Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 72
Filter
Add filters

Document Type
Year range
1.
PLoS One ; 17(1): e0262522, 2022.
Article in English | MEDLINE | ID: covidwho-1635737

ABSTRACT

BACKGROUND: Venous thromboembolism is a frequent complication of COVID-19 infection. Less than 50% of pulmonary embolism (PE) is associated with the evidence of deep venous thrombosis (DVT) of the lower extremities. DVT may also occur in the venous system of the upper limbs especially if provoking conditions are present such as continuous positive airway pressure (CPAP). The aim of this study was to evaluate the incidence of UEDVT in patients affected by moderate-severe COVID-19 infection and to identify potential associated risk factors for its occurrence. METHODS: We performed a retrospective analysis of all patients affected by moderate-severe COVID-19 infection admitted to our unit. In accordance with the local protocol, all patients had undergone a systematic screening for the diagnosis of UEDVT, by vein compression ultrasonography (CUS). All the patients were receiving pharmacological thromboprophylaxis according to international guidelines recommendations. Univariate and multivariate analyses were used to identify risk factors associated with UEDVT. RESULTS: 257 patients were included in the study, 28 patients were affected by UEDVT with an incidence of 10.9% (95% CI, 7.1-14.7). At univariate analysis UEDVT appeared to be significantly associated (p< 0.05) with pneumonia, ARDS, PaO2/FiO2, D-dimer value higher than the age adjusted cut off value and need for CPAP ventilation. Multivariate analysis showed a significant association between UEDVT and the need for CPAP ventilation (OR 5.95; 95% IC 1.33-26.58). Increased mortality was found in patients affected by UEDVT compared to those who were not (OR 3.71; 95% CI, 1.41-9.78). CONCLUSIONS: UEDVT can occur in COVID-19 patients despite adequate prophylaxis especially in patients undergoing helmet CPAP ventilation. Further studies are needed to identify the correct strategy to prevent DVT in these patients.


Subject(s)
COVID-19/pathology , Upper Extremity Deep Vein Thrombosis/epidemiology , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/mortality , COVID-19/virology , Comorbidity , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Incidence , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Oxygen Consumption , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification , Severity of Illness Index , Upper Extremity Deep Vein Thrombosis/diagnosis , Upper Extremity Deep Vein Thrombosis/etiology
2.
Int J Cardiol ; 340: 113-118, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1561875

ABSTRACT

BACKGROUND: Long-term effects of Coronavirus Disease of 2019 (COVID-19) are of utmost relevance. We aimed to determine: 1) the functional capacity of COVID-19 survivors by cardiopulmonary exercise testing (CPET); 2) the characteristics associated with cardiopulmonary exercise testing (CPET) performance; 3) the safety and tolerability of CPET. METHODS: We prospectively enrolled consecutive patients with laboratory-confirmed COVID-19 from Azienda Sanitaria Locale 3, Genoa. Three months after hospital discharge a complete clinical evaluation, trans-thoracic echocardiography, CPET, pulmonary function tests, and dominant leg extension (DLE) maximal strength measurement were performed. RESULTS: From the 225 patients discharged alive from March to November 2020, we excluded 12 incomplete/missing cases and 13 unable to perform CPET, leading to a final cohort of 200. Median percent-predicted peak oxygen uptake (%pVO2) was 88% (78.3-103.1). Ninety-nine (49.5%) patients had %pVO2 below, whereas 101 (50.5%) above the 85% predicted value. Among the 99 patients with reduced %pVO2, 61 (61%) had a normal anaerobic threshold: of these, 9(14.8%) had respiratory, 21(34.4%) cardiac, and 31(50.8%) non-cardiopulmonary reasons for exercise limitation. Inerestingly, 80% of patients experienced at least one disabling symtpom, not related to %pVO2 or functional capacity. Multivariate linear regression showed percent-predicted forced expiratory volume in one-second(ß = 5.29,p = 0.023), percent-predicted diffusing capacity of lungs for carbon monoxide(ß = 6.31,p = 0.001), and DLE maximal strength(ß = 14.09,p = 0.008) to be independently associated with pVO2. No adverse event was reported during or after CPET, and no involved health professional developed COVID-19. CONCLUSIONS: At three months after discharge, about 1/3rd of COVID-19 survivors show functional limitations, mainly explained by muscular impairment, calling for future research to identify patients at higher risk of long-term effects that may benefit from careful surveillance and targeted rehabilitation.


Subject(s)
COVID-19 , Exercise Test , Echocardiography , Exercise Tolerance , Follow-Up Studies , Humans , Oxygen Consumption , SARS-CoV-2
3.
PLoS One ; 16(11): e0257549, 2021.
Article in English | MEDLINE | ID: covidwho-1511814

ABSTRACT

Particulate generation occurs during exercise-induced exhalation, and research on this topic is scarce. Moreover, infection-control measures are inadequately implemented to avoid particulate generation. A laminar airflow ventilation system (LFVS) was developed to remove respiratory droplets released during treadmill exercise. This study aimed to investigate the relationship between the number of aerosols during training on a treadmill and exercise intensity and to elucidate the effect of the LFVS on aerosol removal during anaerobic exercise. In this single-center observational study, the exercise tests were performed on a treadmill at Running Science Lab in Japan on 20 healthy subjects (age: 29±12 years, men: 80%). The subjects had a broad spectrum of aerobic capacities and fitness levels, including athletes, and had no comorbidities. All of them received no medication. The exercise intensity was increased by 1-km/h increments until the heart rate reached 85% of the expected maximum rate and then maintained for 10 min. The first 10 subjects were analyzed to examine whether exercise increased the concentration of airborne particulates in the exhaled air. For the remaining 10 subjects, the LFVS was activated during constant-load exercise to compare the number of respiratory droplets before and after LFVS use. During exercise, a steady amount of particulates before the lactate threshold (LT) was followed by a significant and gradual increase in respiratory droplets after the LT, particularly during anaerobic exercise. Furthermore, respiratory droplets ≥0.3 µm significantly decreased after using LFVS (2120800±759700 vs. 560 ± 170, p<0.001). The amount of respiratory droplets significantly increased after LT. The LFVS enabled a significant decrease in respiratory droplets during anaerobic exercise in healthy subjects. This study's findings will aid in exercising safely during this pandemic.


Subject(s)
Air Conditioning/methods , COVID-19/prevention & control , Exercise/physiology , Particulate Matter/chemistry , Adult , Aerosols/chemistry , Air Filters , Anaerobic Threshold/physiology , COVID-19/metabolism , Exercise Test/methods , Exhalation/physiology , Female , Heart Rate/physiology , Humans , Japan , Lactic Acid/metabolism , Male , Oxygen Consumption/physiology , Respiration , Respiratory System/physiopathology , Running/physiology , SARS-CoV-2/pathogenicity , Ventilation/methods
5.
Sensors (Basel) ; 21(21)2021 Oct 20.
Article in English | MEDLINE | ID: covidwho-1512555

ABSTRACT

Despite the wide range of clinical and research applications, the reliability of the absolute oxygenation measurements of continuous wave near-infrared spectroscopy sensors is often questioned, partially due to issues of standardization. In this study, we have compared the performances of 13 units of a continuous wave near-infrared spectroscopy device (PortaMon, Artinis Medical Systems, NL) to test their suitability for being used in the HEMOCOVID-19 clinical trial in 10 medical centers around the world. Detailed phantom and in vivo tests were employed to measure the precision and reproducibility of measurements of local blood oxygen saturation and total hemoglobin concentration under different conditions: for different devices used, different operators, for probe repositioning over the same location, and over time (hours/days/months). We have detected systematic differences between devices when measuring phantoms (inter-device variability, <4%), which were larger than the intra-device variability (<1%). This intrinsic variability is in addition to the variability during in vivo measurements on the forearm muscle resulting from errors in probe positioning and intrinsic physiological noise (<9%), which was also larger than the inter-device differences (<3%) during the same test. Lastly, we have tested the reproducibility of the protocol of the HEMOCOVID-19 clinical trial; that is, forearm muscle oxygenation monitoring during vascular occlusion tests over days. Overall, our conclusion is that these devices can be used in multi-center trials but care must be taken to characterize, follow-up, and statistically account for inter-device variability.


Subject(s)
Oximetry , Spectroscopy, Near-Infrared , Oxygen , Oxygen Consumption , Reproducibility of Results
6.
Front Immunol ; 12: 714833, 2021.
Article in English | MEDLINE | ID: covidwho-1506100

ABSTRACT

Background: The most severe cases of Coronavirus-Disease-2019 (COVID-19) develop into Acute Respiratory Distress Syndrome (ARDS). It has been proposed that oxygenation may be inhibited by extracellular deoxyribonucleic acid (DNA) in the form of neutrophil extracellular traps (NETs). Dornase alfa (Pulmozyme, Genentech) is recombinant human deoxyribonuclease I that acts as a mucolytic by cleaving and degrading extracellular DNA. We performed a pilot study to evaluate the effects of dornase alfa in patients with ARDS secondary to COVID-19. Methods: We performed a pilot, non-randomized, case-controlled clinical trial of inhaled dornase for patients who developed ARDS secondary to COVID-19 pneumonia. Results: Improvement in arterial oxygen saturation to inhaled fraction of oxygen ratio (PaO2/FiO2) was noted in the treatment group compared to control at day 2 (95% CI, 2.96 to 95.66, P-value = 0.038), as well as in static lung compliance at days 3 through 5 (95% CI, 4.8 to 19.1 mL/cmH2O, 2.7 to 16.5 mL/cmH2O, and 5.3 to 19.2 mL/cmH2O, respectively). These effects were not sustained at 14 days. A reduction in bronchoalveolar lavage fluid (BALF) myeloperoxidase-DNA (DNA : MPO) complexes (95% CI, -14.7 to -1.32, P-value = 0.01) was observed after therapy with dornase alfa. Conclusion: Treatment with dornase alfa was associated with improved oxygenation and decreased DNA : MPO complexes in BALF. The positive effects, however, were limited to the time of drug delivery. These data suggest that degradation of extracellular DNA associated with NETs or other structures by inhaled dornase alfa can be beneficial. We propose a more extensive clinical trial is warranted. Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT04402970.


Subject(s)
COVID-19/drug therapy , Deoxyribonuclease I/therapeutic use , Respiratory Distress Syndrome/drug therapy , SARS-CoV-2/physiology , Administration, Inhalation , Adult , Aged , Aged, 80 and over , Case-Control Studies , DNA/metabolism , Extracellular Traps/metabolism , Female , Humans , Male , Middle Aged , Oxygen Consumption/drug effects , Peroxidase/metabolism , Pilot Projects , Recombinant Proteins/therapeutic use , Young Adult
7.
Sci Rep ; 11(1): 7334, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1500696

ABSTRACT

To identify the risk factors of mortality for the coronavirus disease 19 (COVID-19) patients admitted to intensive care units (ICUs) through a retrospective analysis. The demographic, clinical, laboratory, and chest imaging data of patients admitted to the ICU of Huoshenshan Hospital from February 10 to April 10, 2020 were retrospectively analyzed. Student's t-test and Chi-square test were used to compare the continuous and categorical variables, respectively. The logistic regression model was employed to ascertain the risk factors of mortality. This retrospective study involved 123 patients, including 64 dead and 59 survivors. Among them, 57 people were tested for interleukin-6 (IL-6) (20 died and 37 survived). In all included patients, the oxygenation index (PaO2/FiO2) was identified as an independent risk factor (odd ratio [OR] = 0.96, 95% confidence interval [CI]: 0.928-0.994, p = 0.021). The area under the curve (AUC) was 0.895 (95% CI: 0.826-0.943, p < 0.0001). Among the patients tested for IL-6, the PaO2/FiO2 (OR = 0.955, 95%CI: 0.915-0.996, p = 0.032) and IL-6 (OR = 1.013, 95%CI: 1.001-1.025, p = 0.028) were identified as independent risk factors. The AUC was 0.9 (95% CI: 0.791-0.964, p < 0.0001) for IL-6 and 0.865 (95% CI: 0.748-0.941, p < 0.0001) for PaO2/FiO2. PaO2/FiO2 and IL-6 could potentially serve as independent risk factors for predicting death in COVID-19 patients requiring intensive care.


Subject(s)
COVID-19/mortality , Interleukin-6/analysis , Aged , Area Under Curve , COVID-19/pathology , COVID-19/virology , Comorbidity , Female , Humans , Intensive Care Units , Logistic Models , Male , Middle Aged , Oxygen Consumption , ROC Curve , Retrospective Studies , Risk Factors , SARS-CoV-2/isolation & purification
8.
Int J Environ Res Public Health ; 18(20)2021 10 13.
Article in English | MEDLINE | ID: covidwho-1480722

ABSTRACT

The purpose of this research was to develop the 3 min incremental step-in-place (3MISP) test for predicting maximal oxygen uptake (V.O2max). A total of 205 adults (20-64 years) completed the 3MISP and V.O2max tests. Using age, gender, body composition (BC) including percent body fat (PBF) or body mass index (BMI), and with or without heart rate (HR) at the beginning of exercise (HR0) or difference between HR at the third minute during the exercise and the first minute post exercise (ΔHR3 - HR4) in the 3MISP test, six V.O2max prediction models were derived from multiple linear regression. Age (r = -0.239), gender (r = 0.430), BMI (r = -0.191), PBF (r = -0.706), HR0 (r = -0.516), and ΔHR3 - HR4 (r = 0.563) were significantly correlated to V.O2max. Among the six V.O2max prediction models, the PBF model∆HR3 - HR4 has the highest accuracy. The simplest models with age, gender, and PBF/BMI explained 54.5% of the V.O2max in the PBF modelBC and 39.8% of that in the BMI modelBC. The addition of HR0 and ∆HR3 - HR4 increases the variance of V.O2max explained by the PBF and BMI models∆HR3 - HR4 by 17.98% and 45.23%, respectively, while standard errors of estimate decrease by 10.73% and 15.61%. These data demonstrate that the models established using 3MISP-HR data can enhance the accuracy of V.O2max prediction.


Subject(s)
Cardiorespiratory Fitness , Exercise , Exercise Test , Oxygen , Oxygen Consumption
9.
J Artif Organs ; 23(3): 292-295, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1453765

ABSTRACT

A 71-year-old man undergoing hemodialysis (HD) was admitted to our hospital with congestive heart failure (CHF) and pneumonia. After admission, ultrafiltration with HD was urgently performed because of a lack of respiratory improvement despite the use of noninvasive positive pressure ventilation. During HD, cerebral regional saturation of oxygen (rSO2) was monitored by INVOS 5100c oxygen saturation monitor (Covidien Japan, Japan) to evaluate changes in tissue oxygenation. At HD initiation, cerebral rSO2 was very low at 34% under the fraction of inspiratory oxygen (FiO2) of 0.4. Ultrafiltration was performed at the rate of 0.5 L/h thereafter, cerebral rSO2 gradually improved even as inhaling oxygen concentration decreased. At the end of HD, cerebral rSO2 improved at 40% under a FiO2 of 0.28 as excess body fluid was removed. After pneumonia and CHF improved, he was discharged. Reports of the association between cerebral oxygenation and acute CHF status in patients undergoing HD are limited; therefore, in our experience with this case, cerebral oxygenation deteriorated with the CHF status but was improved by adequate body-fluid management during HD.


Subject(s)
Brain/metabolism , Heart Failure/complications , Oxygen Consumption/physiology , Renal Dialysis , Renal Insufficiency/therapy , Aged , Heart Failure/metabolism , Heart Failure/physiopathology , Humans , Male , Monitoring, Physiologic , Renal Insufficiency/complications , Renal Insufficiency/metabolism
10.
12.
J Breath Res ; 15(4)2021 10 04.
Article in English | MEDLINE | ID: covidwho-1380991

ABSTRACT

This study aimed to evaluate the cardiopulmonary function and impairment of exercise endurance in patients with COVID-19 after 3 months of the second wave of the pandemic in Turkey. A total of 51 consecutive COVID-19 survivors, mostly healthcare providers, still working in the emergency room and intensive care units of the hospital after the second wave of Covid 19 pandemia were included in this study. Cardiopulmonary exercise stress test was performed. The median of the exercise time of the COVID-19 survivors, was 10 (4.5-13) minutes and the mean 6.8 ± 1.3 Mets was achieved. The VO2max of the COVID-19 survivors was 24 ± 4.6 ml kg-1min-1which corresponds the 85 ± 10% of the predicted VO2max value. The VO2WRs value which was reported about 8.5-11 ml min-1per watt in healthy individuals as normal was found lower in Covid 19 survivors (5.6 ± 1.4). The percentage of the maximum peak VO2calculated according to the predictable peak VO2of the COVID-19 survivors, was found significantly lower in male patients (92 ± 9.5% vs 80 ± 8.5%,p: 0.000). Also, there was a positive correlation between the percentage of the maximum predicted VO2measurements and age (r: 0.320,p: 0000). The peak VO2values of COVID-19 survivors decreased, and simultaneously, their exercise performance decreased due to peripheral muscle involvement. We believe that COVID-19 significantly affects men and young patients.


Subject(s)
COVID-19 , Dyspnea/etiology , Exercise Test , Muscle Strength , Oxygen Consumption/physiology , Breath Tests , Dyspnea/diagnosis , Exercise Tolerance , Humans , Lung , Male , SARS-CoV-2
14.
Int J Environ Res Public Health ; 17(24)2020 12 18.
Article in English | MEDLINE | ID: covidwho-1362357

ABSTRACT

BACKGROUND: Aerobic dance (AD) is an appropriate physical activity for improving cardiorespiratory fitness. This study aimed to compare cardiorespiratory and metabolic responses, and muscle fatigue between an air dissipation platform (ADP) and a hard surface during a video-recorded AD session. METHODS: 25 healthy young women (23.3 ± 2.5 years) completed three sessions. In session 1, participants performed an incremental test to exhaustion on a treadmill. One week after session 1, participants were randomly assigned in a crossover design to perform video-recorded AD sessions on an ADP and on a hard surface (sessions 2 and 3). Cardiorespiratory and metabolic responses were assessed during AD sessions. Muscular fatigue was measured before and after AD sessions by a countermovement jump test. RESULTS: Significantly higher heart rate, respiratory exchange ratio, pulmonary ventilation, ventilatory oxygen equivalent, and ventilatory carbon dioxide equivalent were observed on an ADP than on a hard surface (p < 0.05). Despite a significant increase in lactate levels on an ADP (p ≤ 0.01), muscular fatigue and perceived exertion rating were similar on both surfaces (p > 0.05). CONCLUSIONS: Video-recorded AD on an ADP increased the cardioventilatory and metabolic responses compared to a hard surface, preventing further muscle fatigue.


Subject(s)
Air , Dancing , Exercise , Exercise Test , Female , Heart Rate , Humans , Oxygen Consumption , Video Recording
15.
Respir Med ; 187: 106577, 2021 10.
Article in English | MEDLINE | ID: covidwho-1356423

ABSTRACT

BACKGROUND: current data on the impact of acute illness severity on exercise capacity and ventilatory efficiency of COVID-19 survivors, evaluated at cardiopulmonary exercise test (CPET), are limited. METHODS: in this post-hoc analysis of our previous observational, prospective, cohort study on mechanisms of exercise intolerance in COVID-19 survivors, we aimed at evaluating the impact of acute COVID-19 severity on exercise capacity, pulmonary function testing (PFT) and chest computed tomography (CT) outcomes. RESULTS: we enrolled 75 patients (18 with mild-to-moderate disease, 18 with severe disease, and 39 with critical disease). Mean (standard deviation - SD) follow-up time was 97 (26) days. Groups showed a similar PFT and CT residual involvement, featuring a mildly reduced exercise capacity with comparable mean (SD) values of peak oxygen consumption as percentage of predicted (83 (17) vs 82 (16) vs 84 (15), p = 0.895) among groups, as well as the median (interquartile range - IQR) alveolar-arterial gradient for O2 in mmHg at exercise peak (20 (15-28) vs 27 (18-31) vs 26 (21-21), p = 0.154), which was in the limit of normal. In addition, these patients featured a preserved mean ventilatory efficiency evaluated through the slope of the relation between ventilation and carbon dioxide output during exercise (27.1 (2.6) vs 29.8 (3.9) vs 28.3 (2.6), p = 0.028), without a clinically relevant difference. CONCLUSIONS: Disease severity does not impact on exercise capacity in COVID-19 survivors at 3 months after discharge, including a ventilatory response still in the limit of normal.


Subject(s)
COVID-19/complications , COVID-19/physiopathology , Exercise Tolerance/physiology , Adult , Aged , COVID-19/therapy , Cohort Studies , Exercise Test , Female , Humans , Male , Middle Aged , Oxygen Consumption/physiology , Recovery of Function/physiology , Severity of Illness Index , Time Factors
16.
PLoS One ; 16(8): e0256022, 2021.
Article in English | MEDLINE | ID: covidwho-1352710

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic rapidly increases the use of mechanical ventilation (MV). Such cases further require extracorporeal membrane oxygenation (ECMO) and have a high mortality. OBJECTIVE: We aimed to identify prognostic biomarkers pathophysiologically reflecting future deterioration of COVID-19. METHODS: Clinical, laboratory, and outcome data were collected from 102 patients with moderate to severe COVID-19. Interleukin (IL)-6 level and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA copy number in plasma were assessed with ELISA kit and quantitative PCR. RESULTS: Twelve patients died or required ECMO owing to acute respiratory distress syndrome despite the use of MV. Among various variables, a ratio of oxygen saturation to fraction of inspired oxygen (SpO2/FiO2), IL-6, and SARS-CoV-2 RNA on admission before intubation were strongly predictive of fatal outcomes after the MV use. Moreover, among these variables, combining SpO2/FiO2, IL-6, and SARS-CoV-2 RNA showed the highest accuracy (area under the curve: 0.934). In patients with low SpO2/FiO2 (< 261), fatal event-rate after the MV use at the 30-day was significantly higher in patients with high IL-6 (> 49 pg/mL) and SARS-CoV-2 RNAaemia (> 1.5 copies/µL) compared to those with high IL-6 or RNAaemia or without high IL-6 and RNAaemia (88% vs. 22% or 8%, log-rank test P = 0.0097 or P < 0.0001, respectively). CONCLUSIONS: Combining SpO2/FiO2 with high IL-6 and SARS-CoV-2 RNAaemia which reflect hyperinflammation and viral overload allows accurately and before intubation identifying COVID-19 patients at high risk for ECMO use or in-hospital death despite the use of MV.


Subject(s)
COVID-19/mortality , Interleukin-6/blood , RNA, Viral/metabolism , SARS-CoV-2/genetics , Adult , Aged , Aged, 80 and over , Area Under Curve , COVID-19/pathology , COVID-19/virology , Female , Hospital Mortality , Humans , Male , Middle Aged , Oxygen Consumption , Prognosis , Prospective Studies , ROC Curve , Respiration, Artificial , SARS-CoV-2/isolation & purification , Viral Load
17.
Respir Res ; 22(1): 222, 2021 Aug 06.
Article in English | MEDLINE | ID: covidwho-1344107

ABSTRACT

The COVID-19 pandemic has resulted in significant acute morbidity and mortality worldwide. There is now a growing recognition of the longer-term sequelae of this infection, termed "long COVID". However, little is known about this condition. Here, we describe a distinct phenotype seen in a subset of patients with long COVID who have reduced exercise tolerance as measured by the 6 min walk test. They are associated with significant exertional dyspnea, reduced health-related quality of life and poor functional status. However, surprisingly, they do not appear to have any major pulmonary function abnormalities or increased burden of neurologic, musculoskeletal or fatigue symptoms.


Subject(s)
COVID-19/complications , Dyspnea/physiopathology , Exercise Tolerance/physiology , Lung/physiology , Phenotype , Physical Exertion/physiology , Adult , Aged , COVID-19/epidemiology , COVID-19/physiopathology , Dyspnea/epidemiology , Female , Humans , Male , Middle Aged , Oxygen Consumption/physiology , Walk Test/methods
18.
Eur Respir J ; 58(2)2021 08.
Article in English | MEDLINE | ID: covidwho-1295410

ABSTRACT

BACKGROUND: This study aimed to describe cardiopulmonary function during exercise 3 months after hospital discharge for COVID-19 and compare groups according to dyspnoea and intensive care unit (ICU) stay. METHODS: Participants with COVID-19 discharged from five large Norwegian hospitals were consecutively invited to a multicentre, prospective cohort study. In total, 156 participants (mean age 56.2 years, 60 females) were examined with a cardiopulmonary exercise test (CPET) 3 months after discharge and compared with a reference population. Dyspnoea was assessed using the modified Medical Research Council (mMRC) dyspnoea scale. RESULTS: Peak oxygen uptake (V'O2  peak) <80% predicted was observed in 31% (n=49). Ventilatory efficiency was reduced in 15% (n=24), while breathing reserve <15% was observed in 16% (n=25). Oxygen pulse <80% predicted was found in 18% (n=28). Dyspnoea (mMRC ≥1) was reported by 47% (n=59). These participants had similar V'O2  peak (p=0.10) but lower mean±sd V'O2  peak·kg-1 % predicted compared with participants without dyspnoea (mMRC 0) (76±16% versus 89±18%; p=0.009) due to higher body mass index (p=0.03). For ICU- versus non-ICU-treated participants, mean±sd V'O2  peak % predicted was 82±15% and 90±17% (p=0.004), respectively. Ventilation, breathing reserve and ventilatory efficiency were similar between the ICU and non-ICU groups. CONCLUSIONS: One-third of participants experienced V'O2  peak <80% predicted 3 months after hospital discharge for COVID-19. Dyspnoeic participants were characterised by lower exercise capacity due to obesity and lower ventilatory efficiency. Ventilation and ventilatory efficiency were similar between ICU- and non-ICU-treated participants.


Subject(s)
COVID-19 , Exercise Tolerance , Exercise Test , Female , Hospitalization , Humans , Middle Aged , Oxygen Consumption , Prospective Studies , SARS-CoV-2
19.
J Electromyogr Kinesiol ; 59: 102567, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1260783

ABSTRACT

INTRODUCTION: A huge number of COVID-19 patients should be referred to rehabilitation programmes. Individualizing the exercise intensity by metabolic response provide good physiological results. The aim of this study was to investigate the validity of EMG as a non-invasive determinant of the anaerobic threshold and respiratory compensation point, for more precise exercise intensity prescription. METHODS: An observational cross-sectional study with 66 recovered COVID-19 patients was carried out. The patients underwent a cardiopulmonary exercise test with simultaneous assessment of muscle electromyography in vastus lateralis. EMG breakpoints were analyzed during the ramp-up protocol. The first and second EMG breakpoints were used for anaerobic threshold and respiratory compensation point determination. RESULTS: EMG and gas exchange analysis presented strong correlation in anaerobic threshold (r = 0.97, p < 0.0001) and respiratory compensation point detection (r = 0.99, p < 0.0001) detection. Bland-Altman analysis demonstrated a bias = -4.7 W (SD = 6.2 W, limits of agreement = -16.9 to 7.6) for anaerobic threshold detection in EMG compared to gas exchange analysis. In respiratory compensation point detection, Bland-Altman analysis demonstrated a bias = -2.1 W (SD = 4.5 W, limits of agreement = -10.9 to 6.6) in EMG compared to gas exchange analysis. EMG demonstrated a small effect size compared to gas exchange analysis in oxygen uptake and power output at anaerobic threshold and respiratory compensation point detection. CONCLUSIONS: EMG analysis detects anaerobic threshold and respiratory compensation point without clinical significant difference than gas exchange analysis (gold standard method) in recovered COVID-19 patients.


Subject(s)
Anaerobic Threshold , COVID-19 , Cross-Sectional Studies , Exercise Test , Humans , Muscle, Skeletal , Oxygen Consumption , SARS-CoV-2
20.
J Cachexia Sarcopenia Muscle ; 12(4): 1056-1063, 2021 08.
Article in English | MEDLINE | ID: covidwho-1260553

ABSTRACT

BACKGROUND: There is limited information about the impact of coronavirus disease (COVID-19) on the muscular dysfunction, despite the generalized weakness and fatigue that patients report after overcoming the acute phase of the infection. This study aimed to detect impaired muscle efficiency by evaluating delta efficiency (DE) in patients with COVID-19 compared with subjects with chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), and control group (CG). METHODS: A total of 60 participants were assigned to four experimental groups: COVID-19, COPD, IHD, and CG (n = 15 each group). Incremental exercise tests in a cycle ergometer were performed to obtain peak oxygen uptake (VO2 peak). DE was obtained from the end of the first workload to the power output where the respiratory exchange ratio was 1. RESULTS: A lower DE was detected in patients with COVID-19 and COPD compared with those in CG (P ≤ 0.033). However, no significant differences were observed among the experimental groups with diseases (P > 0.05). Lower VO2 peak, peak ventilation, peak power output, and total exercise time were observed in the groups with diseases than in the CG (P < 0.05). A higher VO2 , ventilation, and power output were detected in the CG compared with those in the groups with diseases at the first and second ventilatory threshold (P < 0.05). A higher power output was detected in the IHD group compared with those in the COVID-19 and COPD groups (P < 0.05) at the first and second ventilatory thresholds and when the respiratory exchange ratio was 1. A significant correlation (P < 0.001) was found between the VO2 peak and DE and between the peak power output and DE (P < 0.001). CONCLUSIONS: Patients with COVID-19 showed marked mechanical inefficiency similar to that observed in COPD and IHD patients. Patients with COVID-19 and COPD showed a significant decrease in power output compared to IHD during pedalling despite having similar response in VO2 at each intensity. Resistance training should be considered during the early phase of rehabilitation.


Subject(s)
COVID-19/physiopathology , Exercise Test/methods , Exercise/physiology , Lung/physiopathology , Oxygen Consumption/physiology , COVID-19/virology , Heart Diseases/physiopathology , Humans , Ischemia/physiopathology , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/physiopathology , Resistance Training/methods , Respiratory Function Tests/methods , SARS-CoV-2/physiology
SELECTION OF CITATIONS
SEARCH DETAIL
...