Longitudinal 129xe and 1h Lung Mri Assessment of Lung Structure, Ventilation, Perfusion, and Gas Transfer Following Hospitalization with Covid-19

The long-term effects of coronavirus disease 2019 (COVID- 19) pneumonia on the lungs and pulmonary circulation require further characterization. We assessed progression of pathophysiological pulmonary changes during 1 year of follow-up of patients who had been hospitalized because of COVID-19. After discharge, recruited patients had up to four MRI examinations at a median of 6 (n=9), 12 (n=9), 25 (n=7) and 52 (n=3) weeks. Lung MRI examinations included: ultra-short echo time (UTE), dynamic contrastenhanced (DCE) lung perfusion, 129Xe diffusion weighted (DW-MRI), 129Xe ventilation and 129Xe 3D dissolved phase imaging. Nine patients (age 56 +/-9 years;six male) were recruited. Ventilation defect percentage and whole lung coefficient of variation of lung ventilation decreased significantly at 25 weeks (visit 3) compared with visit 1 at 6 weeks (p=0.010 and p=0.048). The UTE imaging indicated no evidence of lung scarring, and DW-MRI indicated normal lung microstructure across all visits. Dissolved phase xenon imaging showed that RBC:TP increased significantly at visits 2 and 3 compared with visit 1 (p=0.048). Median RBC:TP was abnormally low at all visits compared with reference age- and sex-matched data. An individual's RBC:TP was associated significantly and positively with an increase in their pulmonary blood volume (p=0.026). For patients with 52-week data available, one showed a continued improvement in RBC:TP;however, two of the patients maintained a low RBC:TP. In patients recovering from COVID-19, xenon gas transfer improves alongside pulmonary blood volume. Further work is needed to establish the proportion of post-COVID-19 patients who have longer-term impairment in xenon transfer and to correlate changes in lung MRI parameters with symptoms, lung function tests and other imaging modalities. Persistent impairment of xenon transfer might represent a physiological mechanism underlying ongoing symptoms in some patients and might indicate damage to the pulmonary microcirculation.

Initial Efforts to Manage IPE during the COVID-19 Pandemic: Reports from the Big Ten Academic Alliance

Purpose: The COVID-19 pandemic required higher education institutions to quickly transition to a virtual platform. This was challenging for those involved in interprofessional education (IPE), given the goal that students from two or more professions learn about, from, and with one another. The Big Ten IPE Alliance is a subgroup of the larger Big Ten Academic Alliance. The purpose of this paper is to share the collective experiences of multiple large, research intensive universities in addressing the challenge of implementing IPE programs under the conditions established by the COVID-19 pandemic. Methods: To better understand how the Big Ten schools dealt with the transition to virtual learning for didactic and clinical IPE given the COVID-19 pandemic, a subset of representatives from the Big Ten IPE Alliance met to discuss best practices for virtual learning in the IPE realm. Each participating university completed an electronic 14 question survey related to their IPE curriculum during the COVID-19 pandemic from March 2020 thru August 2020 and the responses were analyzed. Results: Four categories were identified as needing to be addressed to develop and implement successful interprofessional didactic and clinical experiences. The categories identified included content/assessment, virtual technologies, faculty and facilitators, and learners. Conclusions/Recommendations: Consider including authentic and innovative mechanisms to deliver IPE experiences that meet the learning needs and accreditation requirements. Interinstitutional collaborations such as within the Big Ten IPE Alliance can be beneficial in assessing current and future best practices in IPE.

IMPROVING COMMUNICATION ON MEDICAL WARD ROUNDS IN PATIENTS WITH LIMITED ENGLISH BY IMPLEMENTING MEDICAL COMMUNICATION CHARTS

Aim To improve communication on the medical ward round with patients with limited English through implementation of a medical communication chart. Introduction King’s College Hospital (KCH), London, is situated in Southwark in which 11% of households have no members that speak English as a first language, 4.1% of London’s population report they do not speak English well. Language barriers impair healthcare delivery including during daily ward rounds. This has been exacerbated by the need for PPE during the SARS-CoV2 pandemic. Effective communication between healthcare teams and patients is essential for high quality, patient-centred care. Communication tools commonly used include online, telephone and face-to-face translation services but these have limitations. Method Face-to-face patient questionnaires were conducted in the pre-QIP (baseline) group to assess communication on medical ward rounds. Medical communication charts were designed by adapting pre-existing aids commonly used by speech and language therapy. Charts were translated into commonly spoken languages among KCH inpatients. Patients with limited English were selected from both COVID-19 and non-Covid wards. Pre-intervention and post-intervention questionnaires were completed in three Plan–Do–Study–Act (PDSA) cycles. Results At baseline, patients agreed or strongly agreed that the ward round addressed physical symptoms (8/8), concerns or anxieties (7/8), ongoing needs (7/8). Only 2/8 doctors felt they could communicate effectively with patients. In PDSA 1, 4/5 patients reported high satisfaction in communicating physical symptoms, anxieties or concerns pre-intervention with 5/5 post-chart implementation. 5/5 patients reported high satisfaction in communicating ongoing needs pre-intervention but only 3/5 post-intervention. In PDSA 2, 2/5 patients reported increased satisfaction in communicating physical symptoms, concerns or anxieties with 4/4 doctors reporting improved satisfaction in communication in PDSA 2 and 2/3 doctors reporting higher satisfaction in communication in PDSA 3. Conclusion Medical communication charts can help in delivering high-quality, patient-centred care in multicultural and multilingual healthcare settings within the NHS.

The relationship between symptoms and functional physiological outcomes in survivors of severe COVID-19 pneumonia

P136 Table 1Results of correlation analysis Correlation analysis 4MGS 1STSreps SpO2% desaturation Results r p-value r p-value r p-value Pre-COVID mMRC dyspnoea score 0(0–1) -0.267** <0.001 -0.285** <0.001 -0.108 0.094 Post-COVID mMRC dyspnoea score 1(0–2) -0.442** <0.001 -0.457** <0.001 -0.143* 0.025 NRS breathlessness 3(0–5) -0.287** <0.001 -0.406** <0.001 -0.490 0.445 NRS fatigue 3(0–5) -0.315** <0.001 -0.379** <0.001 -0.190* 0.003 NRS cough 0(0–2) -0.660 0.292 -0.153* 0.017 0.083 0.194 NRS pain 1(0–4) -0.278** <0.001 -0.346** <0.001 -0.188* 0.003 NRS sleep difficulty 2(0–5) -0.246** <0.001 -0.386** <0.001 -0.122 0.057 Data are presented as median (interquartile range) or frequency (proportion%;95% confidence interval). SpO2% desaturation = SpO2% desaturation from baseline during 1 minute sit to stand test;1STSreps = repetitions per minute during 1 minute sit to stand test;4MGS = 4 metre gait speed;mMRC = modified Medical Research Council;NRS = 0 – 10 numerical rating scale;r = Spearman correlation coefficient. *indicates statistical significance at 0.05 level. **indicates statistical significance at 0.001 level.ConclusionRespiratory symptoms were not strong predictors of 4-metre gait speed and 1-minute sit-to-stand test performance. These data highlight the importance of face-to-face testing to objectively assess functional limitation in patients recovering from severe COVID pneumonia.

Early supported discharge with Domiciliary Oxygen and Integrated Respiratory Team (DO-IRT) care for hospitalised SARS-CoV2 patients

P22 Table 1Clinical characteristics of patients in DO-IRT pathwayResults24(22%) of 109 referred inpatients were accepted onto DO-IRT;22/24(92%) for oxygen weaning and 2/24(8%) for LTOT. Clinical characteristics are shown in table 1. Majority of declined referrals (55%) were patients who were above target saturations on oxygen and were supported to wean to air by IRT as inpatients. Duration on DO-IRT pathway was mean (SD) 16.3(7.2) days;median (IQR) length of stay saved for the oxygen weaning cohort were 9 (7–13) days. All-cause 30-day mortality and readmission rates on DO-IRT were 0% and 21% respectively. 14(58%) patients completed the satisfaction survey;14(100%) reported confidence in their care and were ‘extremely likely’ to recommend DO-IRT.DiscussionEarly supported discharge with home oxygen weaning for SARS-CoV2 pneumonia patients is feasible, safe and well-received by patients. Integrated respiratory teams with specialist oxygen expertise can make a valuable contribution to supporting acute medical flow. Future studies should investigate the feasibility of supported early discharge pathways with domiciliary oxygen in other conditions.

Clinical, functional and psychological characteristics of survivors of severe COVID-19 pneumonia: a comparison of outcomes from the first and second waves

P135 Table 1Patient demographics, self-reported scores and functional test results by wave 1st wave 2nd wave p-value Demographics n=167 n=141 Age 59±13 58±12 0.564 Female 60 (35.93;28.94–43.40) 62 (43.97;35.97–52.22) 0.15 BMI (kg/m2) 30.5 (26.6–35.2) 32.1 (28.5–37.9) 0.009 ** BAME 115 (69.7;62.39–76.32) 72 (59.5;50.62–67.94) 0.073 Number of comorbidities 2 (1–3) 2 (1–3) 0.144 Patients Receiving Drugs Dexamethasone 11 (6.63;3.57–11.17) 138 (97.87;94.43–99.40) <0.001 *** Remdesivir 18 (10.84;6.79–16.24) 81 (57.45;49.20–65.39) <0.001 *** Other Immunomodulator 2 (1.20;0.25–3.81) 31 (21.99;15.76–29.35) <0.001 *** Questionnaire Scores n=164 n=132 NRS Breathlessness 2 (0–5) 3 (0–5) 0.153 ≥4 56 (34.78;27.75–42.36) 52 (37.14;29.47–45.34) 0.67 NRS Cough 0 (0–2) 0 (0–3) 0.439 ≥4 17 (10.56;6.52–16.00) 18 (13.64;8.59–20.26) 0.419 NRS Fatigue 3 (0–5) 3 (0–5) 0.867 ≥4 65 (40.63;33.24–48.35) 48 (36.92;28.99–45.43) 0.52 NRS Pain 0 (0–5) 1 (0–3) 0.682 ≥4 44 (27.50;21.03–34.78) 30 (23.08;16.48–30.86) 0.39 NRS Sleep disturbance 2 (0–5) 2 (0–5) 0.558 ≥4 52 (32.50;25.61–40.02) 49 (37.40;29.47–45.89) 0.382 Pre-COVID-19 mMRC 1 (0–2) 1 (1–2) 0.478 Post-COVID-19 mMRC 0 (0–1) 0 (0–1) 0.329 Post-COVID-19 mMRC ≥2 66 (40.99;33.61–48.70) 49 (38.58;30.45–47.23) 0.678 PCFS 2 (0–3) 1 (0–2) 0.055 PCFS ≥2 80 (50.00;42.31–57.69) 51 (42.15;33.62–51.05) 0.191 PHQ-9 ≥10 32 (20.38;14.66–27.19) 29 (23.02;16.33–30.92) 0.592 GAD-7 ≥10 34 (21.38;15.56–28.24) 16 (12.80;7.81- 19.49) 0.059 TSQ ≥6 43 (27.56;21.01–34.94) 27 (22.31;15.60–30.33) 0.319 Functional Tests n=160 n=139 4MGS <0.8 (ms-1) 67 (42.41;34.89–50.19) 47 (35.07;27.38–43.40) 0.201 1STS repetitions 18 (12–23) 17 (12–21) 0.460 <2.5 percentile 96 (60.00;52.29–67.36) 108 (77.70;70.25–84.00) 0.011 * Desaturation ≥4% 52 (34.67;27.40–4 .52) 42 (32.31;24.73–40.67) 0.677 Parametric data are presented as mean ± standard deviation, non-parametric data are presented as median (interquartile range) or frequency (proportion;95% confidence interval). Statistical significance indicated by * (p<0.05), ** (p<0.01), *** (p<0.001). BMI = Body mass index, BAME = Black, Asian or minority ethnic, NRS = Numerical rating scale (0–10), mMRC = modified Medical Research Council for dyspnoea (0–4), PCFS = Post-COVID-19 functional status scale (0–4), PHQ-9 = Patient health questionnaire 9 (0–27), GAD-7 = General Anxiety Disorder-7 scale (0–21), TSQ = Trauma screening questionnaire (0–10), 4MGS = 4-metre gait speed, 1STS = 1-minute sit-to-stand.ConclusionDespite shorter admission duration, and less frequent IMV, the burden of symptoms and functional limitation experienced post-hospitalisation for severe COVID-19 pneumonia was at least as severe during Wave 2 as in Wave 1. Identification of contributing factors and impact on post-COVID rehabilitation outcomes requires further study.

Clinical, radiological, functional and psychological characteristics of severe covid-19 pneumonia survivors: A prospective observational cohort study

Introduction The 'Long COVID' syndrome, where symptoms persist beyond the acute illness with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2/COVID-19), is anecdotally described. However, a comprehensive report of clinical, radiological, functional and psychological recovery from COVID-19 is currently lacking. We present a detailed radiological, patient-reported and physiological characterisation of patients attending face-to-face assessment following hospitalisation with COVID-19 pneumonia. Methods Prospective single-centre observational cohort study at an inner-city South London teaching hospital. All patients admitted with severe COVID-19 pneumonia (admission duration-48 hours, oxygen requirement-40% or critical care admission) were invited to attend Post-COVID Clinic 6-8 weeks following hospital discharge. Primary outcome: Radiological resolution of COVID-19 pneumonitis. Secondary outcomes: Demographics and anthropometrics, inpatient clinical course, patient-reported and physiological outcomes at follow-up (symptoms, functional disability, mental health screening, 4-metre gait speed (4MGS), 1-minute sit-to-stand (STS) test). Results 119 consecutive patients attended clinic between 3rd June and 2nd July 2020, at median (IQR) 61 (51-67) days post discharge. Baseline characteristics are presented in table 1. Despite apparent radiographic resolution of lung infiltrates in the majority (RALE score <5 in 87% of patients), patients commonly reported persistent fatigue (78/115 (67.8%;95%CI 60.0-76.5)), sleep disturbance (65/115 (56.5;47.3-66.1)) and breathlessness (37/115 (32.2;25.2-40.0)). mMRC breathlessness score was above pre-COVID baseline in 55/115 (46.2;37.8-54.6). Burdensome cough was less common (8/115 (7.0;3.5-10.4)). 56 thoracic computed tomography scans were performed, of which 75% demonstrated COVID-related interstitial lung disease and/or airways disease. Significant depression (PHQ-9-9) or anxiety (GAD-7-9) were present in 20/111 (18.0;11.7-23.4) and 25/113 (22.1;15.0-29.8), respectively. The Trauma Screening Questionnaire was positive (-6) in 28/113 (24.8;18.1-31.9). Post-COVID functional scale was-2 in 47/115 (40.9;33.0-47.8). 4MGS was <0.8 m/s in 44/115 (38.3;29.6-46.1), 39/109 (34.5;26.5-41.6) desaturated by-4% during STS, 25/32 (78.1;62.5-93.1) who desaturated also had abnormal CT findings. Conclusions Persistent symptoms, functional limitation and adverse mental health outcomes are common 8 weeks after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery. Physiological testing to identify oxygen desaturation is useful for triaging patients for further investigation. Face-to-face or virtual clinical assessments are recommended to facilitate early recognition and management of post-COVID sequelae in this vulnerable cohort.

S55 Clinical, radiological, functional and psychological characteristics of severe COVID-19 pneumonia survivors: a prospective observational cohort study

S55 Table 1Baseline characteristicsAge (years) 58.7 ± 14.4 Sex Female 45 (37.8;29.4–46.2) Male 74 (62.2;53.8–70.6) Ethnicity BAME (Yes/No) 83 (69.7;61.3–78.2) White 36 (30.3;22.6–37.8) Black 52 (43.7;36.1–51.3) Asian 18 (15.1;10.1–20.2) Mixed race 5 (4.2;1.7–6.7) Other 8 (6.7;3.4–10.9) Index of multiple deprivation score (n=115) 26.6 ± 9.7 Body Mass Index (kg/m2) (n=118) 30.0 (25.9–35.2) Charlson comorbidity index 2 (1–4) Admission PaO2:FiO2 168.8 (105.9–272.3) Critical care admission 41 (34.5;26.9–42.9) COVID-19 complications None during admission 49 (41.2;33.6–48.7) Venous thromboembolism 27 (22.7;16.8–29.4) Pulmonary embolism 23 (19.3;12.6–26.1) Deep vein thrombosis 6 (5.0;2.5–7.6) Acute kidney injury 41 (34.5;25.2–43.7) Deranged liver function 17 (14.3;9.2–20.2) Delirium 18 (15.1;10.1–20.2) Data presented as mean ± SD, median (IQR) or frequency (%;95% confidence interval). Abbreviations: BAME = Black, Asian or Minority Ethnic, PaO2:FiO2 = ratio of arterial partial pressure of oxygen to fraction of inspired oxygen.Results119 consecutive patients attended clinic between 3rd June and 2nd July 2020, at median (IQR) 61 (51–67) days post discharge. Baseline characteristics are presented in table 1. Despite apparent radiographic resolution of lung infiltrates in the majority (RALE score <5 in 87% of patients), patients commonly reported persistent fatigue (78/115 (67.8%;95%CI 60.0–76.5)), sleep disturbance (65/115 (56.5;47.3–66.1)) and breathlessness (37/115 (32.2;25.2–40.0)). mMRC breathlessness score was above pre-COVID baseline in 55/115 (46.2;37.8–54.6). Burdensome cough was less common (8/115 (7.0;3.5–10.4)). 56 thoracic computed tomography scans were performed, of which 75% demonstrated COVID-related interstitial lung disease and/or airways disease. Significant depression (PHQ-9 ≥9) or anxiety (GAD-7 ≥9) were present in 20/111 (18.0;11.7–23.4) and 25/113 (22.1;15.0–29.8), respectively. The Trauma Screening Questionnaire was positive (≥6) in 28/113 (24.8;18.1–31.9). Post-COVID functional scale was ≥2 in 47/115 (40.9;33.0–47.8). 4MGS was <0.8 m/s in 44/115 (38.3;29.6–46.1), 39/109 (34.5;26.5–41.6) desaturated by ≥4% during STS, 25/32 (78.1;62.5–93.1) who desaturated also had abnormal CT findings.ConclusionsPersistent symptoms, functional limitation and adverse mental health outcomes are common 8 weeks after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery. Physiological testing to identify oxygen desaturation is useful for triaging patients for further investigation. Face-to-face or virtual clinical assessments are recommended to facilitate early recognition and management of post-COVID sequelae in this vulnerable cohort.