Introduction The COVID-19 pandemic has greatly impacted not only the physical health of society, but also its social, mental, and economic health. The Illinois shelter in place orders enacted in March and April limited work and activities outside the home. Our aim for this study was to compare the effects of the COVID-19 shelter in place orders on PAP use patterns in patients with OSA. Methods We selected 30 patients seen between May and October 2020. Patients had been diagnosed with OSA for at least one year, prescribed PAP therapy and had been compliant with therapy as defined by 70% use greater 4-hour for 30 days prior to their clinic visit. Using data collected from chart review as well as online ResMed AirView cloud data, we evaluated PAP on/off and average use time during shelter in place order for a 90 day period (March through May 2020). We compared this data to a similar period in the year prior. Results Average age of our study group was 58.6 years old with 19 men and 11 women. Mean AHI was 51.7. Reported average bedtime was 10:00pm with average wake time 7:30am during the shutdown compared with a bedtime of 9pm and wake up time 6:30am. Patients reported having more time to sleep and required less naps during the day. Average PAP use during shut down was 7 hours 20 minutes and average PAP use prior to shutdown was 6 hours and 50 minutes. An average of 30 additional PAP minutes was observed among patients during the shelter in place order. Only one of our patients was diagnosed with COVID during this time period. Conclusion For patients with OSA on PAP therapy we observed an increase in PAP use. Among patients suddenly required to shelter in place, we observed a delayed sleep onset and wake time of more than 1 hour, resulting in a slightly longer overall PAP use time. This circadian phase shift was greater among working patients compared to retired patients. The health effects of longer PAP use and circadian phase shifting remain to be determined. Support (if any):

Purpose To elucidate the considerations pharmacists have when using concomitant vancomycin and piperacillin/tazobactam (VPT) and strategies implemented across hospitals in response to published data on this phenomenon. Methods A survey of pharmacist members of the infectious diseases and critical care (CC) practice and research networks of the American College of Clinical Pharmacy was conducted. Participants were grouped based on their belief (yes or no) in the association between VPT and acute kidney injury (AKI) and queried regarding AKI with VPT, antimicrobial stewardship practices, and demographics. Descriptive statistics were performed. Between‐group responses were compared using χ2 or Fisher's exact tests. Results There were 238 responses. Most (88.7%) respondents believed combination VPT is associated with greater expected odds of AKI development than vancomycin monotherapy or with cefepime. Nonbelievers more commonly practiced in CC or emergency medicine (P = .006) and less frequently recommended the combination in patients already experiencing AKI (64% vs 7.4%, P < .001) and in patients with chronic kidney disease class III or IV (56.9% vs 3.7%, P < .001). Opinions varied regarding risk factors for and odds of AKI development in specific scenarios. Respondents who believed combination VPT is associated with greater odds of AKI development more frequently provided formal (18% vs 0, P = .01) and informal (73% vs 33.3%, P < .001) education on potential AKI from combination VPT and discouraged empiric combination VPT in favor of other combination(s) (40.8% vs 14.8%, P = .01). Other AMS strategies were used to a similar extent regardless of belief in the association of VPT with AKI. Conclusion Most respondents, particularly those practicing in CC and emergency medicine, believe combination VPT is associated with AKI development. These beliefs have affected antimicrobial recommendations and educational efforts. The impact of these beliefs on patient outcomes and health care expenditures requires further investigation.

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Introduction Obstructive sleep apnea (OSA) and Chronic obstructive airway disease (COPD) affect millions of Americans. The combination (overlap syndrome) results in increased morbidity, mortality and associated healthcare costs. Type III sleep testing via portable monitoring (PM) is not recommended for patients with COPD, and there is little guidance in regards to inpatient testing. We aim to determine the feasibility of inpatient PM for diagnosing OSA in patients admitted with acute exacerbation of COPD (AECOPD) and hypercapnic respiratory failure requiring noninvasive positive pressure ventilation (NIPPV). Methods This is a retrospective review of prospectively collected data. Inpatients 40 year-old and older admitted with AECOPD and PaCO2≥52mmHg on arterial blood gas (ABG) testing requiring NIPPV were included for analysis. One patient died and one withdrew consent. The remaining patients underwent overnight PM (ApneaLink Airtm by ResMed®) once clinically stable, off NIPPV, on oxygen when needed to sustain oxygen saturation at or above 88%. Patients were discharged on volume-assured pressure support ventilation (VAPS) for nightly use at home and followed for 6 months. Results Five patients were included. Average age was 60 years, majority were African-American males, former smokers (average 31.2 pack-years), with moderate to severe airflow obstruction (FEV1 24–52 %Pred). Except for one (BMI 17 kg/m2), patients had concomitant morbid obesity (average BMI 39.7 kg/m2). Four out of 5 patients had overlap syndrome (AHI 19.4/h -75/h). Follow-up objective download data demonstrated AHI &lt;10 in all patients with available data (3/5 at 6 months). One patient required in-sleep center VAPS titration. Conclusion This pilot study suggests portable monitoring is feasible in diagnosing OSA in this complex patient population admitted for AECOPD, despite concomitant oxygen use during PM testing. Despite the small number of patients, 4/5 were diagnosed with moderate to severe OSA and objective data on VAPS demonstrated effective treatment. Further studies using PM for screening of OSA in inpatients with COPD and obesity and impact on patient-centric outcomes are needed. Support (if any):

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