scholarly journals Clusters of Survivors of COVID-19 Associated Acute Respiratory Failure According to Response to Exercise

2021 ◽  
Vol 18 (22) ◽  
pp. 11868
Author(s):  
Michele Vitacca ◽  
Mara Paneroni ◽  
Alberto Malovini ◽  
Annalisa Carlucci ◽  
Chiara Binda ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Walking Distance ◽  
Long Term Effects ◽  
Walking Aids ◽  
High Prevalence ◽  
Exercise Induced ◽  
Different Characteristics ◽  
Response To Exercise

COVID-19 survivors are associated with acute respiratory failure (ARF) and show a high prevalence of impairment in physical performance. The present studied aimed to assess whether we may cluster these individuals according to an exercise test. The presented study is a retrospective analysis of 154 survivors who were admitted to two hospitals of Istituti Clinici Scientifici Maugeri network, Italy. Clinical characteristics, walked distance, heart rate (HR), pulse oximetry (SpO2), dyspnoea, and leg fatigue (Borg scale: Borg-D and Borg-F, respectively) while performing the six-minute walking distance (6MWT) were entered into unsupervised clustering analysis. Multivariate linear regression identified variables that were informative for the set of variables used for cluster definition. Cluster 1 (C1: 86.4% of participants) and Cluster 2 (C2: 13.6%) were identified. Compared to C1, the individuals in C2 were significantly older, showed significantly higher increase in fatigue and in dyspnoea, greater reduction in SpO2, and a lower HRpeak during the test. The need of walking aids, time from admission to acute care hospitals, age, body mass index, endotracheal intubation, baseline HR and baseline Borg-D, and exercise-induced SpO2 change were significantly associated with the variables that were used for cluster definition. Different characteristics and physiological parameters during the 6MWT characterise survivors of COVID-19-associated ARF. These results may help in the management of the long-term effects of the disease.

Long-term outcomes of adults with acute respiratory failure treated with veno-venous extracorporeal membrane oxygenation

2021 ◽  
pp. 0310057X2110423
Author(s):  
Emma L Gray ◽  
Paul Forrest ◽  
Timothy J Southwood ◽  
Richard J Totaro ◽  
Brian T Plunkett ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Respiratory Failure ◽  
Standard Deviation ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Body Mass ◽  
Multiple Logistic Regression Analysis ◽  
Membrane Oxygenation ◽  
Retrospective Audit

Veno-venous extracorporeal membrane oxygenation is increasingly used for severe but potentially reversible acute respiratory failure in adults; however, there are limited data regarding long-term morbidity. At our institution, most patients requiring veno-venous extracorporeal membrane oxygenation have been followed up by a single physician. Our primary aim was to describe the serial long-term morbidity for respiratory, musculoskeletal and psychological functioning. A retrospective audit of inpatient and outpatient medical records was conducted. A total of 125 patients treated with veno-venous extracorporeal membrane oxygenation for primary respiratory failure were included. The patients were young (mean (standard deviation) age 43.7 (4.1) years), obese (mean (standard deviation) body mass index 30.8 (10.4) kg/m2), and mostly were male (59%). Most patients (60%) had no comorbidities. The survival rate to discharge was 70%, with body mass index and the number of comorbidities being independent predictors of survival on multiple logistic regression analysis. Over half (57%) of the Australian survivors had regular outpatient follow-up. They had a median of three reviews (range 1–9) over a median of 11.8 months (range 1.5-79) months. Breathlessness and weakness resolved in most within six months, with lung function abnormalities taking longer to resolve. Over half (60%) returned to employment within six months of discharge. Over a quarter (29%) displayed symptoms of anxiety, depression or post-traumatic stress disorder.

The metabolic implications of long term cannabis use in patients with psychosis

2008 ◽  
Vol 17 (3) ◽  
pp. 221-226 ◽  
Author(s):  
Farrah Mushtaq ◽  
Valeria Mondelli ◽  
Carmine M. Pariante
Keyword(s):  
Body Weight ◽  
General Population ◽  
Endocannabinoid System ◽  
Cannabis Use ◽  
Long Term Effects ◽  
Glucose Levels ◽  
High Prevalence ◽  
Vulnerable Patient ◽  
Vulnerable Patient Group

SummaryAimsThe aim of this paper is to summarise the effects of cannabis use on appetite and energy balance, and to subsequently investigate the possible implications this may have in patients with psychosis, in whom a high prevalence of cannabis use has been reported.Methods– A narrative review based on the recent literature regarding cannabis use in the gen-eral population and patients with psychosis.Results– The short-term abilities of cannabis to increase appetite and body weight, through actions on the endogenous endocannabinoid system, have been well characterised throughout the literature. The long term effects of cannabis use are however unclear and only a minority of studies have been conducted in the general population with overall conflicting results. In terms of the effects of cannabis in patients with psychosis, there has only been one study to date that has investigated this and interestingly found cannabis use to be associated with increased body weight and blood glucose levels, thus providing evidence that cannabis use may be an important contributing factor to the reduced life expectancy, as is currently observed in this vulnerable patient group.Conclusions– It is clear from the literature that patients with psychosis are at a high risk of metabolic and cardiovascular disease in comparison to the general population. However the contribution of cannabis use to this risk is as of yet undetermined and further long term studies are need to confirm current findings and evaluate hypothesised mechanisms.Declaration of Interest: None.

Long-term management of acute respiratory failure in metabolic myopathy

1996 ◽  
Vol 22 (12) ◽  
pp. 1406-1409
Author(s):  
G. Pfeiffer ◽  
G. Winkler ◽  
P. Neunzig ◽  
W. Wolf ◽  
G. Thayssen ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Metabolic Myopathy ◽  
Term Management

scholarly journals Intrapulmonary shunting and pulmonary gas exchange during normoxic and hypoxic exercise in healthy humans

2008 ◽  
Vol 104 (5) ◽  
pp. 1418-1425 ◽  
Author(s):  
Andrew T. Lovering ◽  
Lee M. Romer ◽  
Hans C. Haverkamp ◽  
David F. Pegelow ◽  
John S. Hokanson ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Contrast Echocardiography ◽  
Pulmonary Gas Exchange ◽  
Pulmonary Vasculature ◽  
Long Term Effects ◽  
Arteriovenous Shunting ◽  
Healthy Humans ◽  
Intrapulmonary Shunting ◽  
Exercise Induced

Exercise-induced intrapulmonary arteriovenous shunting, as detected by saline contrast echocardiography, has been demonstrated in healthy humans. We have previously suggested that increases in both pulmonary pressures and blood flow associated with exercise are responsible for opening these intrapulmonary arteriovenous pathways. In the present study, we hypothesized that, although cardiac output and pulmonary pressures would be higher in hypoxia, the potent pulmonary vasoconstrictor effect of hypoxia would actually attenuate exercise-induced intrapulmonary shunting. Using saline contrast echocardiography, we examined nine healthy men during incremental (65 W + 30 W/2 min) cycle exercise to exhaustion in normoxia and hypoxia (fraction of inspired O2 = 0.12). Contrast injections were made into a peripheral vein at rest and during exercise and recovery (3–5 min postexercise) with pulmonary gas exchange measured simultaneously. At rest, no subject demonstrated intrapulmonary shunting in normoxia [arterial Po2 (PaO2) = 98 ± 10 Torr], whereas in hypoxia (PaO2 = 47 ± 5 Torr), intrapulmonary shunting developed in 3/9 subjects. During exercise, ∼90% (8/9) of the subjects shunted during normoxia, whereas all subjects shunted during hypoxia. Four of the nine subjects shunted at a lower workload in hypoxia. Furthermore, all subjects continued to shunt at 3 min, and five subjects shunted at 5 min postexercise in hypoxia. Hypoxia has acute effects by inducing intrapulmonary arteriovenous shunt pathways at rest and during exercise and has long-term effects by maintaining patency of these vessels during recovery. Whether oxygen tension specifically regulates these novel pathways or opens them indirectly via effects on the conventional pulmonary vasculature remains unclear.

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