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1.
Chest ; 162(4):A2265, 2022.
Article in English | EMBASE | ID: covidwho-2060927

ABSTRACT

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: SARS-CoV-2 infection can lead to persistent, long-term sequelae after recovery from the acute disease process. One such reported sequelae is reduced exercise capacity (i.e., low peak pulmonary O2uptake;V̇O2peak). However, only cross-sectional approaches that did not account for baseline (i.e., before COVID-19) V̇O2peak support this assumption. As such, whether reduced exercise capacity is a consequence of or in fact predates SARS-CoV-2 infection remains unknown. Accordingly, we compared the cardiopulmonary responses to maximal incremental exercise (CPET) before and after COVID-19. Specifically, we determined whether COVID-19 is associated with a decrease in V̇O2peak. METHODS: We retrospectively reviewed CPET data collected across the Mayo Clinic Enterprise between Oct 2018 and Mar 2022. 42 individual patients who completed a CPET before and after a COVID-19 diagnosis were included (36, 4, and 2 patients experienced mild, moderate, or severe illness, respectively). In addition, we included a control group of 25 individual patients who performed two separate CPETs but did not contract SARS-CoV-2 (CTL). All patients were clinically stable between the two CPETs, defined as no worsening/change in disease status or medication, and performed the same CPET protocol for both tests. A mixed within- and between-subjects design was used to examine differences in cardiopulmonary responses to CPET both across time and between the COVID-19 and CTL groups. RESULTS: The COVID-19 and CTL groups were matched for sex (36 vs. 32% female;P = 0.757), age (49 ± 15 vs. 50 ± 16 y, P = 0.652), BMI (29.1 ± 5.4 vs. 29.7 ± 5.2 kg/m2;P = 0.868), and time between the two CPETs (489 ± 225 vs. 534 ± 257 days, P = 0.662). In the COVID-19 group, the first and second CPET were performed 312 ± 232 days before and 176 ± 110 days after SARS-CoV-2 infection, respectively. Exercise time, peak heart rate, peak systolic pressure, O2pulse (V̇O2/heart rate), anaerobic threshold, peak ventilation, and ventilatory efficiency (V̇E/V̇CO2 slope) were not different between the groups. There was a small but significant reduction in V̇O2peak from before to after SARS-CoV-2 infection (−1.4 ± 0.5 mL/Kg/min, P = 0.038);however, the change in V̇O2peak between the two CPETs was not different between COVID-19 vs. CTL (−5 ± 13 vs. −3 ± 15%, P = 0.585). The change in V̇O2peak in the groups likely falls within the normal error of the measurement during CPET. CONCLUSIONS: Accounting for baseline measures of V̇O2peak, we find no substantial evidence for decreased exercise capacity within one to 15 months after SARS-CoV-2 infection, especially when compared to patients who did not suffer COVID-19. CLINICAL IMPLICATIONS: Our findings suggest that care may need to be taken when reporting a consequential impairment in exercise capacity secondary to COVID-19 when prior baseline (i.e., before COVID-19) data are not available. DISCLOSURES: No relevant relationships by Arvind Balavenkataraman No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Igor Fernandes no disclosure on file for Scott Helgeson;No relevant relationships by Neal Patel Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support

2.
Chest ; 162(4):A2261-A2262, 2022.
Article in English | EMBASE | ID: covidwho-2060925

ABSTRACT

SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Short- and long-term postacute sequelae of SARS-CoV-2 infection (PASC) includes a constellation of clinical symptoms that persist following recovery from COVID-19. The precise pathophysiology of PASC is unknown but likely multifactorial, and intervention strategies to combat PASC are lacking. Our aim was to investigate whether homebased exercise training (HBExT) enhances recovery of and/or improves exercise capacity, pulmonary function, symptoms, and overall health-related quality of life (HRQoL) in people with PASC. METHODS: Pulmonary function [including lung diffusing capacity for carbon monoxide (DLCO) and maximal inspiratory pressure (MIP)] and the cardiopulmonary responses to maximal incremental treadmill exercise (CPET) were assessed before and after 8-weeks of HBExT in three adults (2 males, 48 and 40 years old;1 female, 37 years old) with PASC. Symptoms (via standard questionnaire) and HRQoL (via EQ-5D-3L questionnaire) were also assessed before and after HBExT. HBExT consisted of 3-to-4 aerobic (duration 25-40 min, intensity 60-80% heart rate reserve) and 2-to-3 resistance (7 exercises, 8-12 repetitions, 2-3 sets) sessions per week, and was prescribed and tracked in each participant using a mobile application (Connected mHealth) integrated with a heart rate monitor (Polar H7). RESULTS: Time from initial SARS-CoV-2 infection to enrollment in the study (in months) and adherence rate to HBExT was 8 and 66%, 4 and 71%, and 3 and 100% for the three participants. Before to after HBExT, there was a 13 ± 7% increase in exercise time (12.6 ± 2.0 vs. 14.1 ± 1.3 min) and a 14 ± 9% increase in peak O2 uptake (V̇O2peak;27.6 ± 2.8 vs. 31.5 ± 2.5 ml/kg/min) during the CPET. Neither the heart rate nor the pulmonary gas exchange (V̇E/V̇CO2, PETCO2, SpO2) response to CPET was different before vs. after HBExT. Conversely, peak-exercise breathing reserve was lower (13 ± 16 vs. 30 ± 11 L/min) and O2pulse was greater (16.3 ± 1.2 vs. 13.8 ± 0.2 ml/beat) following HBExT. No remarkable changes in pulmonary function or DLCO were noted after HBExT;however, there was a 16 ± 12% increase in MIP from before to after HBExT (74 ± 21 vs. 85 ± 18 cmH2O). After HBExT, a fraction of the participants reported resolution of persistent fatigue (n = 1), breathlessness (n = 2), chest tightness (n = 1), palpitations (n = 1), and dizziness (n = 2), and overall health score (via EQ-5D-3L) was increased (42 ± 34 vs. 81 ± 6;100 = ‘best health imaginable’). CONCLUSIONS: Prescribed exercise training may increase exercise capacity and inspiratory muscle strength, alleviate persistent symptoms of fatigue and breathlessness, and improve overall HRQoL in people with PASC. CLINICAL IMPLICATIONS: Exercise-based therapy may improve functional capacity and partially alleviate persistent symptoms in people with PASC, strengthening calls for cardiopulmonary rehabilitation as a potential therapeutic intervention in such individuals. DISCLOSURES: No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Isabel Cortopassi No relevant relationships by Igor Fernandes No relevant relationships by Scott Helgeson No relevant relationships by Elizabeth Johnson No relevant relationships by Augustine Lee No relevant relationships by Amy Lockwood No relevant relationships by Patricia Mergo No relevant relationships by Bala Munipalli No relevant relationships by Tathagat Narula No relevant relationships by Brian Shapiro Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support

3.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927899

ABSTRACT

Rationale: The early recognition of COVID-19 patients at high risk of clinical deterioration is important to help triage, allocate resources, and improve patient care. In this study, we aimed to compare the performance of the Charlson Comorbidity Index (CCI), mSOFA, MEWS, qCSI, and PRIEST COVID-19 Clinical Severity scores in predicting risk of admission to the intensive care unit (ICU) and in-hospital mortality. Methods: This was a multicenter retrospective cohort study which included a random sample of confirmed COVID-19 patients admitted to three academic medical centers. All patients were admitted in July 2021. Patients with a positive COVID-19 polymerase chain reaction at time of admission were included. All scores were calculated within the first 24 hours of admission to the hospital. A univariate and backward multivariate logistic regression analysis were used to evaluate correlation of CCI, mSOFA, MEWS, qCSI, and PRIEST COVID-19 Clinical Severity score to the primary outcome, ICU admission, and secondary outcome, death (in-hospital). Results: One-hundred and three patients were included in this study with a median age of 59 years old (IQR 51-70). The majority were male (64.1%, n = 66) and Caucasian (81.6%, n = 84). Twenty-six patients (25.2%) required ICU admission with an in-hospital death occurring in nine patients (8.7%). In the multivariate analysis, patients admitted to the ICU were more likely to be African-American (12.96 OR;95% CI 1.49, 155.91), and of the five scores assessed, mSOFA (1.61 OR;95% CI 1.13, 2.41), MEWS (1.74 OR;95% CI 1.06, 3.09), and qCSI (1.52 OR;95% CI 1.12, 2.16) scores were associated with ICU admission. However, only mSOFA score (1.93 OR;95% CI 1.34, 3.11) was associated with in-hospital mortality. Conclusions: There are multiple scores for COVID-19 clinical deterioration that are accurate in predicting the need for ICU admission. Despite the ability to predict clinical deterioration, other scores were not associated with an increased in-hospital mortality. Interestingly, the CCI was not associated with an increased in-hospital mortality. This study provides evidence to use the mSOFA, along with other scores to accurately triage patients to a higher level of care.

4.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880829
5.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407513
6.
American Journal of Respiratory and Critical Care Medicine ; 203(9):2, 2021.
Article in English | Web of Science | ID: covidwho-1407512
7.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277783

ABSTRACT

Background: Peak flow testing is a common procedure performed in ambulatory care. There are currently no data regarding aerosol generation during this procedure. We measured small particle concentrations generated during peak flow testing. Several peak flow devices were compared to assess for differences in aerosol generation. The amount of aerosol generation should objectively inform infection control and mitigation strategies during the COVID-19 pandemic. Methods: Five healthy volunteers performed peak flow maneuvers in a particle free laboratory space. Two devices continuously sampled the ambient air during the procedure. One device can detect ultrafine particles from 0.02 - 1 micron, while the second device can detect particles of size 0.3, 0.5, 1.0, 2.0, 5.0, and 10 microns. Five different peak flow meters were compared to ambient baseline during masked and unmasked tidal breathing. Results: Ultrafine particles (0.02 - 1 micron) were generated during peak flow rate measurement. Ultrafine particle mean concentration was lowest with Respironics peak flow meter (1.25±0.47 particles/cc) and similar between Philips (3.06±1.22), Clement Clarke (3.55±1.22 particles/cc), Respironics low range (3.50±1.52 particles/cc), and Monaghan (3.78±1.31 particles/cc) peak flow meters. Although ultrafine particle mean concentration increased during peak flow measurements compared ambient baseline during masked (0.22±0.29 particles/cc) and unmasked (0.15±0.18 particles/cc) tidal breathing, these differences were small and remained well below ambient PFT room particle concentrations (89.9±8.95 particles/cc). Conclusions: In this study, we were able to establish the feasibility of measuring small particle production after peak flow testing. Our study shows that ultrafine particles are generated during peak flow measurement. Although all peak flow meters demonstrated increased mean particle concentration, differences were small compared to the mean particle concentrations found in the ambient clinical environment. Outpatient practices should be aware of the potential risk of these findings and take appropriate infection control precautions.

8.
Critical Care Medicine ; 49(1 SUPPL 1):471, 2021.
Article in English | EMBASE | ID: covidwho-1194035

ABSTRACT

INTRODUCTION: Frontline healthcare workers who perform aerosol-generating procedures (AGP) are at increased risk of exposure to SARS-CoV-2 causing COVID-19. In order to continue to care for patients with COVID-19, minimizing exposure is paramount and barrier devices are potentially the answer. Using an intubation manikin with two different barrier devices (Plexiglas intubation box and a modified horizontal drape), we evaluated the operators' experience and satisfaction with these two devices and no device METHODS: This was a single-center study that prospectively intubated a manikin three different ways, no device, Plexiglas intubation box, and horizontal drape (Snaport). Each operator completed a survey about ease of use, likelihood to use each device in the future, and any comments following all three intubations. A separate survey was sent to all providers that perform intubations in the hospital about using barrier devices while intubating RESULTS: Fifty-six participants completed the pre-survey. The majority had not previously used a barrier during AGP (64.3%), during bronchoscopy (88.5%), or transporting a patient (87.5%). Most participants would use Snaport during an AGP (85.7%) Thirty participants completed barrier testing and post-survey. The average age was 39.7 years, average years in practice 11.5, and with an average of 22.6 intubations per month. There were no intubation failures. First pass intubation success was achieved for all except for one with Snaport and two with the Plexiglas intubation box. On average, participants found that it was ?easy? to intubate with Snaport (2.3, range 1-5), that it provided enough visibility during intubation (2.8, range 1-3), and did not hinder maneuverability (1.7, range 1-2). Eighteen participants preferred Snaport (60%), seven preferred the Plexiglas box (23%), three preferred to use nothing (10%), and one participant preferred to use Snaport only if the arm slits were redesigned to allow more maneuverability CONCLUSIONS: Snaport was the provider preferred method of barrier protection for intubation. Most participants felt it provided enough visibility without compromising maneuverability. The materials to assemble Snaport are inexpensive and the design is easy to assemble. Snaport is a good option in resource-limited healthcare settings.

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