toolbox Odor Identification Test failed to show differences among the groups. In contrast, the Monell Smell Questionnaire revealed persistently diminished and distorted smell in 50% of the long-COVID sample. Olfactory bulb volume was lower in the long-COVID group (p=0.02). Primary olfactory cortex volume was reduced in the long-COVID group (p=0.004). Caudate volume was also lower in the long-COVID group (p=0.04). Conclusion(s): Conclusions. In the absence of olfactory discrimination problems, long-COVID, but not COVID, patients experience persistent olfactory loss and distortion. These perceptual problems are associated with lower olfactory bulb, primary olfactory cortex, and caudate volume, suggesting that the effects of SARS-CoV-2 infection can extend beyond the olfactory periphery in some cases to affect central targets. (Figure Presented).

Antibody Response to Sars-Cov-2 Vaccination in Adolescents Following Solid Organ Transplantation

Serological responses to Covid-19 vaccines in adults post solid organ transplant are impaired [1]. We sought to measure antibodies to SARS-CoV-2 in adolescents post lung, heart, kidney-liver and kidney transplant following the vaccine rollout to 12-17 year-olds in the UK. We measured anti-spike, receptor binding domain and nucleocapsid IgG in adolescents attending our centre for routine drug monitoring after Pfizer/BioNTech BNT 162b2 was made available in autumn 2021, and collected information on prior infection from electronic records and via patient/parent recall. Samples were obtained from 42 participants, with paired samples pre and post vaccine in 14 patients. 52% had serological evidence of past exposure at baseline (fig 1). Receptor binding domain IgG was positive in all subjects at follow up, with spike IgG positive in 13/14 (p<0.001, fig 2). Individuals who had received vaccine and been infected had higher levels of spike IgG than those who had been infected and unvaccinated (p<0.05). All subjects demonstrated antibody responses to vaccine, and vaccine increases antibody levels in adolescents who have also had a SARS-CoV-2 infection in comparison to the unvaccinated. These data support an age-related relationship to antibody responses in post solid organ transplant recipients and support efforts to increase vaccine uptake in this at-risk group. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Nutrition Support in the Intensive Care Unit during the COVID19 pandemic

The aim of this analysis was to determine nutrition support needs and characteristics of COVID19 patients assessed by critical care dietitians during the COVID19 pandemic. Nutrition parameters were collected for all patients admitted to the intensive care unit (ICU) with COVID19 with length of stay (LOS) >48hrs. Data was compared from March-June 2020 (T1) to January-April 2021 (T2). The patients who met the inclusion criteria (n=64 in T1 and n=77 in T2) were assessed by a critical care Dietitian: 100% required nutrition support. Mean age in T1 was 60.6yrs (66% male) compared to 63.1yrs in T2 (62% male). Mean BMI was 29.6kg/m2 vs. 30.2kg/m2. In T1 72% required mechanical ventilation vs. 78% in T2, remainder on non-invasive ventilation (NIV). Average ICU LOS was 16days in T1 and 25days in T2. During T1 78% transferred to ward level care, 48% in T2 and all these patients required on going dietetic input at ward level. In T1 41% were discharged from ICU on enteral nutrition which increased to 48% in T2. Type of nutrition support during ICU stay is described in the table below. [Formula presented] All COVID19 patients with and ICU LOS >48hours were assessed by a critical care Dietitian. Patient profile was similar in both cohorts and all required nutrition support either by ONS, EN, PN or a combination of these. All patients on NIV required ONS with increasing numbers being commenced on supplementary EN in T2. More patients also required supplementary PN in T2. On transfer to ward level care 100% of patients required nutrition support highlighting the need for on-going dietetic input. Disclosure of Interest: None Declared

Applying learning from 1st to the 3rd wave of the COVID19 pandemic: nutritional provision in critical care

The aim of this analysis was to compare route and adequacy of nutrition support in patients with COVID19 admitted to an intensive care unit (ICU) between March-June 2020 (T1) compared to January-April 2021 (T2). Parameters related to nutrition support were collected from the records of all patients admitted to ICU with COVID19 with length of stay of ≥7days on mechanical ventilation requiring artificial nutrition support. Data was collected during the late acute phase which was defined as day 4-7 post intubation. Energy and protein intake was compared to calculated estimated nutritional requirements. 35 patients met the inclusion criteria in T1, 94% were on enteral nutrition (EN), 3% parenteral nutrition (PN) and 3% EN+PN. In T2, there were 54 patients (92% EN, 2% PN and 6% EN+PN). [Formula presented] Of patients who achieved <70% of energy and protein requirements in T1 (n=17) 35% had constipation or ileus and 47% had GI intolerance (high gastric residual volumes or vomiting). In T2 (n=19), 84% experienced constipation or ileus and 63% had GI intolerance. 35% of patients in T1 had hypernatraemia vs. 47% in T2 and 41% in T1 had hyperglycaemia vs. 100% in T2 despite only 12% and 32% of patients respectively having a history of diabetes. Despite a higher incidence of GI intolerance in T2, a statistically significant improvement in achieving energy targets was noted. Learning from T1 showed that where strategies to improve GI tolerance are unsuccessful supplementary PN should be considered without delay to optimise nutritional intake. There was a clinically significant trend in protein intake which may be attributed to prompt initiation of modular protein supplements or perhaps an earlier transition from fat-based sedation. Meeting protein requirements while preventing overfeeding remains a challenge in the ICU. Disclosure of Interest: None Declared

Nutrition in critical care: An audit of protein and energy intakes compared to international recommendations

Adequate protein and energy provision in critical care is associated with better clinical outcomes. The aim of this audit was to evaluate compliance with achieving recommended protein and energy targets in our Intensive Care Unit (ICU) and to explore the reasons for any deficits identified. Nutrition parameters were collected on patients admitted to our ICU between March and May 2021. Inclusion criteria were requirement for nutritional support and mechanical ventilation with an ICU length of stay ≥ 4 days. Patients with COVID19 were excluded. Protein and energy intakes were compared to best practice guidelines1. 51 patients met the inclusion criteria: 53% male, 47% female. Mean age was 59.6 years and mean length of stay was 19.9 days (range 5-61 days). Protein and energy intakes achieved as follows: [Formula presented] Of the patients who received < 80% of their nutritional requirements, the main barriers to achieving targets identified were fasting and constipation in this cohort. Cumulative deficit ranged from 0 - 903g protein and 0 - 12717kcal over duration of ICU stay. Mean deficit was 315g protein and 2945kcal. Of concern, 12 patients had a deficit of > 500g protein and 7 patients had > 5000kcal deficit. While 69% of patients met ≥ 80% protein requirements and 77% of patients met ≥ 80% energy requirements, we have identified areas to consider to improve nutritional adequacy including increasing awareness of minimising fasting times and the introduction of a bowel management protocol. References 1. Singer P, Blaser AR, Berger MM. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019 1;38(1):48-79. Disclosure of Interest: None Declared

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

University student experiences of work-based placements during COVID-19 pandemic: an inter-disciplinary survey of allied health and social work students

Purpose: Work-based placements are central to the university education of allied health and social work (AHSW) students. As a result of COVID-19, the clinical learning environment of students' work-based placements was dramatically altered resulting in numerous documented challenges. This inter-disciplinary study aimed to evaluate AHSW students' perceptions and experiences of completing a diverse range of work-based placements during COVID-19. Design/methodology/approach: This study was a mixed-method inter-disciplinary study using an anonymous online survey consisting of multiple choice, Likert scale and free text questions. Mixed-methods design supported amalgamation of insights from positivism and interpretivism perspectives and enabled research questions to be answered with both breadth and depth. 436 students were invited to participate who were enrolled in five AHSW educational university programmes: speech and language therapy, occupational therapy, physiotherapy, radiation therapy and social work. Data collected was analysed using both quantitative (descriptive and analytical statistics) and qualitative (thematic analysis) methods. Findings: 118 students participated (response rate: 27%) representing a range of AHSW disciplines who attended diverse placement settings. While there was extensive disruption in the learning environment leading to increased levels of stress and concern, a triad of individual and systemic supports helped to ensure positive work-based placement experiences and student success for the majority of AHSW students during COVID-19: (1) university preparation and communication;(2) placement site and supervisor support;and (3) students' resilience and capacity to adapt to a changed work-place environment. Originality/value: This inter-disciplinary study reports the work-based placement experiences from the professional education programmes of healthcare students during the COVID-19 pandemic, giving a unique view of their perspectives and learning during this unprecedented crisis. © 2022, Duana Quigley, Claire Poole, Sinead Whiting, Erna O'Connor, Claire Gleeson and Lucy Alpine.

General practice attendances among patients attending a post-COVID-19 hospital clinic: A pilot study

Background: About 10-35% of people with COVID-19 merit medical care within 3 weeks of infection. However, the prevalence of ongoing care needs among individuals experiencing severe COVID-19 illness is unclear. Research question: What is the prevalence of ongoing care needs among severe COVID-19 patients? Methods: This pilot study applied a cross-sectional design whereby data was collected from adult patients attending a post-COVID-19 follow-up clinic at the Mater Misericordiae University Hospital, Dublin, Ireland, 3-6 months after their initial presentation at the clinic. Participants completed questionnaires documenting their demographics, medical histories, hospital admissions/re-admissions where applicable, and where relevant, primary care service use following hospital discharge. Analyses were conducted using descriptive/inferential statistics. Results: Participants' (n=153) median age =43.5 (IQR =30.9-52.1). There were 105 females (68.6%) and 48 males (31.4%). Various medical histories were reported among participants. 67 (43.2%) reported being admitted to the hospital for COVID-19. Older individuals, males, ICU admissions, and re-admissions were common among hospital attendees. Of the hospital attendees, 16 (24%, 95% CI =13.7-34.2%) and 26 (39%, 95% CI =27.3-50.7%) attended general practices within seven and 30 days of hospital discharge. Older adults (median age =49.8 years), people with pre-existing medical conditions, and individuals admitted to ICU/readmitted to hospital were common among general practice attendees. Conclusion: Persistent health issues appear to be common among patients who experienced severe COVID-19 illness. Older adults, people with pre-existing health problems, and individuals who received ICU and/or re-admission care may have greater long-term care needs requiring attention.

Nationwide strategies employed to provide and integrate palliative care to patients with covid-19

Background: Little is known on what palliative care (PC) has been provided to patients with COVID-19. Aims: To understand what PC was provided nationwide to patients with COVID-19 and strategies implemented to overcome barriers during the pandemic. Methods: Semi-structured interviews were conducted with physicians across Canada about their experiences providing PC to patients with COVID-19. Thematic analysis was used to describe and interpret overarching themes. Results: Twelve specialized PC (SPC) and 11 primary PC (PPC) were interviewed. Interim analysis of 16 coded interviews demonstrated SPC and PPC physicians used traditional strategies (such as opioids, oxygen and serious illness conversations) to manage symptoms, support end of life, and engage patients and families in goals of care conversations (GOC). Neither SPC nor PPC indicated strong adoption of GOC and symptom management tools circulated early in the pandemic. Both SPC and PPC indicated a shift to virtual communication due to restrictive visitor policies, highlighting the need for distanced support and planned communication. Care coordination for PC patients was challenged by a lack of community resources, family infected with COVID-19, prolonged hospital stays, and increased number of PC patients discharged to rehabilitation services. New PC structures included;GOC teams that functioned in the emergency department and medicine floors, integrated clinical rounding by non-PC clinicians with PC teams, and hospital-based PC outreach to long term care. Strategies to improve PC implementation included: virtual technologies, team collaboration, patient and family engagement tools, and symptom management and GOC conversations tools. Conclusions: While PC management approaches to support patients with COVID-19 were mostly unchanged, new structures and strategies were developed to ensure patients and their families were provided with support.

Home spo2 monitoring of patients with covid-19: The mater cvc project

Background: The COVID19 pandemic has necessitated innovative ways to provide safe healthcare remotely for large numbers of infected patients. We implemented a COVID Virtual Clinic (CVC) in a tertiary referral centre allowing such patients to be monitored in the community. This study describes the CVC's remote monitoring experience and explores the predictors of need for specialist intervention. Methods: We included all patients enrolled in the CVC at the Mater Misericordiae University Hospital, Dublin between March 1st and June 1st 2020. Patients received a Bluetooth-enabled pulse oximeter and smartphone application (Patient-M-Power®) and uploaded twice-daily SpO2 readings, heart rate and dyspnoea score (1-10). A team of 2-14 healthcare providers monitored results. Abnormal or absent data triggered calls from the CVC, with assessments and/or admission as required. We collected data on demographics, calls received from/made to patients, outcomes and readmissions. Descriptive analysis of the CVC was performed as well as simple logistic regression to explore factors associated with the likelihood of readmission. Results: 502 patients were included (179 (36.4%) male, median age 39 (IQR 50-3) years, 360 (73.2%) staff). Outcomes are illustrated in Figure 1. Median time in CVC was 12 days (IQR 13-10). 1902 calls were made to patients by CVC staff prompted by abnormal data: dyspnoea (41 patients, 8.2%), low SpO2 (133, 26.5%), tachycardia, (99, 19.7%), technical issues (81, 16.1%), absent results (255, 50.1%). This resulted in 45 (9%) patients requiring re-assessment and 42 (8.4%) being readmitted. Of those readmitted, 3 (7%) required critical care admission. Median length of stay was 2 (IQR 6.75-1) days. Those readmitted were more likely to be older (odds ratio [OR] per year older 1.03 (1.01, 1.05), P=0.0050, have an abnormal SpO2 (<94%, OR 5.43 [2.93, 11.1], P<0.001), a high dyspnoea score (>7, OR 4.33 (2.04, 9.3), P<0.001) and be staff (OR 6.08 (3.11, 11.87), P<0.001). Neither gender nor abnormal HR were associated with higher likelihood of readmission. 22.2% of presenting patients were hypoxic in the absence of dyspnoea, of which 70% required admission and one patient required intensive care. Conclusion: We describe the largest remotely monitored cohort of COVID19 patients to date. The low frequency of readmissions and value of SpO2 monitoring and dyspnoea scores as predictors of readmission highlights the value of this model in providing safe care whilst minimising unnecessary admissions.

A model for occupational stress amongst paediatric and adult critical care staff during COVID-19 pandemic.

PURPOSE: The coronavirus 2019 pandemic has placed all intensive care unit (ICU) staff at increased risk of psychological distress. To date, measurement of this distress has largely been by means of validated assessment tools. We believe that qualitative data may provide a richer view of staff experiences during this pandemic. METHODS: We conducted a cross-sectional, observational study using online and written questionnaires to all ICU staff which consisted of validated tools to measure psychological distress (quantitative findings) and open-ended questions with free-text boxes (qualitative findings). Here, we report our qualitative findings. We asked four questions to explore causes of stress, need for supports and barriers to accessing supports. A conventional content analysis was undertaken. RESULTS: In total, 269 of the 408 respondents (65.9%) gave at least one response to a free-text question. Seven overarching themes were found, which contribute to our proposed model for occupational stress amongst critical care staff. The work environment played an important role in influencing the perceived psychological impact on healthcare workers. Extra-organisational factors, which we termed the "home-work interface" and uncertainty about the future, manifested as anticipatory anxiety, had a proportionally larger influence on worker well-being than would be expected in non-pandemic conditions. CONCLUSION: Our findings have important implications for appropriate allocation of resources and ensuring well-being of the ICU multidisciplinary team for this and future pandemics.

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.