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1.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927852

ABSTRACT

Rationale: 'Cardiac Effort' (CE), the total number of heart beats used during the 6-minute walk test (6MWT) divided by walk distance (beats/m), improves reproducibility in the 6MWT and correlates with right ventricular function in pulmonary arterial hypertension (PAH). The SARS-CoV-2 pandemic made in-office 6MWT challenging. We aimed to determine 1) whether a chestbased accelerometer could estimate 6MWT distance in the clinic and remotely;2) the reproducibility of CE measured during a remote 6MWT;and 3) the safety of remote 6MWT. We also compared measures of heart rate (HR) derived from electrocardiogram (ECG) and wrist-based photoplethysmography (PPG) during the 6MWT in PAH. Methods: This was a singlecenter, prospective observational study with IRB approval completed October 2020-April 2021. Group 1 PAH subjects on stable therapy for >90 days completed 4-6 total 6MWT during a 2 week period to assess reproducibility;we anticipated no clinical change during this short interval. The first and last 6MWT were performed in the clinic;2-4 remote 6MWT were completed at participant's discretion. Participants did not wear masks but did wear the MC10 Biostamp nPoint sensors to measure ECG HR and accelerometry. Two blinded readers estimated 6MWT distance using raw accelerometry data. We measured PPG HR with a wrist Nonin 3150 pulse oximeter during clinic 6MWT only. Averages of clinic variables and remote variables were used for paired Student's t test, Bland-Altman Plot, or Pearson correlation. Results: We enrolled 20 participants: 80% female;60% connective tissue disease;and 65% on initial combination therapy with ambrisentan and tadalafil. There was a wide range in baseline, clinicperformed 6MWT distance (220 -570 m). The median length of the remote 'hallway' was 40 ft. For clinic walks, there was 0.10% average difference between the directly observed and Biostamp accelerometry-estimated 6MWT distance with a strong correlation of r=0.99, p<0.0001 (figure 1). The 6MWT distance estimated using Biostamp in the clinic was greater than what was estimated remotely, 405 m vs. 389 m, p=0.007. There was no clear difference between clinic or remote CE, 1.83 beats/m vs 1.93 beats/m, p=0.14, or Borg Dyspnea Index, 3.5 vs 3.4, p=0.35. There were no safety concerns. PPG undercounted total HR expenditure during 6MWT compared to Biostamp (629 vs 719, p<0.0001). Conclusion: Remote 6MWT was feasible, appeared safe, and 6MWT distance was shorter than clinic distance. CE calculated by ECG HR and accelerometer-estimated distance provides a reproducible remote assessment of exercise tolerance, comparable to the clinic measured value. (Figure Presented).

2.
European Clinical Respiratory Journal ; 9(SUPPL):29, 2022.
Article in English | EMBASE | ID: covidwho-1915473

ABSTRACT

Background: SARS-CoV-2 displays high affinity for ACE2 receptors as a vector of pathogenesis. ACE2 receptors are highly expressed on surfactant producing type 2 alveolar cells. These cells produce pulmonary surfactant - a crucial thin layer of surface-active fluid mainly composed of lipids, lining the alveolar epithelial surface. The main function, to reduce the surface tension, is fundamental for proper gas exchange. Aims and Objectives: To investigate changes in surfactant lipid composition and the relationship to longstanding symptoms of post Covid-19 among patients treated in intensive care for Covid-19 infection. Methods: We recruited 43 patients (17 women, aged 44-80 years) who had previously been treated in ICU in a major Swedish hospital, in average 6 months before inclusion. The participants answered a questionnaire regarding symptoms, we collected particles in exhaled air with PExA-instrument (PExA AB) and conducted pulmonary function tests, body plethysmography, and diffusion capacity of the lungs for carbon monoxide. Twenty-two healthy, non-infected, ageand gender-matched controls were enrolled. Lipids were analysed using liquid chromatography with a triple quadrupole mass spectrometer. Statistical analyses were performed with Qlucore. Results: Early results suggest a significant change in the composition of surfactant lipids among post-Covid -19 patients treated in intensive care compared to controls. Early analysis show significant reductions of all measured phosphatidyl-glycerols (PG, n = 14) an increase of all measured phosphatidyl-inositols (PI, n = 4), for example were PG 18:1-18:1 22% lower (p < 0.001, q = 0.04) and PI:16:0:18:1 67% higher (p < 0.001, q = 0.0003) in subjects post-Covid compared to controls. Conclusions: Our findings suggest that surfactant composition is altered also in the recovery after Covid-19 infection, which could be a key component in the post-Covid syndrome and the lingering effects on the respiratory system.

3.
4th IEEE Global Conference on Life Sciences and Technologies, LifeTech 2022 ; : 72-73, 2022.
Article in English | Scopus | ID: covidwho-1840272

ABSTRACT

Telecare has become of increasing importance during the COVID-19 pandemic, and the precise measurement of plethysmography has been shown to be highly effective. We propose a plethysmography measurement method using skin images captured by a combination of RGB and a narrowband filter (NBF) camera. For precise measurement, we introduce an independent component analysis score combined with the moving images. Our experimental results showed that the proposed method resulted in a better reproduction of plethysmography than that of individual images and also ICA scores only from RGB moving images. © 2022 IEEE.

4.
Clin Nutr ESPEN ; 48: 356-360, 2022 04.
Article in English | MEDLINE | ID: covidwho-1693778

ABSTRACT

BACKGROUND & AIMS: The BOD POD (COSMED USA Inc., Concord, CA) is a common instrument used to assess body composition by employing air displacement plethysmography and whole-body densitometry to determine body volume. This instrument requires isothermal conditions during testing; therefore, the introduction of outside isothermal air can impact testing results. With the COVID-19 pandemic introducing face mask mandates, it is unknown whether the use of a face mask during BOD POD testing may lead to erroneous measurement by introducing isothermal air. Thus, the purpose of this cross-sectional study was to investigate the impact of wearing a surgical face mask compared to not wearing a surgical face mask on body composition assessment among adults. METHODS: During testing, female subjects were required to wear a swimsuit or form-fitting lycra shorts and a sports bra and male subjects were required to wear form-fitting lycra shorts. American Society for Testing and Materials (ASTM) level one surgical face masks (bacterial and particulate filtration efficiency of 95%) and standard swim caps were provided by researchers. Variables of interest included percent body fat, body fat, percent lean body mass, and lean body mass. Participants (n = 33) completed one test wearing a mask and one test without a mask back-to-back with conditions held constant. Dependent-sample sign tests, Bland-Altman Plots, and Passing-Bablok regression analyses were used to test mask-on versus mask-off differences and agreement between variables of interest. RESULTS: There were no significant median differences in any body composition results between face mask use and non-face mask use using dependent-sample sign tests. Bland-Altman Plots demonstrated acceptable agreement between mask usage and non-mask usage. No significant differences were seen in the slopes of the variables using Passing-Bablok regression. CONCLUSIONS: Results suggest that wearing a face mask does not appreciably impact body composition results. Therefore, ASTM level 1 disposable surgical face mask does not introduce a significant amount of isothermal air during BOD POD testing.


Subject(s)
COVID-19 , Masks , Adult , Body Composition , Cross-Sectional Studies , Female , Humans , Male , Pandemics , Plethysmography/methods
5.
Cardiopulmonary Physical Therapy Journal ; 33(1):e9, 2022.
Article in English | EMBASE | ID: covidwho-1677317

ABSTRACT

PURPOSE/HYPOTHESIS: Altered breathing patterns have been reported after SARS-CoV-2 infection, but it is unclear if they result from changes in chest wall kinematics, inspiratory muscle weakness, or both. Lung volumes can be estimated through chest wall motion via optoelectronic plethysmography (OEP). We hypothesized that poor inspiratory muscle performance would relate to impaired quiet breathing pattern as assessed by OEP in adults post COVID-19 infection. NUMBER OF SUBJECTS: 20. MATERIALS AND METHODS: A convenience sample of 20 subjects recovered from RT-PCR-confirmed COVID-19 (mean ± SD age = 52.45 ± 11.93 years and BMI = 30.89 ± 6.48 kg/m2) with no overt pulmonary disease underwent measures of maximal inspiratory pressure (MIP) using a digital manometer followed by OEP analysis to evaluate chest wall motion and its compartments during quiet breathing. All OEP data were collected with subjects in a seated position and with arms supported laterally. Eighty-nine reflective markers were distributed on the anterior surface, side and back of the participants' trunks, who were instructed to breathe normally for three minutes while the system was operated. The displacement of markers during the requested spontaneous quiet breathing was picked up by six synchronized cameras that recorded their coordinates, from which lung volumes were later estimated using algorithms. Statistical analyses included normality tests, descriptive statistics, Pearson's correlation and independent samples t-tests. RESULTS: The mean ± SD MIP and tidal volume (VT) of the sample were 82.15 ± 34.32 cmH2O and 369 ± 216.31 ml, respectively. 65% of the participants were below their predicted values for VT, and 70% had lower than predicted MIP values. MIP was significantly and positively associated with VT (r = 0.40, P=0.04), while a negative relationship was found between MIP and the percentage contribution of abdominal rib cage motion to VT (r=- 0.45, P=0.02). No further correlation was observed between MIP and other OEP variables. Additionally, subjects classified as having normal inspiratory muscle function (i.e. MIP > 80 cmH2O) had significantly greater VT when compared to those presenting with inspiratory muscle weakness (450.64 ± 262.57 versus 269.22 ± 67.67 ml, respectively;P = 0.04). CONCLUSIONS: The variability of post COVID-19 ventilatory impairment requires a complex screening process. In our sample, most subjects presented with lower than predicted VT and MIP. Moreover, a significant association existed between inspiratory muscle dysfunction and reduced tidal volume. Changes in abdominal rib cage motion were also observed and likely occurred to compensate for a less efficient diaphragm even during normal, regular breathing. CLINICAL RELEVANCE: Subjects recovering from COVID-19 may present with diaphragm myopathy and impairment, highlighting the need to screen for inspiratory muscle weakness which may help identify altered breathing patterns and guide management such as inspiratory muscle training to mitigate persistent symptoms related to abnormal ventilation.

6.
Italian Journal of Medicine ; 15(3):71, 2021.
Article in English | EMBASE | ID: covidwho-1567763

ABSTRACT

Background and Aim: Pulmonary involvement from CoViD-19 is frequent, after acute phase dyspnoea, cough, desaturation, respiratory insufficiency, can persist, pneumonia leads to interstitial disease (ground- glass) and to pulmonary fibrosis (honeycomb lung). A diagnostic algorithm can be a simple way for differential diagnoses (pulmonary embolism, PE) and to set up therapies in a systematic way. Our objective was to propose a simple and easy diagnostic algorithm, to identify with chest CT scan, excluding PE in high dimer- D patients, suggestive gait test and compatible objectivity. Methods: Prescription of: blood tests, radiological (CT chest CMC or High Resolution), respiratory physiopathology (Walking test, Global spirometry, Plethysmography, DLCO). Set drug therapies in case of PE, oral steroid (OCS) in case of extensive interstitial disease, long-acting beta 2 agonist bronchodilators (LABA), antimuscarinics (LAMA), inhaled steroids (ICS). For fibrosis and a honeycomb pattern, treatment with dipalmitoylethanolamide (PEA). Results: 258 outpatients, average 60.68 years, 115 women, 143 men, with an urgent request for pneumological visit and treated on an outpatient basis. 1 pt died during treatment, 4 pts were diagnosed with pulmonary embolism. 4 pts required a prescription for oxygen therapy. 228 pts presented ground-glass, 30 pts showed normal chest CT. Conclusions: DLCO shows progressive improvement in values after ICS treatment. Small pathway deficiency evidenced by spirometry can be treated with LABA-LAMA especially in patients with a previous history of cigarette smoking or COPD.

7.
European Heart Journal ; 42(SUPPL 1):320, 2021.
Article in English | EMBASE | ID: covidwho-1554687

ABSTRACT

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, numerous centres in Europe used on-demand photoplethysmography (PPG) technology to remotely assess heart rate and rhythm in conjunction with teleconsultations within the TeleCheck-AF project. Purpose: To develop an educational structured stepwise practical guide on how to interpret PPG signals and to study typical clinical scenarios how on-demand PPG was used in the TeleCheck-AF project. Methods: During an online conference, the structured stepwise practical guide on how to interpret PPG signals was discussed and further refined during an internal review process. We provide the number of respective PPG recordings and number of patients managed within a clinical scenario during the TeleCheck-AF project. Results: To interpret PPG recordings, we introduce a structured stepwise practical guide and provide representative PPG recordings. In the TeleCheck-AF project, 2522 subjects collected 90.616 recordings. The majority of these recordings was classified by the PPG algorithm as sinus rhythm (57.6%), followed by atrial fibrillation (AF) (23.6%). In 9.7% of recordings the quality was too low to interpret. Other observed rhythms were tachycardia (1.4%), extra systoles (4.7%), bigeminy episodes (1.8%), trigeminy episodes (0.6%) and atrial flutter (0.2%). The most frequent clinical scenario where PPG technology was used in the TeleCheck-AF project was follow-up after AF ablation (1110 patients) followed by heart rate and rhythm assessment around (tele)consultation (966 patients), sometimes including remote PPG-guided adaption of rate or rhythm control. 275 patients were followed around cardioversion, either (semi-)acute or elective. Other possible scenarios are assessment of palpitations, assessment of symptom-rhythm correlation and monitoring during up-titration of heart failure medication. Conclusion: We introduce a newly developed structured stepwise practical guide on PPG signal interpretation developed based on presented experiences from TeleCheck-AF. The present clinical scenarios for the use of on-demand PPG technology derived from the TeleCheck-AF project will help to implement PPG technology in the management of arrhythmia patients. (Figure Presented).

8.
European Heart Journal ; 42(SUPPL 1):3090, 2021.
Article in English | EMBASE | ID: covidwho-1554419

ABSTRACT

Background: COVID-19 exerts deleterious cardiopulmonary effects, leading to worse prognosis in the most effected. Purpose: The aim of this retrospective multi-center observational cohort study was to analyze the trajectories of key advanced hemodynamic parameters amongst hospitalized COVID-19 patients according to different risk populations using a chest-patch wearable providing continuous remote patient monitoring. Methods: The study was conducted in five COVID-19 isolation units. Patients admitted to the units were connected to a photoplethysmography based noninvasive remote advanced hemodynamic monitor after completing a basic risk factor survey. Physiological parameters were measured every 15 minutes during the hospitalization, including cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), heart rate, blood pressure (BP), respiratory rate, blood oxygen saturation (SpO2), and body temperature. Results: 492 COVID-19 patients (179 females, average age 58.7 years) were included in the final analysis, with more than 3 million measurements collected during an average of 75.3 hours. Overall, within the first five days of hospitalizations we found a significant increase in SVR, and a significant decrease in SpO2, DBP, CO and CI (p<0.01 for all). The changes were more prominent in high risk populations- males, older age and obesity and had a temporal correspondence to changes in respiratory parameters. Conclusions: This is the first comprehensive continuous advanced hemodynamic profiling of COVID-19 patients. Worse hemodynamic status was prominent in high risk populations.

9.
Pulm Ther ; 7(2): 503-516, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1540322

ABSTRACT

INTRODUCTION: Lung hyperinflation in chronic obstructive pulmonary disease (COPD) is associated with activity limitation, impaired cardiac output, and mortality. Several studies have demonstrated that long-acting muscarinic antagonists (LAMAs) delivered by dry powder inhalers can promote lung deflation; however, the potential of nebulized LAMAs on improving hyperinflation in COPD is currently unknown. METHODS: This single-center, randomized, double-blind, two-way crossover study (NCT04155047) evaluated the efficacy of a single dose of nebulized LAMA [glycopyrrolate (GLY) 25 µg] versus placebo in patients with COPD and lung hyperinflation. Patients with moderate-to-severe COPD and a residual volume (RV) ≥ 130% of predicted normal were included. The primary endpoint was changed from baseline in RV at 6 h post-treatment. Other endpoints included changes from baseline in spirometric and plethysmographic measures up to 6 h post-treatment. RESULTS: A total of 22 patients (mean pre-bronchodilator RV, 153.7% of predicted normal) were included. The primary objective of the study was not met; the placebo-adjusted least squares (LS) mean [95% confidence interval (CI) change from baseline in RV with GLY at 6 h post-treatment was - 0.323 l (- 0.711 to 0.066); p = 0.0987]. A post hoc evaluation of the primary analysis was conducted after excluding a single statistical outlier; substantial improvements in RV with GLY compared with placebo was observed after exclusion of this outlier [placebo-adjusted LS mean change from baseline (95% CI) in RV was - 0.446 l (- 0.741 to - 0.150)]. Improvements from baseline were also observed with GLY compared with placebo in spirometric and plethysmographic measures up to 6 h post-treatment. GLY was generally safe, and no new safety signals were detected. CONCLUSIONS: This is the first study to evaluate the effect of nebulized GLY on lung deflation. Nebulized GLY resulted in marked improvements in RV up to 6 h post-treatment, compared with placebo. Improvements were also observed with GLY in spirometric and plethysmographic parameters of lung function. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT04155047.

10.
Rev Mal Respir ; 37(6): 505-510, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1386577

ABSTRACT

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.


Subject(s)
Aftercare/methods , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Aftercare/standards , Ambulatory Care/methods , Ambulatory Care/standards , COVID-19 , Cardiovascular Diseases/prevention & control , Coronavirus Infections/complications , Coronavirus Infections/rehabilitation , Critical Care/methods , Critical Care/standards , Diagnostic Techniques, Respiratory System/standards , Disease Management , Emergency Medical Services/methods , Emergency Medical Services/standards , Health Priorities , Hospitalization , Humans , Inpatients , Outpatients , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/rehabilitation , Respiratory Therapy/methods , Respiratory Therapy/standards , Symptom Assessment/methods , Symptom Assessment/standards , Thromboembolism/prevention & control , Thrombophilia/drug therapy , Thrombophilia/etiology
11.
Respir Med ; 187: 106570, 2021 10.
Article in English | MEDLINE | ID: covidwho-1347815

ABSTRACT

We must be aware that new respiratory virus pandemic can happen frequently. Standard lung function tests should keep their crucial role to assist the clinicians in the decision-making process, but they are at risk for the spread of infection because of the generated droplets. We used opto-electronic plethysmography to investigate the post-COVID-19 syndrome on 12 patients after ICU. We found normal ventilatory pattern at rest, a restrictive pattern located in the ribcage during vital capacity and surgical mask to significantly increase minute ventilation. The attention on unconventional respiratory function tests should be sponsored for the important information they can provide.


Subject(s)
COVID-19/complications , Plethysmography , Respiratory Function Tests , Respiratory Mechanics/physiology , COVID-19/diagnosis , COVID-19/physiopathology , Humans
12.
Children (Basel) ; 8(4)2021 Apr 11.
Article in English | MEDLINE | ID: covidwho-1232580

ABSTRACT

(1) Background: The determination of body composition is an important method to investigate patients with obesity and to evaluate the efficacy of individualized medical interventions. Bioelectrical impedance-based methods are non-invasive and widely applied but need to be validated for their use in young patients with obesity. (2) Methods: We compiled data from three independent studies on children and adolescents with obesity, measuring body composition with two bioelectrical impedance-based devices (TANITA and BIACORPUS). For a small patient group, additional data were collected with air displacement plethysmography (BOD POD) and dual-energy X-ray absorptiometry (DXA). (3) Results: Our combined data on 123 patients (age: 6-18 years, body mass index (BMI): 21-59 kg/m²) and the individual studies showed that TANITA and BIACORPUS yield significantly different results on body composition, TANITA overestimating body fat percentage and fat mass relative to BIACORPUS and underestimating fat-free mass (p < 0.001 for all three parameters). A Bland-Altman plot indicated little agreement between methods, which produce clinically relevant differences for all three parameters. We detected gender-specific differences with both methods, with body fat percentage being lower (p < 0.01) and fat-free mass higher (p < 0.001) in males than females. (4) Conclusions: Both bioelectrical impedance-based methods provide significantly different results on body composition in young patients with obesity and thus cannot be used interchangeably, requiring adherence to a specific device for repetitive measurements to ascertain comparability of data.

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