Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19- a quasi-experimental study

Background:Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory tract disease. The most common clinical manifestation of severe COVID-19 is acute respiratory failure. Respiratory rehabilitation can be a crucial part of treatment but data lack for patients with COVID-19. This study investigates the effects of short-term respiratory rehabilitation (i.e., breathing exercises) on respiratory recovery among hospitalised patients with COVID-19. Methods: This quasi-experimental, pre-post-test study recruited 110 patients hospitalised with COVID-19. All patented received standardised care, and 65 patients also received the intervention (i.e., breathing exercises). Data on peripheral oxygen saturation (SpO2), respiratory rate (breaths/minute) and heart rate (beats/minute) and oxygen therapy requirement (litre/min) were collected at baseline and 4-5 days after the baseline assessment. Analysis of variance on repeated measures was applied to compare the outcomes of two-time points. Results: The mean (±Standard deviation, SD) age of the intervention group was 49.5 (±10.4) years and 73.8% were men. The mean (±SD) age of the control group was 49.3 (±7.9) years and 62.2% were men. After 4-5 days of respiratory rehabilitation SpO2 (96.7% ±2.1 vs 90.4% ±1.5), P<0.01), respiratory rate (20.5 ±2.4 vs 23.0 ±2.2) breaths/minute, P<0.01), heart rate (80.5 ±9.2 vs 91.2 ±8.6) beats/minute, P<0.01), and oxygen therapy requirement (0.4 ±0.98 vs 1.4 ±2.0) litre/min, P<0.01) improved in the intervention group compared to the control group. The mean days of hospitalisation for the intervention group and the control group were 7.1 days vs. 14.6 days, respectively. Conclusions:Our results indicate that breathing exercise, even for a short period, is effective in improving certain respiratory parameters in patients with COVID-19. As a non-invasive and cost-effective respiratory rehabilitation intervention, breathing exercise can be a useful tool for a health care system overwhelmed by COVID-19 pandemic. These results should be considered preliminary until they are replicated in larger samples in different settings.

Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19- a quasi-experimental study

Background:Coronavirus disease 2019 (COVID-19) is a highly infectious respiratory tract disease. The most common clinical manifestation of severe COVID-19 is acute respiratory failure. Respiratory rehabilitation can be a crucial part of treatment but data lack for patients with COVID-19. This study investigates the effects of short-term respiratory rehabilitation (i.e., breathing exercises) on respiratory recovery among hospitalised patients with COVID-19. Methods: This quasi-experimental, pre-post-test study recruited 110 patients hospitalised with COVID-19. All patented received standardised care, and 65 patients also received the intervention (i.e., breathing exercises). Data on peripheral oxygen saturation (SpO2), respiratory rate (breaths/minute) and heart rate (beats/minute) and oxygen therapy requirement (litre/min) were collected at baseline and 4-5 days after the baseline assessment. Analysis of variance on repeated measures was applied to compare the outcomes of two-time points. Results: The mean (±Standard deviation, SD) age of the intervention group was 49.5 (±10.4) years and 73.8% were men. The mean (±SD) age of the control group was 49.3 (±7.9) years and 62.2% were men. After 4-5 days of respiratory rehabilitation SpO2 (96.7% ±2.1 vs 90.4% ±1.5), P<0.01), respiratory rate (20.5 ±2.4 vs 23.0 ±2.2) breaths/minute, P<0.01), heart rate (80.5 ±9.2 vs 91.2 ±8.6) beats/minute, P<0.01), and oxygen therapy requirement (0.4 ±0.98 vs 1.4 ±2.0) litre/min, P<0.01) improved in the intervention group compared to the control group. The mean days of hospitalisation for the intervention group and the control group were 7.1 days vs. 14.6 days, respectively. Conclusions:Our results indicate that breathing exercise, even for a short period, is effective in improving certain respiratory parameters in patients with COVID-19. As a non-invasive and cost-effective respiratory rehabilitation intervention, breathing exercise can be a useful tool for a health care system overwhelmed by the COVID-19 pandemic. These results should be considered preliminary until they are replicated in larger samples in different settings.

Effects of dexmedetomidine on intraoperative hemodynamics, recovery profile and postoperative pain in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

Background To investigate the optimal dose of dexmedetomidine to maintain hemodynamic stability, prevent of cough and minimize postoperative pain for patients undergoing laparoscopic cholecystectomy. Methods One hundred twenty patients were randomly divided into D1, D2, D3 and NS groups, and dexmedetomidine 0.4, 0.6, 0.8μg/kg and normal saline were administrated respectively. Patients’ heart rate, systolic blood pressure and diastolic blood pressure were measured at T1-T7. The incidence of cough was recorded. Other parameters were noted, the time of spontaneous respiratory recovery and extubation, visual analogue scale scores and dosage of tramadol. Results The heart rate, systolic blood pressure and diastolic blood pressure of D2 and D3 groups has smaller fluctuations at T2–3 and T7 compared with NS and D1 groups (P < 0.05). The incidence of cough was lower in D2 and D3 groups than NS group (P < 0.05). The visual analogue scale scores and tramadol dosage of D2 and D3 groups were lower than NS group (P < 0.05). The time of spontaneous respiratory recovery and extubation in D3 group was longer than that in D1 and D2 groups (P < 0.05). Conclusions Intravenous infusion of 0.6μg/kg dexmedetomidine before induction can maintain hemodynamic stability, decrease cough during emergence, relieve postoperative pain of patients undergoing laparoscopic cholecystectomy. Trial registration ChiCTR1900024801, registered at the Chinese Clinical Trial Registry, principal investigator: Qin Ye, date of registration: July 28, 2019.

Effects of Dexmedetomidine on Intraoperative Hemodynamics, Recovery Profile and Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Background: To investigate the optimal dose of dexmedetomidine to maintain hemodynamic stability, prevent of cough and minimize postoperative pain for patients undergoing laparoscopic cholecystectomy.Methods: 120 patients were randomly divided into D1, D2, D3 and NS groups, and dexmedetomidine 0.4, 0.6, 0.8ug/kg and normal saline were administrated respectively. Patients' heart rate, systolic blood pressure and diastolic blood pressure were measured at T1-T7. The incidence of cough was recorded. Other parameters were noted, the time of spontaneous respiratory recovery and extubation, visual analogue scale scores and dosage of tramadol.Results: The heart rate, systolic blood pressure and diastolic blood pressure of D2 and D3 groups has smaller fluctuations at T2-3 and T7 compared with NS and D1 groups (P < 0.05). The incidence of cough was lower in D2 and D3 groups than NS group (P < 0.05). The visual analogue scale scores and tramadol dosage of D2 and D3 groups were lower than NS group (P < 0.05). The time of spontaneous respiratory recovery and extubation in D3 group was longer than that in D1 and D2 groups (P < 0.05). Conclusions: Intravenous infusion of 0.6ug/kg dexmedetomidine before induction can maintain hemodynamic stability, decrease cough during emergence, relieve postoperative pain of patients undergoing laparoscopic cholecystectomy.Trial registration: ChiCTR1900024801, registered at the Chinese Clinical Trial Registry, principal investigator: Qin Ye, date of registration: July 28, 2019.

Management of Cepacia Syndrome With a Combination of Intravenous and Inhaled Antimicrobials in a Non-Cystic Fibrosis Pediatric Patient

Burkholderia cepacia complex (Bcc) is an opportunistic pathogen, posing little risk to healthy individuals. The presentation of Bcc can vary from a virtually asymptomatic chronic infection, to an acute, life-threatening necrotizing pneumonia, acute respiratory distress syndrome, and bacteremia (cepacia syndrome) associated with a mortality rate up to 75%. We present the successful treatment of a 17-year-old male with chronic granulomatous disorder who presented with cepacia syndrome and confirmed Bcc pneumonia using a novel antimicrobial approach. Despite initial IV antimicrobial therapy, our patient continued to decline, developing hypotension requiring pressor support and eventually extracorporeal membrane oxygenation. An aggressive, multimechanistic approach including the combination of nebulized tobramycin, IV sulfamethoxazole-trimethoprim, ceftazidime, enteral minocycline, and corticosteroids was implemented. This multimechanistic antimicrobial approach in combination with systemic corticosteroids led to the successful treatment of cepacia syndrome in the setting of necrotizing pneumonia due to B cepacia with full respiratory recovery. We suggest that in patients with cepacia syndrome who continue to decline despite IV antimicrobial therapy, using multiple antimicrobial mechanisms of action may improve clinical outcomes.

The race to find a SARS-CoV-2 drug can only be won by a few chosen drugs: a systematic review of registers of clinical trials of drugs aimed at preventing or treating COVID-19

ABSTRACTConsidering the massive amount of clinical trial registers aimed to find effective drugs for the prevention and treatment of COVID-19, it is challenging to have a comprehensive view of which drugs are being studied more extensively and when is expected that we will have consistent results regarding their effectiveness. This systematic review included all clinical trials on pharmacological therapy related to COVID-19 and SARS-CoV-2 registered at the International Clinical Trials Registry Platform (WHO-ICTRP) up to April 22, 2020. Clinical trials characteristics (country, design, sample size, main outcomes, expected completion data, type of participants, length of the interventions, main outcomes). How many trials and he accumulated sample size by drug or combination of drugs, and by month in 2020 was depicted. We identified 412 clinical trials registers addressing the effect of pharmacological treatments on COVID-19, predominantly from Asia and Europe (42.2% and 31.1% of clinical trials registers, respectively). The most main outcomes studied were clinical recovery (54.4% of the clinical trials registers, respiratory recovery (28.2%) mortality (27.4%), viral load/negativity (20.4%). During 2020, a huge amount of clinical trials are expected to be completed: 41 trials (60,366 participants) using hydroxychloroquine, 20 trials (1,588 participants) using convalescent’s plasma, 18 trials (6,830 participants) using chloroquine, 12 trials (9,938 participants using lopinavir/ritonavir, 11 trials (1,250 participants) using favipiravir, 10 trials ( 2,175 participants) using tocilizumab and 6 trials (13,540 participants) using Remdesivir. The distribution of the number of registered clinical trials among the different therapeutic options leads to an excess of sample size for some and a lack for others. Our data allow us to conclude that by the end of June we will have results of almost 20 trials involving 40000 patients for hydroxychloroquine and 5 trials with 4500 patients for remdesivir; however, low statistical power is expected from the 9 clinical trials testing the efficacy of favipiravir or the 5 testing tocilizumab, since they will recruit less than 1000 patients each one.