scholarly journals Measurement of breathing in patients with post-COVID-19 using structured light plethysmography (SLP)

2021 ◽  
Vol 8 (1) ◽  
pp. e001070
Author(s):  
Eyas Alhuthail ◽  
James Stockley ◽  
Andrew Coney ◽  
Brendan Cooper
Keyword(s):  
Respiratory Symptoms ◽  
Structured Light ◽  
Intensive Therapy ◽  
Management Strategies ◽  
Respiratory Physiology ◽  
Hospital Treatment ◽  
Tidal Breathing ◽  
Promising Tool ◽  
Hospitalised Patients ◽  
The Uk

IntroductionCOVID-19 pandemic has had a huge impact on global health to date, with 5.6 million cases in the UK since its emergence. The respiratory symptoms largely mimic those of pneumonia’ with symptoms ranging from mild to severe. The effects on respiratory physiology are not yet fully understood, but evidence is emerging that there is much dysfunctional breathing reported but little information on tidal ventilation from the acute phase of the infection. Structured light plethysmography (SLP) is a contactless technique of respiratory function testing that measures tidal breathing parameters by assessing thoracoabdominal displacement.MethodsIn a postdischarge clinic, SLP was performed routinely on 110 hospitalised patients recovering from COVID-19 who had been screened for respiratory symptoms to confirm any respiratory changes occurring after the disease. Patients were categorised based on their hospital treatment in (1) the intensive therapy unit (ITU) (requiring intubation) (n=65) or (2) respiratory wards only (n=45). Data from these two patient cohorts were compared with preacquired data from healthy controls (n=30).ResultsWe have found a significantly increased respiratory rate (p=0.006) in ITU patients compared with the healthy cohort and also a significant decrease in the inspiratory time (p=0.01), expiratory time (p=0.005) and the total breathing cycle (p=0.008). There were no significant differences between ITU and ward patients and no significant differences in healthy compared with ward patients. We examined the variability of breathing (‘entropy’) both in terms of the breath-to-breath interval and the volume-to-volume change. The breath-to-breath interval alone was significantly lower in ITU patients compared with healthy cohorts (p=0.02).ConclusionOur findings suggest that abnormalities in tidal breathing can be detected in COVID-19 recovery patients, and SLP may be a promising tool in assessing the aftermath of diseases such as COVID-19, particularly if more intensive management strategies such as mechanical ventilation are required.

scholarly journals Incidence, pattern and severity of abnormal liver blood tests among hospitalised patients with SARS-COV2 (COVID-19) in South Wales

2020 ◽  
pp. flgastro-2020-101532
Author(s):  
Andrew Yeoman ◽  
Daniel Raun Maggs ◽  
Syed A A Gardezi ◽  
Hasan Nadim Haboubi ◽  
Muhammad Imran Yahya ◽  
...  
Keyword(s):  
Intensive Therapy ◽  
Significant Proportion ◽  
Male Gender ◽  
Blood Tests ◽  
South Wales ◽  
Global Pandemic ◽  
Hospitalised Patients ◽  
Period Data ◽  
Novel Coronavirus ◽  
The Uk

IntroductionSARS-CoV-2 (COVID-19) is a novel coronavirus that emerged in Wuhan, China in late 2019 and since become a global pandemic. As such, its clinical behaviour is a subject of much interest. Initial reports suggested a significant proportion of patients have abnormal liver blood tests. Gwent has experienced one of the highest incidences of COVID-19 infection in the UK, which itself has among the highest COVID-19 impacts worldwide.MethodWe set out to report the incidence, clinical pattern and severity of liver blood test abnormalities in hospitalised patients with confirmed COVID-19 in our institution over a 3-week period. Data on clinical outcomes such as admission to intensive therapy unit (ITU), hospital discharge and mortality were recorded.Results318 hospitalised COVID-19 positive had liver blood tests available for analysis. Ninety-seven patients (31%) had one or more abnormal liver blood tests and were abnormal admission in 64%. Liver tests were predominantly cholestatic (72%) in contrast to other studies to date. Male gender and abnormal liver blood tests were associated with ITU admission.ConclusionsAlmost one-third of admissions with COVID-19 have abnormal LBTs which are typically mild and are associated with male gender. Importantly, we have identified that cholestatic patterns dominate but were not clearly associated with ITU admission or death.

Tidal Breathing Parameters Measured by Structured Light Plethysmography in Newborns: Is It Feasible in Neonatal Intensive Care Unit?

2020 ◽  
Author(s):  
Evrim Alyamac Dizdar ◽  
Davut Bozkaya ◽  
Fatma Nur Sari ◽  
Esra Beser ◽  
Cuneyt Tayman ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Respiratory Symptoms ◽  
Neonatal Intensive Care ◽  
Structured Light ◽  
Late Preterm ◽  
Tidal Breathing ◽  
Term Neonates ◽  
Late Preterm Infants ◽  
Relative Contribution ◽  
Study Population

Abstract Objective Structured light plethysmography (SLP) is a novel and noncontact respiratory assessment technique. It provides tidal breathing measurement in patients difficult to cooperate. In this study, we aimed to determine data for tidal breathing parameters measured by SLP in newborns. Study Design Infants between 2 and 5 days of life without having any respiratory symptoms were eligible for this observational study. In total, 5 minutes of tidal breathing was recorded using SLP (Thora-3Di, PneumaCare Ltd, Cambridge, U.K.) in each infant. Various tidal breathing parameters including timing indices, flow-based parameters, and regional parameters were obtained from SLP data. Results A total of 57 infants underwent measurements in the study. Evaluable recordings from 42 term and 11 late preterm infants were analyzed. Median gestational age and birthweight of the infants were 38 (37–39) weeks and 3,195 (2,790–3,585) g, respectively. In terms of flow-based parameters, “tidal inspiratory flow at 50% of inspiratory volume divided by tidal expiratory flow at 50% of expiratory volume” was 1.29 (1.13–1.53). Relative contribution of the thorax to each breath in percentage was measured as 38.67 (28.21–43.60). Median values of left–right hemithoracic asynchrony and thoraco-abdominal asynchrony were 6.92 (5.35–9.04) and 17.96 (12.98–36.44) degrees in the study population, respectively. There were no differences in tidal breathing parameters except “hemithoracic asynchrony” between term and late preterm infants. Hemithoracic asynchrony was significantly lower in term neonates than late preterms. Conclusion SLP was found to be feasible to obtain measures of tidal breathing parameters in newborns and it could be performed successfully even in the first days of life.

scholarly journals Post-acute COVID-19 sequelae in cases managed in the community or hospital in the UK: a population based study

2021 ◽  
Author(s):  
Hannah R Whittaker ◽  
Claudia Gulea ◽  
Ardita Koteci ◽  
Constantinos Kallis ◽  
Ann D Morgan ◽  
...  
Keyword(s):  
Cox Regression ◽  
Management Strategies ◽  
Healthcare Utilisation ◽  
Population Based ◽  
Practice Research ◽  
Research Database ◽  
Community Group ◽  
Hospitalised Patients ◽  
The Uk ◽  
Age And Sex

Objective To compare post-COVID-19 sequelae between hospitalised and non-hospitalised individuals Design Population-based cohort study Setting 1,383 general practices in England contributing to Clinical Practice Research Database Aurum Participants 46,687 COVID-19 cases diagnosed between 1st August to 17th October 2020 (45.4% male; mean age 40), either hospitalised within two weeks of diagnosis or non-hospitalised, and followed-up for a maximum of three months. Main outcome measures Event rates of new symptoms, diseases, prescriptions and healthcare utilisation in hospitalised and non-hospitalised individuals, with between-group comparison using Cox regression. Outcomes compared at 6 and 12 months prior to index date, equating to first UK wave and pre-pandemic. Non-hospitalised group outcomes stratified by age and sex. Results 45,272 of 46,687 people were non-hospitalised; 1,415 hospitalised. Hospitalised patients had higher rates of 13/26 symptoms and 11/19 diseases post-COVID-19 than the community group, received more prescriptions and utilised more healthcare. The largest differences were noted for rates per 100,000 person-weeks [95%CI] of breathlessness: 536 [432 to 663] v. 85 [77 to 93]; joint pain: 295 [221 to 392] v. 168 [158 to 179]; diabetes: 303 [225 to 416] v. 36 [32 to 42], hypertension: 244 [178 to 344] v. 47 [41 to 53]. Although low, rates of chest tightness, tinnitus and lung fibrosis were higher in the community group. 4.2% (1882/45,272) of the community group had a post-acute burden, most frequently reporting anxiety, breathlessness, chest pain and fatigue. In those non-hospitalised, age and sex differences existed in outcome rates. Healthcare utilisation in the community group increased 28.5% post-COVID-19 relative to pre-pandemic. Conclusions Post-COVID-19 sequelae differ between hospitalised and non-hospitalised individuals, with age and sex-specific differences in those non-hospitalised. Most COVID-19 cases managed in the community do not report ongoing issues to healthcare professionals. Post-COVID-19 follow-up and management strategies need to be tailored to specific groups.

Entitlement to hospital treatment in the UK: qualifiers, challenges and comment

2011 ◽  
Vol 72 (3) ◽  
pp. 156-160
Author(s):  
Simon W Dubrey ◽  
Paresh A Mehta ◽  
Ritu Sharma ◽  
Sheila Shah
Keyword(s):  
Hospital Treatment ◽  
The Uk

scholarly journals A review of respiratory manifestations and their management in Ehlers-Danlos syndromes and hypermobility spectrum disorders

2021 ◽  
Vol 18 ◽  
pp. 147997312110253
Author(s):  
Karan Chohan ◽  
Nimish Mittal ◽  
Laura McGillis ◽  
Laura Lopez-Hernandez ◽  
Encarna Camacho ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Muscle Function ◽  
Respiratory Muscle ◽  
Respiratory Symptoms ◽  
Management Strategies ◽  
Narrative Review ◽  
Respiratory Muscle Function ◽  
Respiratory Management ◽  
Spectrum Disorders ◽  
Continuous Positive Pressure

Background: Ehlers-Danlos Syndromes (EDS) and Hypermobility Spectrum Disorders (HSD) are a heterogeneous group of heritable genetic connective tissue disorders with multiple characteristics including joint hypermobility, tissue fragility, and multiple organ dysfunction. Respiratory manifestations have been described in EDS patients, but have not been systematically characterized. A narrative review was undertaken to describe the respiratory presentations and management strategies of individuals with EDS and HSD. Methods: A broad literature search of Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL was undertaken from inception to November 2020 of all study types, evaluating EDS/ HSD and pulmonary conditions. This narrative review was limited to adult patients and publications in English. Results: Respiratory manifestations have generally been described in hypermobile EDS (hEDS), classical and vascular EDS subtypes. Depending on EDS subtype, they may include but are not limited to dyspnea, dysphonia, asthma, sleep apnea, and reduced respiratory muscle function, with hemothorax and pneumothorax often observed with vascular EDS. Respiratory manifestations in HSD have been less frequently characterized in the literature, but exertional dyspnea is the more common symptom described. Respiratory symptoms in EDS can have an adverse impact on quality of life. The respiratory management of EDS patients has followed standard approaches with thoracotomy tubes and pleurodesis for pleural manifestations, vocal cord strengthening exercises, continuous positive pressure support for sleep apnea, and exercise training. Reduced respiratory muscle function in hEDS patients responds to inspiratory muscle training. Conclusion: Respiratory symptoms and manifestations are described in EDS and HSD, and have generally been managed using conservative non-surgical strategies. Research into the prevalence, incidence and specific respiratory management strategies in EDS and HSD is needed to mitigate some of the associated morbidity.

scholarly journals National survey of feasibility of NIV trials for management of children with bronchiolitis

2020 ◽  
Vol 4 (1) ◽  
pp. e000780
Author(s):  
Anna Rosala-Hallas ◽  
Ashley P Jones ◽  
Emma Bedson ◽  
Vanessa Compton ◽  
Ricardo M Fernandes ◽  
...  
Keyword(s):  
National Survey ◽  
Controlled Trial ◽  
Management Strategies ◽  
Eligibility Criteria ◽  
Training Requirements ◽  
Non Invasive Ventilation ◽  
Respiratory Management ◽  
Randomised Controlled ◽  
The Uk ◽  
Future Work

BackgroundBronchiolitis is a major cause of admission to hospital in children. Non-invasive ventilation (NIV) support with continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) oxygen is routinely used for infants in the UK with bronchiolitis.ObjectiveTo establish UK paediatric practice regarding management of bronchiolitis, and to explore issues pertinent to the design of a potential future randomised controlled trial of NIV.DesignScreening logs were completed in hospitals in England capturing information on paediatric bronchiolitis admissions. An online national survey of clinical practice was disseminated to healthcare professionals (HCPs) across the UK to ascertain current management strategies.ResultsScreening logs captured data on 393 infants from 8 hospitals. Reasons for admission were most commonly respiratory distress and/or poor fluid intake. Oxygen was administered for 54% of admissions. Respiratory (CPAP and HFNC) and non-respiratory support administered varied considerably. The national survey was completed by 111 HCPs from 76 hospitals. Data were obtained on criteria used to commence and wean NIV, responsibilities for altering NIV settings, minimum training requirements for staff managing a child on NIV, and numbers of trained staff. Most centres were interested in and capable of running a trial of NIV, even out of normal office hours.ConclusionsRespiratory and non-respiratory management of bronchiolitis in UK centres varies widely. A trial of HFNC oxygen therapy in this group of patients is feasible and HCPs would be willing to randomise patients into such a trial. Future work should focus on defining trial eligibility criteria.

scholarly journals AGILE: a seamless phase I/IIa platform for the rapid evaluation of candidates for COVID-19 treatment: an update to the structured summary of a study protocol for a randomised platform trial letter

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Gareth O. Griffiths ◽  
Richard FitzGerald ◽  
Thomas Jaki ◽  
Andrea Corkhill ◽  
Helen Reynolds ◽  
...  
Keyword(s):  
Phase I ◽  
Early Stage ◽  
Late Phase ◽  
Optimum Dose ◽  
Open Label ◽  
Link Type ◽  
Hospitalised Patients ◽  
Volunteer Study ◽  
The Uk ◽  
Phase Trial

Abstract Background There is an urgent unmet clinical need for the identification of novel therapeutics for the treatment of COVID-19. A number of COVID-19 late phase trial platforms have been developed to investigate (often repurposed) drugs both in the UK and globally (e.g. RECOVERY led by the University of Oxford and SOLIDARITY led by WHO). There is a pressing need to investigate novel candidates within early phase trial platforms, from which promising candidates can feed into established later phase platforms. AGILE grew from a UK-wide collaboration to undertake early stage clinical evaluation of candidates for SARS-CoV-2 infection to accelerate national and global healthcare interventions. Methods/design AGILE is a seamless phase I/IIa platform study to establish the optimum dose, determine the activity and safety of each candidate and recommend whether it should be evaluated further. Each candidate is evaluated in its own trial, either as an open label single arm healthy volunteer study or in patients, randomising between candidate and control usually in a 2:1 allocation in favour of the candidate. Each dose is assessed sequentially for safety usually in cohorts of 6 patients. Once a phase II dose has been identified, efficacy is assessed by seamlessly expanding into a larger cohort. AGILE is completely flexible in that the core design in the master protocol can be adapted for each candidate based on prior knowledge of the candidate (i.e. population, primary endpoint and sample size can be amended). This information is detailed in each candidate specific trial protocol of the master protocol. Discussion Few approved treatments for COVID-19 are available such as dexamethasone, remdesivir and tocilizumab in hospitalised patients. The AGILE platform aims to rapidly identify new efficacious and safe treatments to help end the current global COVID-19 pandemic. We currently have three candidate specific trials within this platform study that are open to recruitment. Trial registration EudraCT Number: 2020-001860-27 14 March 2020 ClinicalTrials.gov Identifier: NCT04746183 19 February 2021 ISRCTN reference: 27106947

scholarly journals Routine use of immunosuppressants is associated with mortality in hospitalised patients with COVID-19

2021 ◽  
Vol 12 ◽  
pp. 204209862098569
Author(s):  
Phyo K. Myint ◽  
Ben Carter ◽  
Fenella Barlow-Pay ◽  
Roxanna Short ◽  
Alice G. Einarsson ◽  
...  
Keyword(s):  
Medical Attention ◽  
Close Monitoring ◽  
Plain Language ◽  
Discharge Data ◽  
Specific Patient ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

Background: Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study population was drawn from the COPE Study (COVID-19 in Older People), a multicentre observational cohort study, across the UK and Italy. Data were collected between 27 February and 28 April 2020 by trained data-collectors and included all unselected consecutive admissions with COVID-19. Load (name/number of medications) and dosage of immunosuppressant were collected along with other covariate data. Primary outcome was time-to-mortality from the date of admission (or) date of diagnosis, if diagnosis was five or more days after admission. Secondary outcomes were Day-14 mortality and time-to-discharge. Data were analysed with mixed-effects, Cox proportional hazards and logistic regression models using non-users of immunosuppressants as the reference group. Results: In total 1184 patients were eligible for inclusion. The median (IQR) age was 74 (62–83), 676 (57%) were male, and 299 (25.3%) died in hospital (total person follow-up 15,540 days). Most patients exhibited at least one comorbidity, and 113 (~10%) were on immunosuppressants. Any immunosuppressant use was associated with increased mortality: aHR 1.87, 95% CI: 1.30, 2.69 (time to mortality) and aOR 1.71, 95% CI: 1.01–2.88 (14-day mortality). There also appeared to be a dose–response relationship. Conclusion: Despite possible indication bias, until further evidence emerges we recommend adhering to public health measures, a low threshold to seek medical advice and close monitoring of symptoms in those who take immunosuppressants routinely regardless of their indication. However, it should be noted that the inability to control for the underlying condition requiring immunosuppressants is a major limitation, and hence caution should be exercised in interpretation of the results. Plain Language Summary Regular Use of Immune Suppressing Drugs is Associated with Increased Risk of Death in Hospitalised Patients with COVID-19 Background: We do not have much information on how the COVID-19 virus affects patients who use immunosuppressants, drugs which inhibit or reduce the activity of the immune system. There are various conflicting views on whether immune-suppressing drugs are beneficial or detrimental in patients with the disease. Methods: This study collected data from 10 hospitals in the UK and one in Italy between February and April 2020 in order to identify any association between the regular use of immunosuppressant medicines and survival in patients who were admitted to hospital with COVID-19. Results: 1184 patients were included in the study, and 10% of them were using immunosuppressants. Any immunosuppressant use was associated with increased risk of death, and the risk appeared to increase if the dose of the medicine was higher. Conclusion: We therefore recommend that patients who take immunosuppressant medicines routinely should carefully adhere to social distancing measures, and seek medical attention early during the COVID-19 pandemic.

The Hidden Half: Linking microbial communities to habitat condition and vegetation management in UK blanket bogs

2021 ◽  
Author(s):  
William Burn ◽  
Andreas Heinemeyer ◽  
Thorunn Helgason ◽  
David Glaves ◽  
Michael Morecroft
Keyword(s):  
Water Quality ◽  
Ecosystem Services ◽  
Microbial Communities ◽  
Structural Equation ◽  
Management Strategies ◽  
Vegetation Management ◽  
Equation Model ◽  
Habitat Condition ◽  
Blanket Bog ◽  
The Uk

<p>Peatlands are globally valued for the ecosystem services they deliver, including water quality regulation and carbon sequestration. In the UK, blanket bogs are the main peatland habitat and previous work has linked blanket bog management, especially rotational burning of heather vegetation on grousemoors, to impacts on these ecosystem services. However, we still lack a mechanistic, process-level understanding of how peatland management and habitat status is linked to ecosystem service provision, which is mostly driven by soil microbial processes.</p><p>Here we examine bacterial and fungal communities across a spectrum of “intact” to degraded UK blanket bogs and under different vegetation management strategies. Sites included grousemoors under burnt and alternative mown or uncut management along with further locations including 'near intact', degraded and restored sites across a UK climatic gradient ranging from Exmoor (South UK), the Peak District (Mid) to the Flow Country (North). Moreover, an experiment was setup at the University of York with peat mesocosms taken from all sites and management/habitat conditions to allow a comparison between field and controlled conditions and assessing root-mediated processes. Using a structural equation model, we linked grousemoor management to specific fungal/bacterial functional groups, and have started to relate this to changes in water quality provision and carbon cycle aspects. This represents a significant step in the effort to use microbial communities as indicators of peatland habitat condition in UK upland blanket bogs. </p><p> </p>

scholarly journals Respiratory parameter estimation using forced oscillatory impedance data

1977 ◽  
Vol 43 (2) ◽  
pp. 322-330 ◽  
Author(s):  
M. J. Tsai ◽  
R. L. Pimmel ◽  
E. J. Stiff ◽  
P. A. Bromberg ◽  
R. L. Hamlin
Keyword(s):  
Respiratory Symptoms ◽  
Forced Oscillation ◽  
Respiratory Resistance ◽  
Added Resistance ◽  
Tidal Breathing ◽  
Frequency Dependency ◽  
Respiratory Parameter ◽  
Clinically Normal ◽  
Impedance Data ◽  
Residual Capacity

The frequency dependency of the magnitude and phase angle of total respiratory impedance was measured in apneic dogs at functional residual capacity during forced oscillation by a special electronics unit. Regression analysis of these data yielded estimates of total respiratory resistance (RFO), inertance (IFO), and compliance (CFO). After correcting for the effects of the endotracheal tube, mean control values (+/-SE) of RFO, IFO, and CFO for the clinically normal dogs were 1.30+/-0.10 cmH2O–1–1-s, 0.0114+/-0.0022 cmH2O–1–1-s2, and 0.0306+/-0.0009 1-cm H2O–1, respectively. Estimates obtained with added resistance, a less dense gas, and abdominal weighting were consistent with predicted effects. In four dogs with mild respiratory symptoms, mean RFO was significantly elevated with no change in IFO or CFO. Independent measurements of resistance and compliance during tidal ventilation correlated well with RFO (r=0.87) and CFO (r=0.80), but RFO and CFO were, on the average, 71% of the tidal breathing values. Thus, the method provides precise estimates of RFO, IFO, and CFO, and allows detection of small changes in these parameters.

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