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P174 Table 1List of studies that NWCORR have undertaken since its inceptionStudy name Description Project start Project end No. of trainees involved No. of hospitals No. of patients Presentations Publications CURB-COVID-NOW Project Investigating the use of CURB65 as a prognostic score for COVID-19 patients. March 2020 December 2020 19 Trainees 9 sites 830 Patients BTS Winter Meeting Feb 2021 BMJ Open Research DOI: 10.1136/bmjresp-2020-000729 PMID: 33293361 * CPAP COVID Project Investigating ward-based oxygen therapy and CPAP in patients with COVID-19 pneumonitis August 2020 May 2021 18 trainees 7 Sites 479 Patients North West Thoracic Society March 2021 Manuscript in preparation Post inflation pneumothorax chest drain management project Investigating clamping of chest drain post pneumothorax resolution August 2020 Ongoing 7 trainees 4 sites Ongoing * Bradley P, Frost F, Tharmaratnam K, Wootton DG;NW Collaborative Organisation for Respiratory Research. Utility of established prognostic scores in COVID-19 hospital admissions: multicentre prospective evaluation of CURB-65, NEWS2 and qSOFA. BMJ Open Respir Res. 2020 Dec;7(1):e000729. doi: 10.1136/bmjresp-2020-000729. PMID: 33293361;PMCID: PMC7722817.ConclusionsThe experience of NWCORR reflects a high rate of trainee enthusiasm to participate in research alongside clinical training and highlights the potential of collaborative networks. It has enabled trainees who may not wish, or have the opportunity, for an ‘out of programme’ research post to develop research skills and interests. We believe NWCORR and other trainee research collaboratives can, and should, play a pivotal role in embedding a research culture into everyday practice, improve patient care and build early career researchers within the NHS.
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S52 Figure 1Kaplan-Meier curve comparing overall survival in the two treatment groups (conventional oxygen therapy vs continuous positive airway pressure therapy). The null hypothesis of no survival difference is evaluated with a log-rank test (p = 0.92)[Figure omitted. See PDF]DiscussionThis is, as far as we are aware, the first study comparing conventional oxygen therapy with CPAP in cohorts unaffected by physician selection. No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the continued widespread use of CPAP in this patient group.Please refer to page A189 for declarations of interest related to this abstract.
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BACKGROUND: Continuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV. METHODS: This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1st March to May 31st, and from 1st September to 31st December. Patients given CPAP were compared to patients receiving oxygen therapy that required FiO2 ≥0.4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering. FINDINGS: Seven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it. INTERPRETATION: No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting. FUNDING: L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.
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Background/AimsPatients infected with severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) may develop acute respiratory inflammation, due toan exaggerated immune response and some develop chroniccomplications. Neutrophils play a major role in the pathology ofinflammatory diseases and have been shown to contribute to lung andvascular damage in COVID-19. Our aim was to establish a relationshipbetween neutrophil phenotype and disease severity and to determinewhether neutrophil abnormalities persist in convalescent patients.MethodsPeripheral blood samples were obtained from acute COVID-19patients (n = 74), follow-up (FU) patients discharged following inpatientadmission (n = 56), a median of 87 days after discharge, and healthycontrols (HCs, n = 22). Patients were stratified by disease severitybased on inspired oxygen (FiO2) and admission to intensive care (ICU).Neutrophils were isolated from whole blood by negative selection forphenotyping and functional analysis. PBMC Isolation Tubes were usedto quantify and phenotype low density neutrophils (LDNs) within thePBMC fraction. For quantification of reactive oxygen species (ROS)production, isolated neutrophils were incubated with a ROS reactivedye, DHR-123 and stimulated with PMA. All samples were stained andfixed prior to analysis by flow cytometry.ResultsThere was a marked increase in neutrophils expressing the activationand degranulation markers, CD64 (P < 0.0001) and CD63 (P < 0.0001)and a reduction in neutrophils expressing the maturity markers, CD10(P < 0.0005) and CD101 (P < 0.0005) in patients with acute COVID-19compared to HCs. Increased frequency of neutrophils expressingCD64 (P < 0.005), CD63 (P < 0.01) and expressing decreased CD101(P < 0.0001) were also detected in FU patients compared to HCs.Notably, 42.3 4.4% of neutrophils were CD101lo in FU patients, compared to 29.0 3.7% in acute patients and 9.6 4.1% in HCs.These changes were most apparent in FU patients recovering fromsevere COVID-19 compared to mild or moderate disease. Thefrequency of LDNs in PBMCs from acute patients was significantlyhigher than HCs (P < 0.0001), and correlated with disease severity.Similarly, the frequency of LDNs in FU patients was significantly higherthan in HCs (P < 0.0005). We found a trend towards higher basal ROSproduction in acute and FU patients, but a blunted response to PMAstimulated ROS production in neutrophils from acute patients versusHCs (P < 0.0001). Impaired ROS production persisted in FU patientscompared to HCs (P < 0.01).ConclusionCirculating neutrophils in acute COVID-19 have an altered phenotypeand comprise immature and activated cells. This altered phenotypepersisted in convalescence and may contribute to the persistence ofsymptoms and an increased susceptibility to subsequent infections.Future work will aim to investigate the functional implications of thesefindings.
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Introduction The recovery of patients after COVID-19 has been poorly described. Related coronavirus infections (SARSCOV1 and MERS) have protracted recovery time-courses with significant respiratory morbidity,1 suggesting the same may be true for COVID-19. A service evaluation was therefore undertaken to evaluate the short-term effects of COVID-19. Methods Respiratory specialist doctors conducted structured telephone consultations of patients admitted between 17th March 2020 and 2nd May 2020 with a diagnosis of COVID- 19 pneumonia at a teaching hospital. Using time from discharge patients were allocated into 3 groups: 3-4 weeks, 4-5 weeks and 5+. Patients were asked to recall acute COVID-19 symptoms, current symptoms, activity levels, and exercise capacity after discharge. Exercise capacity was quantified by self-assessment of walking distance on flat (metres), stairs (flights). Patient reported outcome measures (MRC dyspnoea scale and WHO performance status) were also collated. Results A total of 102 patients were screened, 70 were included in the study, with the rest being unreachable (n=32) Cough, dyspnoea, fever and lethargy were the most common symptoms at time of admission. All these symptoms, except lethargy, improved following discharge (figure 1). Prevalence in the 5+ week cohort of other symptoms is as follows: dyspnoea 35.7%, cough 11.5%, fever 0%;however, 70% of patients had at least 1 symptom 5 weeks after discharge. Self-reported exercise capacity and MRC dyspnoea score also improved after discharge. Despite this 21.4% of patients had a persistent impairment in walking ability on the flat, 17.8% in stair-climbing with 28.5% persistent deficit in MRC dyspnoea score after 5 weeks. In contrast 40% of patients had a deficit in WHO performance status and this was not affected by time after discharge. In conclusion patients did improve following discharge from hospital for COVID-19 pneumonia, however many were left with residual symptoms and a functional deficit in short term (5 weeks). It remains to be seen whether this results in long term health problems.