Clinical Variables Related to Functional Capacity and Exertional Desaturation in Patients with COVID-19.

Impaired functional capacity is one of the most commonly reported consequences among post-COVID-19 patients. This study aimed to analyse the clinical variables related to functional capacity and exertional desaturation in post-COVID-19 patients at the time of hospital discharge. A cross-sectional study was conducted on patients recovering from COVID-19 pneumonia. The main outcomes measures were functional capacity, assessed using the 1 min sit-to-stand test (1 min STST), and exertional desaturation, defined as a drop of ≥4% in the arterial oxygen saturation. Factors used to characterise the participant outcomes included the use of a high-flow nasal cannula (HFNC), prolonged hospitalisation, occurrence of pulmonary embolism during hospitalisation, and underlying comorbidities. A total of 381 participants (mean age = 53.7 ± 13.2 years, 65.6% men) were included. Participants completed a mean of 16.9 ± 6.2 repetitions in the 1 min STST. Exertional desaturation was observed in 51% of the patients. Higher odds of exertional desaturation were found in the participants who used a HFNC (OR = 3.6; 95%CI: 1.6 to 7.8), were admitted in the hospital >10 days (OR = 4.2; 95%CI: 2.6 to 6.8), and had a pulmonary embolism (OR = 3.5; 95%CI: 2.2. to 5.3). Use of a HFNC (ß = -3.4; 95%CI: -5.3 to -1.44), a hospital stay >10 days (ß = -2.2; 95%CI: -3.4 to -0.9), and a history of pulmonary embolism (ß = -1.4; 95%CI: -2.6 to -0.2) were also negatively associated with the 1 min STST. Most post-COVID-19 patients exhibited reduced functional capacity at the time of hospital discharge, and approximately half had exertional desaturation after the 1 min STST. The use of a HFNC, prolonged hospitalisation and pulmonary embolism were the main clinical variables associated with worse a 1 min STST performance and a higher likelihood of exertional desaturation.

Exploring long COVID condition in Latin America: Its impact on patients' activities and associated healthcare use.

Background: Studies exploring long COVID condition (LCC) in low- and middle-income countries are scarce. Further characterization of LCC patients experiencing activity limitations and their associated healthcare use is needed. This study aimed to describe LCC patients' characteristics, its impact on activities, and associated healthcare use in Latin America (LATAM). Participants: Individuals who (cared for someone or) had COVID-19 and could read, write, and comprehend Spanish and lived in a LATAM country were invited to complete a virtual survey. Sociodemographic characteristics, COVID-19 and LCC symptoms, activity limitations, and healthcare use. Results: Data from 2,466 people from 16 countries in LATAM were analyzed (females = 65.9%; mean age of 39.5 ± 53.3 years). 1,178 (48%) of the respondents had LCC symptoms (≥3 months). These were more likely to have COVID-19 earlier in the pandemic, were older, had no COVID vaccines, had more comorbidities, needed supplementary oxygen, and reported significantly more COVID-19 symptoms during the infectious period. 33% of the respondents visited a primary care provider, 13% went to the emergency department, 5% were hospitalized, 21% visited a specialist, and 32% consulted ≥1 therapist for LCC symptoms mainly extreme fatigue, sleep difficulties, headaches, muscle or joint pain, and shortness of breath with activity. The most consulted therapists were respiratory therapists (15%) and psychologists (14%), followed by physical therapists (13%), occupational therapists (3%), and speech pathologists (1%). One-third of LCC respondents decreased their regular activities (e.g., work, school) and 8% needed help with activities of daily living (ADLs). LCC respondents who reduced their activities reported more difficulty sleeping, chest pain with activity, depression, and problems with concentration, thinking, and memory, while those who needed help with ADLs were more likely to have difficulty walking, and shortness of breath at rest. Approximately 60% of respondents who experienced activity limitations sought a specialist and 50% consulted therapists. Conclusions and relevance: Results supported previous findings in terms of the LCC demographics, and provided insight into LCC impact on patients' activities and healthcare services used in LATAM. This information is valuable to inform service planning and resource allocation in alignment with the needs of this population.

Assessment of Exercise Capacity in Post-COVID-19 Patients: How Is the Appropriate Test Chosen?

There is a wide range of sequelae affecting COVID-19 survivors, including impaired physical capacity. These sequelae can affect the quality of life and return to work of the active population. Therefore, one of the pillars of following-up is the evaluation of physical capacity, which can be assessed with field tests (such as the six-minute walk test, the one-minute standing test, the Chester step test, and the shuttle walking test) or laboratory tests (such as the cardiopulmonary exercise test). These tests can be performed in different contexts and have amply demonstrated their usefulness in the assessment of physical capacity both in post-COVID-19 patients and in other chronic respiratory, metabolic, cardiologic, or neurologic diseases. However, when traditional tests cannot be performed, physical function can be a good substitute, especially for assessing the effects of an intervention. For example, the Short Physical Performance Battery assessment and the Timed Up and Go assessment are widely accepted in older adults. Thus, the test should be chosen according to the characteristics of each subject.

Rehabilitación respiratoria en pacientes con SARS-CoV-2. Estado de conocimiento actual / Respiratory Rehabilitation in Patients with SARS-COV-2. Current State of Knowledge

En diciembre del año 2019, en la localidad china de Wuhan se detectó el primer caso de enfermedad por el virus SARS-Cov-2. A diferencia del carácter limitado de las dos últimas epidemias, la del Síndrome Respiratorio de Medio Oriente (MERS) y el Síndrome Respiratorio Agudo Grave por Coronavirus (SARS-CoV), la rápida expansión del SARS-CoV-2 obligó a la Organización Mundial de la Salud (OMS) a declarar la situación de pandemia en marzo de 2020

Simplified sleep resistance test for daytime sleepiness detection.

OBJECTIVES: Excessive daytime sleepiness (EDS) is a highly prevalent symptom that increases the risk of traffic accidents and deteriorates the quality of life. The diagnosis of EDS is difficult because of the complex infrastructure that is required. The new test here proposed assesses the ability of a simple test of simplify the detection of daytime sleepiness compared with the OSLER test. MATERIAL AND METHODS: In the new test, during 20 minute subjects were asked to pass a finger by a groove in response to a light emitting diode, inside dark glasses, which was lit for 1s in every three, with headphones that reduce the ambient noise and was compared with the OSLER test on each subject in random order. RESULTS: The proposed method showed a sensitivity of 100% and a specificity of 61%, with a positive predictive value of 67% and negative predictive value of 100% when compared with the OSLER test. The value of area under the ROC curve was 0.81 (0.62-0.99), p=0.013. In a Bland-Altman plot, most of the latency times differences are in the 95% agreement interval (p=0.05). In addition, the confidence interval of the mean and most of the positive results are above the zero line. The Cohens Kappa coefficient obtained is 0.58 (95% CI 0.29-0.88). CONCLUSION: In this sample of patients, the proposed method detects EDS in a similar way as OSLER test and can be performed in different environments without requiring special infrastructure or expert personnel.

Recuperación de la frecuencia cardíaca post ejercicio en enfermos respiratorios crónicos

Las enfermedades respiratorias crónicas se asocian frecuentemente con disfunción autonómica cardíaca y esta se puede evaluar midiendo la recuperación de la frecuencia cardíaca (RFC) post ejercicio. Existen evidencias que la RFC calculada luego de un minuto de reposo después de la prueba de marcha de seis minutos (PM6M) puede predecir mortalidad y exacerbaciones agudas en pacientes con enfermedades respiratorias crónicas. El objetivo de este trabajo fue comparar la recuperación de la frecuencia cardíaca al finalizar una prueba del escalón de tres minutos de duración (PE3M) en enfermos respiratorios crónicos con la obtenida al finalizar la PM6M. La PE3M se realizó sin dificultad en un consultorio de reducidas dimensiones y todos los pacientes pudieron terminarlo. Aplicando el índice de correlación de Pearson se obtuvo como resultado 0,84 al comparar la RCF al minuto de detenerse en ambas pruebas lo que muestra una buena correlación entre ellas. En el gráfico de Bland Altman, se observa que los resultados están dentro de los límites de confianza mostrando concordancia a pesar de ser una muestra pequeña de pacientes. La PE3M se realiza con facilidad en un pequeño consultorio. Los resultados de la RCF después de esta prueba son comparables a los obtenidos al finalizar la PM6M.

Post-exercise Heart Rate Recovery in Patients with Chronic Respiratory Disease

Chronic respiratory diseases are frequently associated with cardiac autonomic dysfunction and this can be evaluated by measuring post-exercise heart rate recovery (HRR). There is evidence that the HRR calculated after one minute of rest following a Six-Minute Walk Test (6MWT) can predict mortality and acute exacerbations in patients with chronic respiratory diseases. The purpose of this study is to compare the heart rate recovery after finishing a Three-Minute Step Test (3MST) in chronic respiratory patients with that obtained after the 6MWT. The 3MST was performed without difficulty in a small doctor's office and all the patients were able to finish it. Applying the Pearson Correlation Index, the result was 0.84 when comparing the HRR one minute after stopping in both tests, showing a good correlation between them. In the Bland-Altman Plot, we can see that the results are within the confidence limits and show concordance despite being a small sample of patients. The 3MST is easily done in a small doctor's office. The results of the HRR after the 3MST are comparable to those obtained after finishing the 6MWT.

Recomendaciones sobre el uso de oxigenoterapia en situaciones especiales / Recommendations on the Use of Oxygen Therapy in Special Situations

La hipoxemia crónica severa se define por la presencia de una presión parcial de oxígeno arterial inferior a 60 mmHg. La oxigenoterapia, es decir el uso terapéutico del oxígeno, consiste en su administración a concentraciones mayores de las que se encuentran en el aire ambiente, con la intención de tratar o prevenir las manifestaciones de la hipoxia. Cuando se prescribe y se usa correctamente, ha demostrado que mejora la sobrevida en pacientes con EPOC e hipoxemia. Ha sido establecido que la oxigenoterapia a largo plazo representa el único tratamiento que mejora la evolución de pacientes con EPOC en etapa avanzada. En particular, dos estudios clave, el NOTT (Nocturnal Oxygen Therapy Trial) y el MRC (British Medical Research Council) hace más de 30 años han demostrado que la oxigenoterapia usada más de 15 horas por día, mejora la sobrevida de pacientes con EPOC severo más hipoxemia en reposo. A pesar de que este concepto se ha extendido por analogía a la insuficiencia respiratoria crónica originada por otras enfermedades respiratorias y no respiratorias, la eficacia de la oxigenoterapia continua no está demostrada claramente en otras entidades. Considerando que el 25% de las prescripciones de oxigenoterapia en nuestro medio no corresponden a pacientes con EPOC e hipoxemia, la Asociación Argentina de Medicina Respiratoria encomendó a un grupo de médicos neumonólogos argentinos la elaboración de la presente normativa, redactada a modo de guía sencilla, sobre el uso de la oxigeno-terapia en “situaciones especiales”, basada en nivel de evidencia por el sistema Grade.

The severe chronic hypoxemia is defined as an arterial partial oxygen pressure measuring less than 60 mmHg. Oxygen therapy is defined as the therapeutic use of oxygen; it consists in oxygen administration at higher concentrations than room air concentrations, to prevent or treat hypoxia. The right use of oxygen therapy has clearly shown to improve survival in hypoxemic chronic obstructive pulmonary disease (COPD) patients. It is well known that long-term oxygen therapy (LTOT) is the only treatment that has been proved to improve the late course of chronic obstructive pulmonary disease. Specially, two landmark studies, the Nocturnal Oxygen Therapy Trial (NOTT) and the British Medical Research Council (MRC) study conducted in the late 1970s have clearly demonstrated that LTOT (when used for more than 15hours/day) improves survival rates in patients with severe COPD associated with hypoxemia at rest. Although this concept has been extended by analogy to chronic respiratory failure caused by respiratory and non-respiratory diseases, continuous oxygen therapy has not been shown to be equally effective in other disorders. Because of 25% of patients who receive oxygen therapy do not have COPD with hypoxemia, the Argentine Association of Respiratory Medicine established a task force of pneumonologists to recommend guidelines about oxygen therapy in “special situations”, based on the level of evidence of the Grades System.