Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: A multicenter cohort study.

BACKGROUND: Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19. METHODS: This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge. RESULTS: Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality. CONCLUSION: The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality.

Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: A multicenter cohort study

Abstract Background: Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19. Methods: This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge. Results: Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality. Conclusion: The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality.

Endothelial dysfunction in people with depressive disorders: A systematic review and meta-analysis.

The study aimed to identify whether people diagnosed with depression have endothelial dysfunction, assessed by the technique of flow-mediated dilation (FMD), when compared to controls without depression. In addition, to verify whether people with depressive symptoms have impaired endothelial function when compared to controls without symptoms. Also to explore the potential moderators of the association between depression and endothelial dysfunction. Systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase and Web of Science, from inception to April 16, 2021, for studies in people with depression and controls evaluating endothelial function through FMD. The primary outcome was the percentage of change in FMD. Comparative random effects meta-analysis, calculating the mean difference (MD) of the FMD between depressed and controls was performed. Potential sources of heterogeneity were explored by meta-regressions and subgroup analyses. The study protocol was registered with PROSPERO (CRD42020192070). Nine studies evaluating 1367 participants (379 depressed and 988 controls) (median age = 39.8 years, 44.9% men) were included. People with depression had lower FMD = -1.48% (95%CI = -2.62 to -0.33). High density lipoprotein (HDL) cholesterol levels moderated the effect (beta = -0.408, 95%CI = -0.776 to -0.040). Differences in FMD were found when assessment was done in the first minute after release of the occlusion, when using occlusion position in distal forearm, and when using occlusion pressure between 250 and 300 mmHg. Those with clinical depression (established by diagnostic instruments) presented the greatest dysfunction. Individuals with depression have a more impaired endothelial dysfunction when compared to controls. HDL cholesterol levels and differences in FMD assessment modalities moderate the difference.

Capacidade funcional e qualidade de vida entre sujeitos saudáveis e pacientes com apneia obstrutiva do sono / Functional capacity and quality of life between healthy subjects and patients with obstructive sleep apnea

Caso-controle. Objetivos do estudo: Comparar a capacidade funcional, parâmetros respiratórios e qualidade de vida entre sujeitos saudáveis e pacientes com apneia obstrutiva do sono. Metodologia: Em 19 pacientes com apneia obstrutiva do sono e 19 sujeitos saudáveis foram avaliadas a qualidade de vida (The Medical Study 36-item Short-Form Health Survey), capacidade funcional (teste de caminhada de seis minutos), função pulmonar (espirometria) e força muscular respiratória(manovacuometria). Resultados: Os pacientes apresentaram declínio na qualidade de vida pelos domínios capacidade funcional, estado geral de saúde e saúde mental. A distância percorrida no teste de caminhada de seis minutos foi menor nos pacientes com apneia obstrutiva do sono. Os parâmetros respiratórios não diferiram entre os grupos. Conclusão: Pacientes com apneia obstrutiva do sono apresentam comprometimento da qualidade de vida e da capacidade funcional...

To compare the functional capacity, respiratory parameters and quality of life between healthy subjects and patients with obstructive sleep apnea. Methodology: 19 patients with obstructive sleep apnea and 19 healthy subjects were evaluated regarding their quality of life (The Medical Study 36-Item Short-Form Health Survey), their functional capacity (six-minute walk test), pulmonary function (spirometry) and their strength respiratory muscle(manovacuometer). Results: Patients showed a decline in the quality of life concerning functional capacity domains, general state of health and mental health. The distance walked in the six-minute walktest was shorter for patients with obstructive sleep apnea. Respiratory parameters did not differ between groups. Conclusion: Patients with obstructive sleep apnea present impairment regarding their quality of life and functional capacity...

Functional electrical stimulation in the treatment of patients with chronic heart failure: a meta-analysis of randomized controlled trials.

Functional electrical stimulation (FES) produces beneficial effects in the treatment of patients with chronic heart failure (CHF), but studies carried out in these patients show small sample sizes and conflicting results. The aim of this meta-analysis was to systematically review the effect of treatment with FES compared with conventional aerobic exercise training (CA) or control group in patients with CHF. The search strategy included MEDLINE, LILACS, Physiotherapy Evidence Database and Cochrane Library. Randomized trials comparing FES versus CA or control group in the treatment of patients with CHF were included. Two reviewers independently extracted the data. Main analysis used a fixed-effects model. The search retrieved 794 articles, from which seven studies were included. Treatment with FES provided a smaller gain in peak VO2 compared with CA {-0.74 ml/kg per min [95% confidence interval (CI): -1.38 to -0.10]}. There was no difference in the muscle strength [-0.33 Nm (95% CI: -4.56 to 3.90)] and in the distance of the 6-min walk test [2.73 m (95% CI: -15.39 to 20.85)] on comparing FES with CA. An increase in peak VO2 of 2.78 ml/kg per min (95% CI: 1.44-4.13) was observed in FES versus the control group. Treatment with FES provides a similar gain in the distance of the 6-min walk test and in the muscle strength when compared with CA, but a small gain in the peak VO2. An increase in the peak VO2 can be obtained with FES as compared with the control group. Thus, FES may be an alternative in relation with CA for patients with CHF and with those who are unable to perform this kind of exercise.