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1.
Critical Care Medicine ; 51(1 Supplement):461, 2023.
Article in English | EMBASE | ID: covidwho-2190638

ABSTRACT

INTRODUCTION: ARDS net trial recommends keeping low tidal volumes (6-8 cc/IBW) and plateau pressures less than 30 cm H20. However, it is not well studied if sporadic elevation or continuous elevation of plateau pressures results in poor outcomes. We hypothesize that persistent elevation of p plat for >24 hrs. or > 6 times (measured 4 hrs. apart) continuously is associated with increased mortality. METHOD(S): Retrospective chart review of patients admitted with COVID-19 during the surge of August to September 2021 at Houston Methodist Baytown hospital. Inclusion Criteria- COVID-19 patients with respiratory failure, ards and intubated. Plateau pressures are recorded every 4 hrs. Data obtained from EPIC ICU flowsheet. Persistent elevation was defined as all the plateau pressures measured for > 24 hrs. and are continuously elevated. Exclusion criteria - patients admitted to ICU with cardiac arrest, patients who are covid negative and covid positive, but no ARDS are excluded. Tidal volume recorded is when the first highest p plateau pressure was documented. Descriptive statistics and t-tests were used to interpret the results. RESULT(S): Out of a total of 48 patients, only 12 patients survived, and 36 patients died. Mortality rate- 75%. Survivors vs. non survivors average Age(y) 42 vs.55 (p< 0.05), Tidal volume 5.98 ml/PBW vs.6.03 ml/PBW (p=0.105), Normal elastance 4.06 vs. 4.07(p=0.44), Delta P 22 vs.23(p=0.27) and ventilatory ratio 84 vs. 98(p< 0.05) were calculated during maximum plateau pressures. In patients with continuous p plat >30, 29 (85%) patients died and 5 (15%) survived. OR- 5.8 (P< 0.05). Out of the 5 patients that survived 2 went on ECMO. Intermittent p plat elevation was noted in 11 out of 14 patients who did not have continuous p plat elevation. CONCLUSION(S): Ventilatory ratio, a simple index of impaired ventilation and physiological dead space was higher in nonsurvivors compared with survivors. Continuous p plat elevation for more than 24 hrs. that is resistant to intervention might be an indirect indicator of worsening lung ventilation and increasing mortality. Rather than a single-time daily measurement of variables like delta P or p plateau pressure multiple measurements and trends might be helpful to prognosticate patients that might have poor outcomes and indicate worsening lung function.

2.
The Journal of infectious diseases ; 06, 2023.
Article in English | EMBASE | ID: covidwho-2189174
3.
Sestrinsko delo / Information for Nursing Staff ; 54(3):48-52, 2022.
Article in Bulgarian | GIM | ID: covidwho-2169900

ABSTRACT

Infection by COVID-19 is accompanied by inflammatory changes and damage to the lung, with chronic lung disease and concomitant changes in the immune response further increasing the risk of severe disease and death. The aim of the study was to investigate the incidence of COVID-19 in healthcare professionals and the impact on respiratory function. Material and methods: Respiratory function testing was conducted using spirometry, and an anonymous questionnaire survey of women in the health care field was performed. The data show that those who have recovered from the coronavirus infection are a significant part of the examined health care professionals - 86.60%. In order to prevent more serious lung damage, it is necessary to develop and quickly introduce preventive care and rehabilitation programs for all professionals who have recovered from the coronavirus infection, regardless of the severity of its course.

4.
Journal of Isfahan Medical School ; 40(678):498-508, 2022.
Article in Persian | GIM | ID: covidwho-2206927

ABSTRACT

Background: The aim of this systematic review was to evaluate and identify the latest evidence on the feasibility and accessibility of telerehabilitation services in the prevention, diagnosis, treatment and control of patients with COVID-19.

5.
African Journal of Thoracic and Critical Care Medicine ; 28(4):181-192, 2022.
Article in English | Scopus | ID: covidwho-2203074

ABSTRACT

Spirometry is required as part of the comprehensive evaluation of both adult and paediatric individuals with suspected or confirmed respiratory diseases and occupational assessments. It is used in the categorisation of impairment, grading of severity, assessment of potential progression and response to interventions. Guidelines for spirometry in South Africa are required to improve the quality, standardisation and usefulness in local respiratory practice. The broad principles of spirometry have remained largely unchanged from previous versions of the South African Spirometry Guidelines;however, minor adjustments have been incorporated from more comprehensive international guidelines, including adoption of the Global Lung Function Initiative 2012 (GLI 2012) spirometry reference equations for the South African population. All equipment should have proof of validation regarding resolution and consistency of the system. Daily calibration must be performed, and equipment quality control processes adhered to. It is important to have standard operating procedures to ensure consistency and quality and, additionally, strict infection control as highlighted during the COVID-19 pandemic. Adequate spirometry relies on a competent, trained operator, accurate equipment, standardised operating procedures, quality control and patient co-operation. All manoeuvres must be performed strictly according to guidelines, and strict quality assurance methods should be in place, including acceptability criteria (for any given effort) and repeatability (between efforts). Results must be categorised and graded according to current guidelines, taking into consideration the indication for the test. © 2022, South African Medical Association. All rights reserved.

6.
Archivos de Bronconeumología ; 2023.
Article in English | ScienceDirect | ID: covidwho-2165080

ABSTRACT

Introduction: Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. Methods: Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission;clinical and biological parameters throughout hospital stay;and, lung function and CT scan at a follow-up visit. Results: The median [p25-p75] time from discharge to follow-up was 3.57 [2.77-4.92] months. Median age was 60 [53-67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18-2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37-1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18-1.63)), urea (OR: 1.16 (0.97-1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73-1.06)). Bacterial pneumonia (1.62 (1.11-2.35)) and duration of ventilation (NIMV (1.23 (1.06-1.42), IMV (1.21 (1.01-1.45)) and prone positioning (1.17 (0.98-1.39)) were associated with fibrotic lesions. Conclusion: Age and CLD, reflecting patients' baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities.

7.
Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration ; 23(Supplement 1):189, 2022.
Article in English | EMBASE | ID: covidwho-2160824

ABSTRACT

Background: Smart phone mobile application (Breathe Easy app) with data dashboard (https://www.zephyrx.com/) receive and display results of remote FVC accelerated in use during COVID-19 pandemic. Objective(s): We assessed the reliability of FVC as reported with in-clinic Conventional (Viaire and Vyasis, USA) and inclinic portable and at-home portable (MIR Spirobank Smart, Italy) spirometers that calculated FVC as percentage of predicted values based on GLI (Global Lung Index)-2012 reference standard. Method(s): In this retrospective study, twenty-two ALS patients were analyzed from a total of 95 ALS patients seen in clinic between July 2020 and June 2021. Independent analysis of FVC % predicted values acquired with portable spirometer was performed using GLI-2012 online calculator equations based on age, height, gender and ethnicity. To confirm that the same reference standard GLI-2012 was displayed by the software application, a web-based tool was used to calculate % predicted FVC to confirm that spirometric values were standardized according to GLI-2012 (glicalculator. ersnet.org). Result(s): A third of dashboard-reported measurements were found to be 1% less than calculated measurements (29 out of 87 portable spirometry measurements) and appeared to be a fairly consistent difference in the first 1/3 of FVC followed longitudinally. Query was brought to the attention of the ZephyRx software development team. Dashboard algorithm was assessed to investigate for possible systematic error to account for the difference. The automated dashboard reporting of age using exact birth date to one decimal place on the day of testing as opposed to birth year used with manual calculations was confirmed to result in the 1% predicted difference in manually calculated FVC. Discussion(s): Reported difference in spirometric values can be due to systematic difference in spirometric reference standards or a true difference in pulmonary function (1). ALS-specific digital health technology require vetting by independent ALS neuromuscular and pulmonary researchers and quality testing needs to occur within the clinical realm (2).

8.
International Journal of Infectious Diseases ; 2022.
Article in English | ScienceDirect | ID: covidwho-2149855

ABSTRACT

Objective To describe the full scope of long-term outcomes and the ongoing pathophysiological alterations among the COVID-19 survivor. Methods We established a longitudinal cohort of 208 COVID-19 convalescents and followed them at 3.3 (IQR: 1.3, 4.4, visit 1), 9.2 (IQR: 9.0, 9.6, visit 2), and 18.5 (IQR: 18.2, 19.1, visit 3) months after infection, respectively. Serial changes in multiple physical and psychological outcomes were comprehensively characterized. We additionally explored the potential risk factors of SARS-CoV-2 antibody response and sequelae symptoms. Results We observed continuous improvement of sequelae symptoms, lung function, chest CT, 6-minute walk test, and the Borg dyspnoea scale, whereas sequelae symptoms (at least one) and abnormal chest CT patterns still existed in 45.2% and about 30% of the patients at 18.5 months, respectively. Both anxiety and depression disorders were alleviated for the convalescents, although the depression status was sustained for a longer duration. Conclusions Most COVID-19 convalescents had an overall improved physical and psychological health status, whereas sequelae symptoms, residual lesions on lung function, exercise impairment, and mental health disorders were still observed in a small proportion of the participants at 18.5 months after infection. Implementing appropriate preventive and management strategies for the ever-growing COVID-19 population is warranted.

9.
EClinicalMedicine ; 54: 101668, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2158746

ABSTRACT

Background: Data on the long-term trajectories of lung function are scarce in COVID-19 survivors. Methods: We re-analyzed the data from a prospective longitudinal cohort follow-up study of COVID-19 survivors over 2 years after infection. All participants were divided into scale 3, scale 4 and scale 5-6 groups according to seven-category ordinal scale. The changes of pulmonary function tests (PFTs), the Modified Medical Research Council (mMRC) Dyspnea Scale, 6-min walking test health-related quality of life (HRQoL) across the three serial follow-up visits were evaluated, and compared among three groups. We performed liner regression to determine potential factors that were associated with changes of PFTs and distance walked in 6 minutes (6MWD). Findings: In this study, 288 participants generally presented an improvement of PFTs parameters from 6 months to 1 year after infection. The scale 5-6 group displayed a significantly higher increase of PFTs compared with scale 3 and scale 4 groups (all p<0.0167), and corticosteroids therapy was identified as a protective factor for the PFTs improvement with a correlation coefficient of 2.730 (0.215-5.246) for forced vital capacity (FVC), 2.909 (0.383-5.436) for total lung capacity (TLC), and 3.299 (0.211-6.387) for diffusion capacity for carbon monoxide (DLco), respectively. From 1-year to 2-year follow-up, the PFTs parameters generally decreased, which was not observed to be associated with changes of 6MWD and HRQoL. Dyspnea (mMRC≥1) generally decreased over time (23.3% [61/262] for 6-month, 27.9% [67/240] for 1-year, 13.4% [35/261] for 2-year), and 6MWD increased continuously (500.0 m vs 505.0 m vs 525.0 m). Interpretation: Corticosteroids therapy during hospitalization was a protective factor for PFTs improvement from 6 months to 1 year. The relatively fast decline trend of PFTs from 1 year to 2 years needs to be paid attention and further validated in the future follow-up study. Fundings: This work was supported by Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (CIFMS 2021-I2M-1-048) and the National Key Research and Development Program of China (2021YFC0864700).

10.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128251

ABSTRACT

Background: Patients with severe respiratory failure come to the hospital emergency room, where they are triaged to support lung ventilation. Coagulation markers are one of the important methods for triage. The main method used so far is DDIM. Their elevation is due to the activation of coagulation with prothrombogenic potential, which manifests itself mainly in the microcirculation. These processes lead to the excessive release of Von Willebrand factor (VWF) from the Weibel Palade bodies and its cleavage by ADAMTS13, which is thus consumed. Aim(s): The aim of our study was to assess the effect of ADAMTS13 levels on the prognosis of patients with acute respiratory failure due to COVID-19 infection. Method(s): 46 patients coming to the emergency department were examined and admitted to the intensive care unit to support lung function based on clinical symptoms and elevated D-Dimers. These patients were retrospectively examined for ADAMTS13. Result(s): The levels of ADAMTS13 showed a statistically significant difference (P = 0.02) that corresponded to the clinical course of severe respiratory failure due to COVID-19 infection. Ninghteen patients with a relatively mild course had an ADAMTS13 level of 0.74 IU/ml (0.28 -1.14 IU/ml), in contrast to a skip of 27 patients with a severe course, which had an ADAMTS13 level of 0.54 IU/ml (0.25 -1.01 IU/ml). Conclusion(s): The levels of D-Dimer as a commonly used marker in triage of the COVID-19 severity infection is mainly due to the activation of coagulation and its manifestations, especially in the microcirculation. The level of ADAMTS13 is a key marker in the early prognosis of the severity of COVID-19 due to pulmonary insufficiency, whereas D-DIm is only a consequence of this process.

11.
Open Forum Infect Dis ; 9(11): ofac596, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2135527

ABSTRACT

Background: Studies on the pulmonary consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are impeded by limited access to pre-SARS-CoV-2 examinations. Methods: We invited Copenhagen General Population Study participants with a confirmed SARS-CoV-2 polymerase chain reaction (PCR) test during the first and second coronavirus disease 2019 waves in Denmark for a repeat chest computed tomography (CT) scan. Paired CT scans were independently assessed for interstitial and noninterstitial abnormalities by 2 trained radiologists. A semiquantitative CT score (ranging from 0 to 20) was used to quantify the extent of interstitial abnormalities. Results: Of 111 SARS-CoV-2-infected individuals, 102 (91.2%) experienced symptoms and 12 (11.2%) were hospitalized. Follow-up examination was performed at median of 5.4 (interquartile range, 4.1-7.8) months after a positive SARS-CoV-2 PCR test. Of 67 individuals with paired CT scans, ground glass opacities and reticulation were present in 31 (46.3%) individuals post-SARS-CoV-2 compared to 23 (34.1%) pre-SARS-CoV-2 (mean CT score, 3.0 vs 1.3; P = .011). Results were similar for nonhospitalized individuals. We did not detect development of bronchiectasis, emphysema, or nodules. Conclusions: SARS-CoV-2 infection in predominantly nonhospitalized individuals with mild disease was associated with a small increase in only interstitial lung abnormalities.

12.
J Transl Med ; 20(1): 506, 2022 Nov 03.
Article in English | MEDLINE | ID: covidwho-2108800

ABSTRACT

BACKGROUND: Many patients who recovered from COVID are still suffering from pulmonary dysfunction that can be persistent even for months after infection. Therefore, treatment to prevent irreversible impairment of lung function is needed. Treamid (bisamide derivative of dicarboxylic acid, BDDA) was shown to have anti-inflammatory and antifibrotic effects in animal models of pulmonary fibrosis. This study was designed to assess the safety, tolerability, and efficacy of Treamid in the rehabilitation of patients after COVID pneumonia. The aim was to establish whether Treamid could be effective in ameliorating post-COVID sequelae. METHODS: The phase 2, randomized, double-blind, placebo-controlled clinical trial was done at 8 medical centers in Russia. Patients with a diagnosis of COVID in the past medical history (with the first symptoms of COVID appear no earlier than 2 months before screening) and having fibrotic changes in the lungs, decreased lung function (percentage of predicted FVC and/or DLCO < 80%), and moderate or severe dyspnea according to mMRC scale were enrolled and randomly assigned in a 1:1 ratio (stratified by the initial degree of lung damage, age, and concomitant chronic diseases) by use of interactive responsive technology to peroral administration of Treamid 50 mg or placebo once a day for 4 weeks. The primary outcome was the proportion of patients who achieved clinically significant improvement in FVC and/or DLCO (defined as a relative increase in FVC of ≥ 10% or a relative increase in FVC in the range of ≥ 5 to < 10% plus a relative increase in DLCO of ≥ 15%) at week 4 compared with baseline. Secondary endpoints included changes from baseline in dyspnea scoring evaluated by the modified Borg and mMRC scales, pulmonary function (FEV1, FVC, FEV1/FVC ratio, DLCO, TLC, FRC), 6-min walk distance, the overall score of the KBILD questionnaire, and the proportion of patients with a reduction in the degree of lung damage assessed by CT scores. This trial was registered on ClinicalTrials.gov (Identifier: NCT04527354). The study was fully funded by PHARMENTERPRISES LLC. RESULTS: 12 out of 29 patients (41%) in Treamid group achieved clinically significant improvement in FVC and/or DLCO compared to 5 out of 30 patients (17%) in placebo group (p = 0.036). There was a significant decrease of dyspnea according to modified Borg scale observed in the Treamid group (- 0.9 ± 0.7 vs. - 0.4 ± 0.8, p = 0.018). No significant differences in the adverse events were noted. Exploratory analysis of the female population indicated superiority of Treamid over placebo by decreasing dyspnea and the extent of lung damage as well as increasing TLC. CONCLUSIONS: 4 weeks oral administration of 50 mg Treamid was associated with clinically significant improvement in the post-COVID patients, evident by an increase in FVC and/or DLCO as well as decreasing dyspnea. Treamid was well tolerated and can be safely administered to patients discharged after COVID. Treamid was more effective in women visible by superior improvement of COVID sequalae after 4 weeks treatment. Considering that female gender is a risk factor associated with the development of post-COVID symptoms, Treamid might offer a pharmacological treatment for long-term sequalae after COVID and supports further investigation in future clinical trials in post-COVID patients.


Subject(s)
COVID-19 , Female , Humans , COVID-19/complications , COVID-19/drug therapy , Lung , Double-Blind Method , Respiratory Function Tests , Dyspnea , Treatment Outcome
13.
Transpl Infect Dis ; : e13970, 2022 Nov 08.
Article in English | MEDLINE | ID: covidwho-2108165
14.
Chest ; 2022 Nov 10.
Article in English | MEDLINE | ID: covidwho-2104538

ABSTRACT

BACKGROUND: Home hospital (HH) is hospital-level substitutive care delivered at home for acutely ill patients who would traditionally be cared for in the hospital. Despite HH programs operating successfully for years, and scientific evidence of similar or better outcomes compared to bricks and mortar care, HH outcomes in the US for respiratory disease have not been evaluated. RESEARCH QUESTION: Do outcomes differ between patients admitted to HH with acute respiratory illness vs other acute general medical conditions? STUDY DESIGN AND METHODS: Retrospective evaluation of prospectively collected data of patients admitted to HH (2017-21). We compared patients requiring admission with respiratory disease (asthma exacerbation (26%), acute exacerbation for COPD [AECOPD] (33%), and non-COVID-19 pneumonia [PNA] (41%)) to all other HH patients. During HH, patients received 2 nurse and 1 physician visit daily, intravenous medications, advanced respiratory therapies, and continuous heart and respiratory rate monitoring. MAIN OUTCOMES: acute and post-acute utilization and safety. RESULTS: We analyzed 1,031 patients; 24% were admitted for respiratory disease. Patients with and without respiratory disease were similar: mean age 68 (SD, 17), 62% female, and 48% White. Respiratory patients were more often active smokers (21% vs 9%; p<0.001). FEV1/FVC ≤70 in 80% of cases; 28% had severe or very severe obstructive pattern (n=118). During HH, respiratory patients had less utilization: length of stay (mean days, 3.4 vs 4.6), laboratory orders (median, 0 vs 2), intravenous medication (43% vs 73%) and specialist consultation (2% vs 7%) (p all <0.001). 96% of patients completed the full admission at home with no mortality in the respiratory group. Within 30-days of discharge, both groups had similar readmission, ED presentation and mortality rates. INTERPRETATION: HH is as safe and effective for patients with acute respiratory disease as for those with other acute general medical conditions. If scaled, it can generate significant high-value capacity for health systems and communities, with opportunities to advance the complexity of care delivered.

15.
Current Respiratory Medicine Reviews ; 18(3):171-178, 2022.
Article in English | Web of Science | ID: covidwho-2083031

ABSTRACT

Exercise training is paramount in improving aerobic capacity, lung function, reducing the symptoms of dyspnea, and reconditioning the lean skeletal muscles. Many literature and guidelines have advocated the importance of exercise intervention in addressing the secondary impairment to post covid-19 infection, including home-based therapy and telerehabilitation. Pulmonary hypertension (PH) was previously thought to be contraindicated by exercise training;however, exercise was later found to be beneficial and relatively safe in chronic PH. However, them is a lack of high-quality evidence on the safety and effectiveness of exercise training in post-COVID-19 infected individuals with PH. Pulmonary hypertension has been documented to be one of the post-COVID-19 complications. PH occurred due to COVID-19 infection should be carefully considered before subjecting them to exercise training, especially in home-based therapy. This article aims to discuss the differing etiological factor, pathophysiological backgrounds, and the possible disease long-term outcomes that may compromise the safety of exercise training in post-COVID-19 patients complicated with PH. By understanding the risk of developing PH, risk assessment and stratification can be explicitly outlined for a safe exercise prescription through proper patient selections. Any possible complications can be anticipated;hence, proper preventive strategies can be instituted.

16.
Current Respiratory Medicine Reviews ; 18(3):171-178, 2022.
Article in English | EMBASE | ID: covidwho-2065266

ABSTRACT

Exercise training is paramount in improving aerobic capacity, lung function, reducing the symptoms of dyspnea, and reconditioning the lean skeletal muscles. Many literature and guidelines have advocated the importance of exercise intervention in addressing the secondary impairment to post covid-19 infection, including home-based therapy and telerehabilitation. Pulmonary hypertension (PH) was previously thought to be contraindicated by exercise training;however, exercise was later found to be beneficial and relatively safe in chronic PH. However, there is a lack of highquality evidence on the safety and effectiveness of exercise training in post-COVID-19 infected individuals with PH. Pulmonary hypertension has been documented to be one of the post-COVID-19 complications. PH occurred due to COVID-19 infection should be carefully considered before subjecting them to exercise training, especially in home-based therapy. This article aims to discuss the differing etiological factor, pathophysiological backgrounds, and the possible disease long-term outcomes that may compromise the safety of exercise training in post-COVID-19 patients complicated with PH. By understanding the risk of developing PH, risk assessment and stratification can be explicitly outlined for a safe exercise prescription through proper patient selections. Any possible complications can be anticipated;hence, proper preventive strategies can be instituted.

17.
American Journal of Transplantation ; 22(Supplement 3):720, 2022.
Article in English | EMBASE | ID: covidwho-2063497

ABSTRACT

Purpose: Liver transplant recipients have a high risk of developing postoperative pulmonary complications. Pulmonary function tests (PFTs) are expensive and often incapable of predicting patients at risk or improving patient outcomes, thus a single-center implemented specific criteria to determine when a PFT is administered for the evaluation of patients for liver transplantation. The protocol recommends a PFT for patients with a history of chronic lung disease, recurrent pneumonia prior to transplant, symptomatic COVID-19 requiring hospitalization, tobacco abuse, alpha-1 antitrypsin positivity, or oxygen dependency. Method(s): We conducted a retrospective cohort study of consecutive adult patients (age greater than 18 years) who underwent deceased donor liver transplantation from January 1, 2020, to June 30, 2021. We analyzed results from pre-protocol (PRE) and post-protocol (POST) implementation. Result(s): There were a total of 215 patients in the study, 186 PRE and 29 POST protocol implementation. In the PRE group, 168 (90%) patients received PFTs compared to 12 (41%) in the POST group, p<0.001). There was no difference between the PRE and POST groups based on age in years (56 vs 55, p=0.713), male gender (65% vs 662%, p=0.83), White race (80% vs 86%, p=0.15), BMI (34 vs 28, p=0.107), or cold ischemic time in hours (5.7 vs 6, p=0.252). There was no difference in FVC (3.3 vs 3.0, p=0.84), FEV1 (2.6 vs 2.2, p=0.87), FEV1/FVC% (76.9 vs 74.4, p=0.47) and DLCO (16.4 vs 13.8, p=0.11). The postoperative variables were the same for both groups with time to extubation hours (25 vs 31, p=0.26), ICU length of stay days (8 vs 10, p=0.12), and transplant admission length of stay days (14.4 vs 17.4, p=0.36). Lastly, there was no difference between PRE and POST graft survival (p=0.69) or patient survival (p=0.08). Conclusion(s): This study demonstrates the successful implementation of a PFT protocol with a cost savings of roughly $38,000 in just three months with no impact on patient outcomes. Further research is indicated for broad-scale implementation.

18.
American Journal of Transplantation ; 22(Supplement 3):993, 2022.
Article in English | EMBASE | ID: covidwho-2063460

ABSTRACT

Purpose: Limited data exists on CT chest abnormalities during acute Coronavirus disease 2019 (COVID-19) infection and associated post-illness loss of lung function among lung transplant (LT) patients. Method(s): The institutional database was interrogated for any LT patient diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021;n=54). 44 patients with acute COVID-19 were alive at 3-month follow up (COVID-survivors: 81.5%). Of the survivors, 34 had a CT chest during the first two weeks of acute illness. A validated CT score was used to quantify the parenchymal abnormalities due to COVID-19. Each lung was divided into 10 separate regions which were scored 0-2 based on the severity and extent of parenchymal opacification (maximum score per lung=20). To avoid confounding from underlying lung disease, only the allograph was assessed in single LT. The average score of both lungs was calculated in bilateral LT. The primary outcome measure was sustained decline of FEV1 or FVC >10% from pre-infection spirometry. Result(s): Abnormal CT score and lung opacities on CT chest were nearly ubiquitous during acute COVID-19 illness (>0;36/37, 97.3%, median score with IDR: 7.25, 4.625-10.125). The lower lobes (LL) were more affected by COVID-19 than the upper and middle lobes (UML) (median CT score in LL: 4, 2.75-6 vs 3.5, 1.25-5 in UML). A >10% decline in FEV1 or FVC was common after COVID-19 pneumonia (38.2%). The overall CT score correlated with amount of lung function loss (r=0.36, p=0.03) although the association was modest and limited to regions reflecting the UML. On ROC curve, CT score was modestly predictive of lung function decline (Fig 1). CT score from UML had the highest area under the curve (78.2%, 61.1-95.4%;p=0.006) with a score of 4.5 being the best cut-off (sensitivity 71%, specificity 85% for post-COVID lung function loss >10%). An UML CT score >4.5 was strongly associated with respiratory failure during acute illness (69% vs 24%;OR: 7.2, 1.5-33.8;p=0.01) and lung function decline >10% (77% vs 19%;OR: 14.2, 2.6-76.7;p=0.001). Conclusion(s): The CT score during acute COVID-19 infection provides prognostic information regarding loss of lung function among LT patients who survive COVID-19. Parenchymal abnormalities in the UML best predict subsequent lung function loss.

19.
American Journal of Transplantation ; 22(Supplement 3):908-909, 2022.
Article in English | EMBASE | ID: covidwho-2063435

ABSTRACT

Purpose: To determine if Apadenoson or Regadenoson has a therapeutic effect in attenuating hyper-inflammation and improving survival rate in K18-hACE2mice or Syrian hamsters infected with SARS-CoV-2. Method(s): 6-8 weeks old male K18-hACE2mice were divided into Control group that received vehicle;Test group 1 that received the drug (Apadenoson or Regadenoson) 24hrs prior to challenge with SARS-CoV-2;and Test Group 2 (Drug-delay), that received the drug with a 5 hr delay post-viral infection (n=6/grp). Viral dose was 1250 PfuHong Kong/VM20001061/2020 delivered via intranasal route. Drug was delivered subcutaneously using 1007D ALZET pumps. 6 weeks old Syrian hamsters were divided into Control group that received Vehicle and Virus (n=4) and 2 test groups (n=5/group) that received Apadenoson+Virus and Regadenoson+Virus. Drugs were delivered by 2ML2 ALZET pumps (4ug/kg/hr). Hamsters were inoculated intratracheally with 750PFU SARS-CoV-2 WA1 strain prior to treatment. Mice were weighed and clinical scores recorded daily. Bronchoalveolar lavage fluid (BALF) and serum were collected along with lungs. Plethysmography was done on days 0, 2, 4 and 7. Result(s): Apadenoson administered post-infection was efficacious in decreasing weight loss, improving clinical score, and increasing the survival rate in K18-hACE2 mice, i.e. 50% survival was observed at Day 5 and at Day 7 post-infection for drug given before or after infection respectively. Apadenoson given post-infection improved the histopathology that was observed in the vehicle control group, decreased pro-inflammatory IL-6, IFN-gamma, MCCP-1, MIP-1beta, IP-10, and Rantes in serum, increased anti-inflammatory Ang1-7 levels, and decreased monocytes in BALF. 42% of mice that received Regadenoson pre-challenge survived infection compared to 6.25% in the vehicle or Drug delay (drug given post-infection) groups. Viral titers in the lungs of Regadenoson-treated mice were found decreased. Treatment also significantly decreased CD4+, CD8+T cells, eosinophils, and neutrophils in BALF. Plethysmography, in hamsters, showed significant improvement of pulmonary function parameters, Rpef and PenH, following treatment with Apadenoson given post-infection. Apadenoson cleared the virus from BALF and maintained Ang1-7 levels. Both drugs decreased plasma IFN-gamma levels. Conclusion(s): Treatment with Apadenoson attenuated inflammation, improved pulmonary function, decreased weight loss, and enhanced survival rate following infection with SARS-CoV-2 virus. The results demonstrate the translational significance of Apadenoson in the treatment of COVID-19.

20.
American Journal of Transplantation ; 22(Supplement 3):350-351, 2022.
Article in English | EMBASE | ID: covidwho-2063370

ABSTRACT

Purpose: There is limited data on the outcomes beyond the acute illness among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19). The current study sought to describe the predictors of 6-month survival among a single center cohort of LT. *Methods: We included all the LT patients diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021;n=54;median age: 60, 20-73 years;M:F 37:17). All patients completed at least 6-month follow up from COVID-19 diagnosis. We reviewed patient characteristics, presenting features, clinical course, and laboratory abnormalities at presentation and during the acute illness. We reviewed the hospital course and post-discharge outcomes including lung function loss among COVID-19 survivors. Median follow-up duration was 304 days. Six-month survival after COVID-19 was analyzed as the primary outcome variable. Result(s): Restrictive lung disease was the most common LT indication (n=41, 75.9%) and most had undergone bilateral LT (n=43, 79.6%). Patients were a median of 48 months (range <1-139 months) from their transplant. Majority of the patients required hospitalization (n=48) and significant proportion of patients developed respiratory failure (n=26). One month survival was 90.7% (n=49) while the survival dropped to 81.5% (n=44) by 6-month follow-up. On univariate analysis, females (35.3% vs 10.8%) and those with pre-existing chronic lung allograft dysfunction (CLAD, 33.3% vs 11.1%) experienced worse 6-month survival. Peak lactate dehydrogenase (LD) levels had the strongest association with 6-month survival on Mann Whitney U comparisons. On receiver operator characteristic curve analysis, the peak LD levels had an area under the curve of 82.9% (69.1-96.7%, p=0.002) with 400 U/L identified as the best cut-off. A peak LD level >400 U/L during the acute illness from COVID-19 was significantly associated with worse 6-month survival (OR, 95% CI: 4.38, 1.31-14.65, p=0.02).On Cox proportion hazard analysis, female gender (adjusted HR: 5.38, 1.13-25.64;p=0.035), pre-infection CLAD (5.63, 1.24-25.57;p=0.025) and peak LD levels >400 U/L (7.49, 1.72-35.53;p=0.007, see Figure for the Kaplan-Meier survival analysis) were independently associated with survival after COVID-19 among LT patients. Conclusion(s): COVID-19 is associated with significant mortality among LT patients with several patients succumbing beyond the period of acute illness. Female gender, established CLAD prior to COVID-19 and an LD>400 U/L at any time during the acute illness are adverse prognostic markers and may form the basis of customized management strategies. (Table Presented).

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