The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, on December 2019. Since then it has spread worldwide, causing an unforeseen global crisis. Respiratory involvement ranging from a mild flu-like illness to potentially lethal acute respiratory distress syndrome (ARDS) is the predominant clinical manifestation of SARS-CoV-2. However, cardiovascular complications can also result in severe morbidity and mortality. Although ARDS appears to be the most common trigger for intensive care unit (ICU) admission, cardiac injury and shock are also frequent. In patients with ARDS and/or cardiogenic shock, the Extracorporeal Membrane Oxygenation (ECMO) is often required to provide respiratory and cardiac support. Nevertheless, evidence on ECMO in COVID-19 patients remains controversial. This review sought to analyse the use of veno-venous-ECMO and veno-arterial-ECMO in SARS-CoV-2 positive patients, of whom age (p-value 0.89), previous medical history, presenting complaints, echocardiography, indication for ECMO, duration of support (p-value0.31), and status at discharge (mortality p-value0.75) were analysed. It has to be acknowledged that a multidisciplinary approach and a frequent reassessment of response to mechanical circulatory support are fundamental for the SARS-CoV-2 population requiring cardiac and/or respiratory support. Keywords: VA-ECMO;VV-ECMO;ECLS;COVID-19;SARS-CoV-2;cardiogenic shock;ARDS
Background The definitive management of acute cholecystitis is laparoscopic cholecystectomy on the same admission if the patient is fit. As the Covid-19 pandemic emerged, evidence suggested adverse outcomes for asymptomatic Covid positive patients undergoing surgery, including increased mortality risk. Risks to theatre staff were also highlighted. This prompted changes in acute cholecystitis management guidelines. Method The audit aim was to assess the impact of guideline change on clinical outcomes and readmission rate for acute cholecystitis. The revised Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) guidelines were the gold standard. All inpatient admissions for acute cholecystitis during the 4-week peak of the pandemic (17/04/2020 – 14/05/2020) were included. Result 24 patients were admitted with acute cholecystitis. 10 patients (41.7%) were managed with antibiotics alone, 4 patients (16.6%) underwent cholecystostomy. 12 patients (50%) were discharged within 3 days. Lack of clinical progress/ongoing symptoms was the indication for laparoscopic cholecystectomy in 5 cases (20.8%). 5 conservatively managed patients (20.8%) were readmitted with ongoing cholecystitis or pancreatitis. Conclusions 19 patients (80%) were managed non-surgically in accordance with AUGIS guidelines. However conservative management was not always appropriate. We recommend that laparoscopic cholecystectomy should remain a management option for acute cholecystitis during the ongoing Covid-19 pandemic.
Introduction and ObjectivesAgeing is typically associated with progressive deleterious changes in respiratory mechanics which increase the work of breathing and limit ventilatory reserve. The impact on exercise capacity and exertional breathlessness in healthy ageing remains incompletely understood, in part due to a failure of previous research to control for negative effects of physical inactivity. This study aimed to compare neural respiratory drive (NRD), respiratory mechanics and breathlessness between highly active older adults (AOA) and recreationally active younger adults (YA). We hypothesised that NRD, quantified as diaphragm electromyogram activity (EMGdi) as a percentage of volitional maximum (EMGdi%max), would be higher in AOA than in YA and that this would be associated with increased breathlessness intensity during exercise.Methods12 YA (mean (+/-SD) age 26.4+/-4.7 years) and 12 AOA (cyclists, 59.0+/-10.1 years), all male, underwent incremental cycle ergometry to their symptom-limited maximum. EMGdi was recorded continuously using an oesophageal multipair electrode catheter and quantified as EMGdi%max. Breathlessness intensity was quantified each minute and at end-exercise using the modified Borg scale.ResultsAbsolute FEV1, FVC, FEV1%FVC and IC tended to lower values in AOA than in YA (Table 1), without significant differences in baseline EMGdi%max (AOA 10.6+/-5.8%max; YA 7.6+/-3.7%max, p=0.15). End-exercise EMGdi%max was significantly higher in AOA than in YA (AOA 61.8+/-13.7%max; YA: 51.9+/-9.1%max p=0.049), with a trend towards higher end-exercise tidal volume (VT) relative to IC (AOA: VT%IC=83.1+/−16.7%; YA: VT%IC=73.2+/−17.1%, p=0.17). There were no significant end-exercise differences in VT (AOA 2.9+/-0.8 L; YA 2.8+/-0.6 L, p=0.85), minute ventilation (VE) (AOA 116.7+/-35.8 L/min; YA: 110.4+/-29.3 L/min, p=0.64) or mBorg breathlessness intensity (median (IQR) AOA 5 (3.25–7.75); YA 5 (5–9), p=0.5).ConclusionsHighly active older adults achieved a similar end-exercise VE to the younger adults despite age-related respiratory constraints. This required higher levels of NRD, which contrary to our hypothesis, was not perceived as increased breathlessness intensity. The contribution of ageing and/or regular physical activity to this apparent blunted perception of breathlessness requires further study.Abstract S83 Table 1Demographics, anthropometrics and lung function data for active older adults (AOA) and younger adults (YA). BMI, body mass index; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; TLC, total lung capacity; RV, residual volume; IC, inspiratory capacity. Values presented are mean ±SD. * Indicates statistically significant difference between groups, p<0.05Younger adultsActive Older Adultsp-value Age (yrs)26.4±4.759.0±10.1<0.0001*BMI (kg/m2)24.5±3.525.7±2.40.35FEV1 (L)4.70±0.803.82±0.860.023*FEV1% pred. (%)105.0±17.9109.1±12.80.53FVC (L)5.88±0.955.23±1.200.16FVC% pred. (%)105.6±15.9112.1±16.80.11FEV1%FVC (%)79.5±5.073.1±6.10.01*IC (L)3.80±0.473.47±0.860.26IC pred. (%)89.4±17...
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