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Lee A, Henderson R, Aylward J, McCombe P. Gut Symptoms, Gut Dysbiosis and Gut-Derived Toxins in ALS. Int J Mol Sci 2024; 25:1871. [PMID: 38339149 PMCID: PMC10856138 DOI: 10.3390/ijms25031871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Many pathogenetic mechanisms have been proposed for amyotrophic lateral sclerosis (ALS). Recently, there have been emerging suggestions of a possible role for the gut microbiota. Gut microbiota have a range of functions and could influence ALS by several mechanisms. Here, we review the possible role of gut-derived neurotoxins/excitotoxins. We review the evidence of gut symptoms and gut dysbiosis in ALS. We then examine a possible role for gut-derived toxins by reviewing the evidence that these molecules are toxic to the central nervous system, evidence of their association with ALS, the existence of biochemical pathways by which these molecules could be produced by the gut microbiota and existence of mechanisms of transport from the gut to the blood and brain. We then present evidence that there are increased levels of these toxins in the blood of some ALS patients. We review the effects of therapies that attempt to alter the gut microbiota or ameliorate the biochemical effects of gut toxins. It is possible that gut dysbiosis contributes to elevated levels of toxins and that these could potentially contribute to ALS pathogenesis, but more work is required.
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Affiliation(s)
- Aven Lee
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia; (R.H.); (P.M.)
| | - Robert Henderson
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia; (R.H.); (P.M.)
- Department of Neurology, Royal Brisbane & Women’s Hospital, Brisbane, QLD 4029, Australia
- Wesley Research Institute, The Wesley Hospital, Auchenflower, QLD 4066, Australia;
| | - James Aylward
- Wesley Research Institute, The Wesley Hospital, Auchenflower, QLD 4066, Australia;
| | - Pamela McCombe
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia; (R.H.); (P.M.)
- Department of Neurology, Royal Brisbane & Women’s Hospital, Brisbane, QLD 4029, Australia
- Wesley Research Institute, The Wesley Hospital, Auchenflower, QLD 4066, Australia;
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2
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Bandara MM, Barina LA, McPhee GM, Goulding SR, Denholm JT, Morpeth SC, Tong SYC. Clinician perceptions of research priorities for the management of noncritically ill patients admitted to hospital with SARS-CoV-2 infection. Intern Med J 2024; 54:337-341. [PMID: 38350659 DOI: 10.1111/imj.16316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 02/15/2024]
Abstract
The changing phenotype of coronarvirus disease 2019 (COVID-19) may quickly render guideline-recommended interventions obsolete. We developed a 40-question clinician survey in consultation with the Australasian COVID-19 Trial site investigators. The survey was designed to assess clinician perceptions of the current treatment strategies and future research priorities in the management of non-critically ill patients admitted to hospital with SARS-CoV-2 infection. There were 84 complete responses from predominantly Australian and New Zealand clinicians. The perceived prevalence of patients with incidental COVID-19, nosocomial infection, underlying illness exacerbated by COVID-19, and/or immunocompromised status suggests new populations to target. The results highlighted clinician interest in antiviral therapies for future research in both immunocompetent and immunocompromised cohorts. These survey results underscore the need for ongoing surveillance of COVID-19 disease phenotypes and clinician and patient priorities for future research.
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Affiliation(s)
- Methma M Bandara
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Lauren A Barina
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Grace M McPhee
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Susan R Goulding
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Justin T Denholm
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Susan C Morpeth
- Department of Microbiology and Infectious Diseases, Middlemore Hospital, Te Whatu Ora Counties Makukau, Auckland, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Brauer SG, Lamont RM, O'Sullivan JD. A physiotherapy group exercise and self-management approach to improve physical activity in people with mild-moderate Parkinson's disease: a randomized controlled trial. Trials 2024; 25:76. [PMID: 38254229 PMCID: PMC10801959 DOI: 10.1186/s13063-023-07870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Physical activity levels are low in people with Parkinson's disease (PD) and have proved difficult to increase with exercise programs alone. Intervention approaches that address both the capacity to engage in physical activity and self-management strategies to change and maintain exercise behaviours are needed to address this intractable issue. METHODS This will be an assessor-blinded, randomized controlled trial performed in Brisbane, Australia. Ninety-two people with mild-moderate PD will be randomly allocated to two groups: usual care, and a physiotherapy-led group exercise program combined with self-management strategies. In the intervention group, twelve, 80-min sessions will be conducted over 4 weeks in groups of up to 4 participants. The intervention will consist of circuit training including treadmill walking to target aerobic fitness, and activities targeting strength, balance, and gait performance. In addition, each session will also incorporate strategies focusing on self-management and behaviour change, augmented by the provision of a fitness activity tracker. Outcome measures will be collected at baseline (T1), immediately post intervention (T2) and at 6 months follow-up (T3). The primary outcome measure is free-living physical activity (average daily step count over 7 days) at pre (T1) and post (T2) intervention measured using an activPAL™ device. Secondary outcome measures captured at all time points include time spent walking, sedentary and in moderate intensity exercise over 7 days; spatiotemporal gait performance (step length, gait speed, endurance); health-related quality of life; and outcome expectations and self-efficacy for exercise. DISCUSSION Sustainability of gains in physical activity following exercise interventions is a challenge for most populations. Our incorporation of a chronic disease self-management approach into the exercise program including fitness tracking extends previous trials and has potential to significantly improve free-living physical activity in people with PD. TRIAL REGISTRATION This study has been prospectively registered in Australian and New Zealand Clinical Trial Registry (ACTRN12617001057370), registered on 19/07/2017. Available from www.anzctr.org.au/ACTRN12617001057370.aspx .
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Affiliation(s)
- Sandra G Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, Qld, St Lucia, Australia.
| | - Robyn M Lamont
- School of Health and Rehabilitation Sciences, The University of Queensland, Qld, St Lucia, Australia
| | - John D O'Sullivan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
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Tirupakuzhi Vijayaraghavan BK, Jha V, Rajbhandari D, Myatra SN, Ghosh A, Bhattacharya A, Arfin S, Bassi A, Donaldson LH, Hammond NE, John O, Joshi R, Kunigari M, Amrutha C, Husaini SHM, Ghosh S, Nag SK, Selvaraj HK, Kantroo V, Shah KD, Venkatesh B. Hydroxychloroquine plus personal protective equipment versus personal protective equipment alone for the prevention of laboratory-confirmed COVID-19 infections among healthcare workers: a multicentre, parallel-group randomised controlled trial from India. BMJ Open 2022; 12:e059540. [PMID: 35649613 PMCID: PMC9160584 DOI: 10.1136/bmjopen-2021-059540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To determine whether hydroxychloroquine when used with personal protective equipment reduces the proportion of laboratory-confirmed COVID-19 among healthcare workers in comparison to the use of personal protective equipment alone. DESIGN Multicentre, parallel-group, open-label randomised trial. Enrolment started on 29 June 2020 and stopped on 4 February 2021. Participants randomised in HydrOxychloroquine Prophylaxis Evaluation were followed for 6 months. SETTING 9 hospitals across India. PARTICIPANTS Healthcare workers in an environment with exposure to COVID-19 were randomised in a 1:1 ratio to hydroxychloroquine plus use of personal protective equipment or personal protective equipment alone. 886 participants were screened and 416 randomised (213 hydroxychloroquine arm and 203 personal protective equipment). INTERVENTION Participants in intervention arm received 800 mg of hydroxychloroquine on day of randomisation and then 400 mg once a week for 12 weeks in addition to the use of personal protective equipment. In the control arm, participants continued to use personal protective equipment alone. MAIN OUTCOME Proportion of laboratory-confirmed COVID-19 in the 6 months after randomisation. RESULTS Participants were young (mean age 32.1 years, SD 9.1 years) with low-comorbid burden. 47.4% were female. In the 6 months after randomisation (primary analysis population=413), 11 participants assigned to the hydroxychloroquine group and 12 participants assigned to the standard practice group met the primary endpoint (5.2% vs 5.9%; OR 0.85, 95% CI 0.35 to 2.07, p=0.72). There was no heterogeneity of treatment effect in any prespecified subgroup. There were no significant differences in the secondary outcomes. The adverse event rates were 9.9% and 6.9% in the hydroxychloroquine and standard practice arms, respectively. There were no serious adverse events in either group. CONCLUSIONS AND RELEVANCE Hydroxychloroquine along with personal protective equipment was not superior to personal protective equipment alone on the proportion of laboratory-confirmed COVID-19. Definitive conclusions are precluded as the trial stopped early for futility, and hence was underpowered. TRIAL REGISTRATION NUMBER CTRI/2020/05/025067.
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Affiliation(s)
| | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Sheila Nainan Myatra
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Anaesthesiology and Critical Care Medicine, Tata Memorial Hospital, Mumbai, India
| | - Arpita Ghosh
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Sumaiya Arfin
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Abhinav Bassi
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Naomi E Hammond
- Critical Care, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Oommen John
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Rohina Joshi
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | - Subir Ghosh
- Apollo Hospitals Ahmedabad, Ahmedabad, Gujarat, India
| | | | | | - Viny Kantroo
- Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Kamal D Shah
- NephroPlus Health Services, Hyderabad, Telangana, India
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, Newtown, New South Wales, Australia
- Wesley Hospital, Brisbane, Queensland, Australia
- Wesley Medical Research, Brisbane, Queensland, Australia
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5
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Li Bassi G, Gibbons K, Suen JY, Dalton HJ, White N, Corley A, Shrapnel S, Hinton S, Forsyth S, Laffey JG, Fan E, Fanning JP, Panigada M, Bartlett R, Brodie D, Burrell A, Chiumello D, Elhazmi A, Esperatti M, Grasselli G, Hodgson C, Ichiba S, Luna C, Marwali E, Merson L, Murthy S, Nichol A, Ogino M, Pelosi P, Torres A, Ng PY, Fraser JF. Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis. Crit Care 2022; 26:141. [PMID: 35581612 PMCID: PMC9112652 DOI: 10.1186/s13054-022-03983-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/10/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. METHODS We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. RESULTS Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28 days, VFD were 16 (IQR 0-25) and 25 (IQR 7-26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0-87) and 87 (IQR 0-88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p = 0.177). CONCLUSIONS In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting.
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Affiliation(s)
- Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD, 4032, Australia.
- University of Queensland, Brisbane, Australia.
- Institut dInvestigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
- Queensland University of Technology, Brisbane, Australia.
- UnitingCare Hospitals, Brisbane, Australia.
- Wesley Medical Research, Brisbane, Australia.
| | - Kristen Gibbons
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD, 4032, Australia
- University of Queensland, Brisbane, Australia
| | - Heidi J Dalton
- INOVA Fairfax Medical Center, Heart and Vascular Institute, Falls Church, VA, USA
| | - Nicole White
- Queensland University of Technology, Brisbane, Australia
| | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD, 4032, Australia
- University of Queensland, Brisbane, Australia
| | - Sally Shrapnel
- University of Queensland, Brisbane, Australia
- The Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009), Brisbane, Australia
| | | | | | - John G Laffey
- Anaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland, and Galway University Hospitals, Galway, Ireland
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD, 4032, Australia
- University of Queensland, Brisbane, Australia
- UnitingCare Hospitals, Brisbane, Australia
- Wesley Medical Research, Brisbane, Australia
| | - Mauro Panigada
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | - Daniel Brodie
- Department of Medicine, Columbia College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New-York-Presbyterian Hospital, New York, NY, USA
| | - Aidan Burrell
- Australian and New Zealand Intensive Care Research Centre, School of Public Health, Monash University, Melbourne, Australia
| | - Davide Chiumello
- Ospedale San Paolo, Milan, Italy
- University of Milan, Milan, Italy
| | - Alyaa Elhazmi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mariano Esperatti
- Hospital Privado de Comunidad, Escuela de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina
| | - Giacomo Grasselli
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- University of Milan, Milan, Italy
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health, Monash University, Melbourne, Australia
| | | | - Carlos Luna
- Neumonología, Hospital de Clínicas, UBA, Buenos Aires, Argentina
| | - Eva Marwali
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Laura Merson
- ISARIC, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- BC Childrens Hospital Research Institute, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health, Monash University, Melbourne, Australia
- University College Dublin-Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
| | - Mark Ogino
- Nemours Alfred I duPont Hospital for Children, Wilmington, DE, USA
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Antoni Torres
- Institut dInvestigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pauline Yeung Ng
- Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD, 4032, Australia
- University of Queensland, Brisbane, Australia
- Institut dInvestigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Queensland University of Technology, Brisbane, Australia
- UnitingCare Hospitals, Brisbane, Australia
- Wesley Medical Research, Brisbane, Australia
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Li Bassi G, Suen JY, Dalton HJ, White N, Shrapnel S, Fanning JP, Liquet B, Hinton S, Vuorinen A, Booth G, Millar JE, Forsyth S, Panigada M, Laffey J, Brodie D, Fan E, Torres A, Chiumello D, Corley A, Elhazmi A, Hodgson C, Ichiba S, Luna C, Murthy S, Nichol A, Ng PY, Ogino M, Pesenti A, Trieu HT, Fraser JF. An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients. Crit Care 2021; 25:199. [PMID: 34108029 PMCID: PMC8188162 DOI: 10.1186/s13054-021-03518-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/26/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level. METHODS We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe CRS-calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]-and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide. RESULTS We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of CRS within the first seven days of MV. Median (IQR) age was 62 (52-71), patients were predominantly males (68%) and from Europe/North and South America (88%). CRS, within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (p = 0.417) nor with PaO2/FiO2 (p = 0.100). Females presented lower CRS than males (95% CI of CRS difference between females-males: - 11.8 to - 7.4 mL/cmH2O p < 0.001), and although females presented higher body mass index (BMI), association of BMI with CRS was marginal (p = 0.139). Ventilatory management varied across CRS range, resulting in a significant association between CRS and driving pressure (estimated decrease - 0.31 cmH2O/L per mL/cmH20 of CRS, 95% CI - 0.48 to - 0.14, p < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that CRS (+ 10 mL/cm H2O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02-1.28, p = 0.018). CONCLUSIONS This multicentre report provides a comprehensive account of CRS in COVID-19 patients on MV. CRS measured within 48 h from commencement of MV has marginal predictive value for 28-day mortality, but was associated with being discharged from ICU within the same period. Trial documentation: Available at https://www.covid-critical.com/study . TRIAL REGISTRATION ACTRN12620000421932.
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Affiliation(s)
- Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia.
- University of Queensland, Brisbane, Australia.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
- Queensland University of Technology, Brisbane, Australia.
- St Andrew's War Memorial Hospital, UnitingCare Hospitals, Brisbane, Australia.
- Wesley Medical Research, Brisbane, Australia.
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- University of Queensland, Brisbane, Australia
| | - Heidi J Dalton
- INOVA Fairfax Medical Center, Heart and Vascular Institute, Falls Church, VA, USA
| | - Nicole White
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | | | - Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- University of Queensland, Brisbane, Australia
- Wesley Medical Research, Brisbane, Australia
| | - Benoit Liquet
- University of Queensland, Brisbane, Australia
- University of Pau et Pays De L'Adour, LMAP, E2S-UPPA, CNRS, Pau, France
- Macquarie University, Sydney, Australia
| | | | | | | | - Jonathan E Millar
- Roslin Institute, University of Edinburgh, Edinburgh, UK
- Queen Elizabeth II University Hospital, Glasgow, UK
| | | | - Mauro Panigada
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - John Laffey
- Anaesthesia and Intensive Care Medicine, National University of Ireland, Galway, Ireland
| | - Daniel Brodie
- Department of Medicine, Columbia College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New-York-Presbyterian Hospital, New York, NY, USA
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
| | - Antoni Torres
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - Davide Chiumello
- Hospital Clinic of Barcelona, Barcelona, Spain
- Ospedale San Paolo, Milan, Italy
| | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- University of Queensland, Brisbane, Australia
| | - Alyaa Elhazmi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Carol Hodgson
- The Alfred Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia
| | - Shingo Ichiba
- Intensive Care, Nippon Medical School Hospital, Tokyo, Japan
| | - Carlos Luna
- Neumonología, Hospital de Clínicas, UBA, Buenos Aires, Argentina
| | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Australia
- University College Dublin-Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland
| | | | - Mark Ogino
- Nemours Alfred I duPont Hospital for Children, Wilmington, DE, USA
| | - Antonio Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- University of Milan, Milan, Italy
| | | | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
- University of Queensland, Brisbane, Australia
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Queensland University of Technology, Brisbane, Australia
- St Andrew's War Memorial Hospital, UnitingCare Hospitals, Brisbane, Australia
- Wesley Medical Research, Brisbane, Australia
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7
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Lange A, Huntress H, Steindl J, Palka P. Incremental role of CT coronary angiography in the assessment of left ventricular diastolic function. Open Heart 2021; 8:e001566. [PMID: 33741690 PMCID: PMC7986954 DOI: 10.1136/openhrt-2020-001566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether Computed Tomography (CT) coronary angiography (CTCA) has clinical value for the assessment of left ventricular (LV) diastolic dysfunction (DD) beyond traditional information on coronary artery anatomy. METHOD In this retrospective study, a consecutive group of 72 patients (mean age 59±13 years)-who met the eligibility criteria of sinus rhythm, no significant valvular abnormalities, and who had transthoracic echocardiogram (TTE)-were analysed. The CTCA was prospectively triggered during diastole. Outcomes of interest were CTCA derived LV and left atrial (LA) volumes, diastolic expansion (DE) index: LV volume÷LA volume and DE fraction (DEF): [(LV volume-LA volume)÷LV volume]×100. TTE-LA volume was measured as maximum, minimum and pre-A. Studied patients were divided according to the current classification of LVDD as a reference standard. A small subgroup of nine patients underwent further invasive cardiac catheterisation. RESULTS CTCA-LV and LA volumes were larger compared with TTE, 37%±20% and 11%±21%, respectively. CTCA-LA volume correlated well with all TTE-LA volumes (maximum: R2=0.58; pre-A wave: R2=0.39; minimum: R2=0.26; p<0.0001) with the smallest differences in maximum LA volume (9±32 mL; mean±2 SD). The DE and DEF correlated with both LA function and LVDD. DE >1.65 and DE <1.40 have good specificity (85% and 88%, respectively), and positive predictive value to differentiate LVDD. DE and DEF were dependent on the patients' age but independent of other variables. CONCLUSIONS CTCA derived diastasis volume indices can provide additional quantifiable information on LVDD.
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Affiliation(s)
- Aleksandra Lange
- Queensland Cardiovascular Group, Wesley Medical Research Limited, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
| | - Harry Huntress
- Queensland Cardiovascular Group, Wesley Medical Research Limited, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
| | - Jesse Steindl
- Queensland Cardiovascular Group, Wesley Medical Research Limited, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
| | - Przemyslaw Palka
- Queensland Cardiovascular Group, Wesley Medical Research Limited, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
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Li Bassi G, Suen J, Barnett AG, Corley A, Millar J, Fanning J, Lye I, Colombo S, Wildi K, Livingstone S, Abbate G, Hinton S, Liquet B, Shrapnel S, Dalton H, Fraser JF. Design and rationale of the COVID-19 Critical Care Consortium international, multicentre, observational study. BMJ Open 2020; 10:e041417. [PMID: 33268426 PMCID: PMC7714653 DOI: 10.1136/bmjopen-2020-041417] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There is a paucity of data that can be used to guide the management of critically ill patients with COVID-19. In response, a research and data-sharing collaborative-The COVID-19 Critical Care Consortium-has been assembled to harness the cumulative experience of intensive care units (ICUs) worldwide. The resulting observational study provides a platform to rapidly disseminate detailed data and insights crucial to improving outcomes. METHODS AND ANALYSIS This is an international, multicentre, observational study of patients with confirmed or suspected SARS-CoV-2 infection admitted to ICUs. This is an evolving, open-ended study that commenced on 1 January 2020 and currently includes >350 sites in over 48 countries. The study enrols patients at the time of ICU admission and follows them to the time of death, hospital discharge or 28 days post-ICU admission, whichever occurs last. Key data, collected via an electronic case report form devised in collaboration with the International Severe Acute Respiratory and Emerging Infection Consortium/Short Period Incidence Study of Severe Acute Respiratory Illness networks, include: patient demographic data and risk factors, clinical features, severity of illness and respiratory failure, need for non-invasive and/or mechanical ventilation and/or extracorporeal membrane oxygenation and associated complications, as well as data on adjunctive therapies. ETHICS AND DISSEMINATION Local principal investigators will ensure that the study adheres to all relevant national regulations, and that the necessary approvals are in place before a site may contribute data. In jurisdictions where a waiver of consent is deemed insufficient, prospective, representative or retrospective consent will be obtained, as appropriate. A web-based dashboard has been developed to provide relevant data and descriptive statistics to international collaborators in real-time. It is anticipated that, following study completion, all de-identified data will be made open access. TRIAL REGISTRATION NUMBER ACTRN12620000421932 (http://anzctr.org.au/ACTRN12620000421932.aspx).
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Affiliation(s)
- Gianluigi Li Bassi
- Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Jacky Suen
- Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Adrian Gerard Barnett
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Amanda Corley
- Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan Millar
- Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jonathon Fanning
- Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Critical Care Medicine, UnitingCare Health, Brisbane, Queensland, Australia
| | - India Lye
- Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sebastiano Colombo
- Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Karin Wildi
- Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Livingstone
- Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gabriella Abbate
- Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland, Australia
| | - Samuel Hinton
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Benoit Liquet
- University of Queensland, Brisbane, Queensland, Australia
- University of Pau et Pays De L'Adour, Pau, France
| | - Sally Shrapnel
- University of Queensland, Brisbane, Queensland, Australia
| | - Heidi Dalton
- Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - John F Fraser
- Critical Care Research Group, Prince Charles Hospital, Chermside, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
- Critical Care Medicine, UnitingCare Health, Brisbane, Queensland, Australia
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Tirupakuzhi Vijayaraghavan BK, Jha V, Rajbhandari D, Myatra SN, John O, Ghosh A, Bassi A, Arfin S, Kunigari M, Joshi R, Donaldson L, Hammond N, Venkatesh B. Hydroxychloroquine plus personal protective equipment versus standard personal protective equipment alone for the prevention of COVID-19 infections among frontline healthcare workers: the HydrOxychloroquine Prophylaxis Evaluation(HOPE) trial: A structured summary of a study protocol for a randomized controlled trial. Trials 2020; 21:754. [PMID: 32867852 PMCID: PMC7456761 DOI: 10.1186/s13063-020-04679-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate the effect of the combination of hydroxychloroquine (HCQ) and standard personal protective equipment (PPE) compared to the use of standard personal protective equipment alone on the proportion of laboratory confirmed COVID-19 infections among frontline healthcare workers(HCWs) in India TRIAL DESIGN: HOPE is an investigator initiated multi-centre open-label parallel group randomized controlled trial. PARTICIPANTS All HCWs currently working in an environment with direct exposure to patients with confirmed COVID-19 infection are eligible to participate in the trial. The trial aims to be conducted across 20-30 centres (public and private hospitals) in India. HCWs who decline consent, who have a confirmed COVID-19 infection, those who are already on chloroquine/HCQ for any indication, or if pregnant or breast-feeding, or have known QT prolongation or are on medications that when taken with HCQ can prolong the QTc will be excluded. INTERVENTION AND COMPARATOR The interventions to be compared in this trial are standard practice (use of recommended PPE) and HCQ plus standard practice. In the standard practice arm, HCWs will use recommended PPE as per institutional guidelines and based on their roles. They will be discouraged from taking HCQ to prevent contamination and contacted every week for the duration of the study to ascertain if they have taken any HCQ. Any such use will be reported as a protocol violation. In the intervention arm, HCWs will be administered 800mg of HCQ as a loading dose on the day of randomization (as two 400mg doses 12hrs apart) and subsequently continued on 400mg once a week for 12 weeks. This will be in addition to the use of recommended PPE as per institutional guidelines and based on their roles. HCWs will collect the drug once every week from designated research and pharmacy staff at site. A weekly phone reminder will be provided to participants in this arm to ensure compliance. An ECG will be performed between 4-6 weeks in this arm and if the QTc is prolonged (greater than 450milliseconds), the drug will be stopped. Follow-up will however continue. Participants in both arms will receive a weekly phone call for evaluation of the primary outcome, to monitor protocol compliance and development of any adverse events (in the HCQ group). MAIN OUTCOMES Participants will be followed on a weekly basis. The primary outcome is the proportion of HCWs developing laboratory confirmed COVID-19 infection within 6 months of randomization. We will also evaluate a number of secondary outcomes, including hospitalization related to suspected/confirmed COVID-19 infection, intensive care unit or high-dependency unit admission due to suspected/confirmed COVID-19 infection, all-cause mortality, need for organ support ( non-invasive or invasive ventilation, vasopressors and renal replacement therapy), ICU and hospital length of stay, readmission, days off work and treatment-related adverse events. RANDOMISATION Randomisation will be conducted through a password-protected, secure website using a central, computer-based randomisation program. Randomisation will be stratified by participating institutions and by the role of HCW - nursing, medical and other. Participants will be randomised 1:1 to either standard practice only or HCQ plus standard practice. Allocation concealment is maintained by central web-based randomisation BLINDING (MASKING): This is an unblinded study: study assigned treatment will be known to the research team and participant. Bias will be mitigated through an objective end point (laboratory confirmed COVID-19 infection). NUMBERS TO BE RANDOMISED (SAMPLE SIZE) A total of 6,950 HCWs will be enrolled (3475 to the intervention) and (3475 to the standard practice group) to detect a 25% relative reduction, or 2.5% absolute reduction, in the infection rate from an estimated baseline infection rate of 10%, with 80% statistical power using a two-sided test at 5% level of significance. Available data from China and Italy indicate that the rate of infection among frontline healthcare workers varies between 4% to 12%. We therefore assumed a baseline infection rate of 10% among HCWs. This sample size allows for a potential loss to follow-up rate of 10% and a potential non-compliance rate of 10% in both the treatment and control arms. TRIAL STATUS HOPE protocol version 3.0 dated June 3rd 2020. Recruitment started on 29th June 2020 and currently 56 participants have been enrolled. Planned completion of enrolment is January 31st 2021. TRIAL REGISTRATION Clinical Trials Registry of India: CTRI/2020/05/025067 (prospectively registered) Date of registration: 6th May 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expedited dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
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Affiliation(s)
| | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Manipal Academy of Higher Education, Manipal, India
| | - Dorrilyn Rajbhandari
- Academic Project Operations, Critical Care Program, The George Institute for Global Health, Sydney, New South Wales Australia
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Oommen John
- The George Institute for Global Health, New Delhi, India
- Prasanna School of Public Health, MAHE, Manipal, India
| | - Arpita Ghosh
- The George Institute for Global Health, New Delhi, India
- Prasanna School of Public Health, MAHE, Manipal, India
| | - Abhinav Bassi
- The George Institute for Global Health, New Delhi, India
| | - Sumaiya Arfin
- The George Institute for Global Health, New Delhi, India
| | | | - Rohina Joshi
- The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Sydney, New South Wales Australia
| | - Lachlan Donaldson
- The George Institute for Global Health, Sydney, New South Wales Australia
- Royal North Shore Hospital, St Leonards, NSW Australia
| | - Naomi Hammond
- The George Institute for Global Health, Sydney, New South Wales Australia
- Royal North Shore Hospital, St Leonards, NSW Australia
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, Sydney, New South Wales Australia
- Wesley Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
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Taylor JL, Holland DJ, Mielke GI, Bailey TG, Johnson NA, Leveritt MD, Gomersall SR, Rowlands AV, Coombes JS, Keating SE. Effect of High-Intensity Interval Training on Visceral and Liver Fat in Cardiac Rehabilitation: A Randomized Controlled Trial. Obesity (Silver Spring) 2020; 28:1245-1253. [PMID: 32475048 DOI: 10.1002/oby.22833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 03/31/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aimed to investigate the effect of exercise intensity on visceral adipose tissue (VAT) and liver fat reduction in patients with coronary artery disease (CAD) over 3 months and the maintenance of improvements over 12 months. METHODS Forty-two participants with CAD were randomized to three sessions/week of either 4 × 4-minute high-intensity interval training (HIIT) or 40 minutes of usual care moderate-intensity continuous training (MICT) for a 4-week supervised cardiac rehabilitation program, followed by three home-based sessions/week for 11 months. Liver fat (as intrahepatic lipid) and VAT were measured via magnetic resonance techniques. Data are mean change (95% CI). RESULTS HIIT and MICT significantly reduced VAT over 3 months (-350 [-548 to -153] cm3 vs. -456 [-634 to -278] cm3 ; time × group effect: P = 0.421), with further improvement over 12 months (-545 [-818 to -271] cm3 vs. -521 [-784 to -258] cm3 ; time × group effect: P = 0.577) and no differences between groups. Both groups improved liver fat over 3 months, with HIIT tending to show greater reduction than MICT (-2.8% [-4.0% to -1.6%] vs. -1.4% [-2.4% to -0.4%]; time × group effect: P = 0.077). After 12 months, improvements were maintained to a similar degree. Higher exercise intensity predicted liver fat reduction (β = -0.3 [-0.7 to 0.0]; P = 0.042). CONCLUSIONS HIIT and MICT reduced VAT over 3 and 12 months. For liver fat, HIIT tended to provide a slightly greater reduction compared with MICT. These findings support HIIT as a beneficial adjunct or alternative to MICT for reducing visceral and liver fat in patients with CAD.
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Affiliation(s)
- Jenna L Taylor
- Centre for Research on Exercise, Physical Activity, and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Cardiac Rehabilitation Department, The Wesley Hospital, Brisbane, Queensland, Australia
| | - David J Holland
- Centre for Research on Exercise, Physical Activity, and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Department of Cardiology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Gregore I Mielke
- Centre for Research on Exercise, Physical Activity, and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Tom G Bailey
- Centre for Research on Exercise, Physical Activity, and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Nathan A Johnson
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Michael D Leveritt
- Centre for Research on Exercise, Physical Activity, and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Sjaan R Gomersall
- Centre for Research on Exercise, Physical Activity, and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Jeff S Coombes
- Centre for Research on Exercise, Physical Activity, and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Shelley E Keating
- Centre for Research on Exercise, Physical Activity, and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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11
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Fulton R, Millar JE, Merza M, Johnston H, Corley A, Faulke D, Rapchuk I, Tarpey J, Lockie P, Lockie S, Fraser JF. High flow nasal oxygen after bariatric surgery (OXYBAR), prophylactic post-operative high flow nasal oxygen versus conventional oxygen therapy in obese patients undergoing bariatric surgery: study protocol for a randomised controlled pilot trial. Trials 2018; 19:402. [PMID: 30053897 PMCID: PMC6062994 DOI: 10.1186/s13063-018-2777-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/29/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The incidence of obesity is increasing worldwide. In selected individuals, bariatric surgery may offer a means of achieving long-term weight loss, improved health, and healthcare cost reduction. Physiological changes that occur because of obesity and general anaesthesia predispose to respiratory complications following bariatric surgery. The aim of this study is to determine whether post-operative high flow nasal oxygen therapy (HFNO2) improves respiratory function and reduces the incidence of post-operative pulmonary complications (PPCs) in comparison to conventional oxygen therapy in these patients. METHOD The OXYBAR study is a prospective, un-blinded, single centre, randomised, controlled pilot study. Patients with body mass index (BMI) > 30 kg/m2, undergoing laparoscopic bariatric surgery, will be randomised to receive either standard low flow oxygen therapy or HFNO2 in the post-operative period. The primary outcome measure is the change in end expiratory lung impedance (∆EELI) as measured by electrical impedance tomography (EIT). Secondary outcome measures include change in tidal volume (∆Vt), partial arterial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, incidence of PPCs, hospital length of stay and measures of patient comfort. DISCUSSION We hypothesise that the post-operative administration of HFNO2 will increase EELI and therefore end expiratory lung volume (EELV) in obese patients. To our knowledge this is the first trial designed to assess the effects of HFNO2 on EELV in this population. We anticipate that data collected during this pilot study will inform a larger multicentre trial. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617000694314 . Registered on 15 May 2017.
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Affiliation(s)
- Rachel Fulton
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
| | - Jonathan E. Millar
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Wellcome-Wolfson Centre for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland UK
| | - Megan Merza
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- St Andrews War Memorial Hospital, Brisbane, Australia
| | | | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- Griffith University, Griffith, Queensland Australia
| | - Daniel Faulke
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - Ivan Rapchuk
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - Joe Tarpey
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - Philip Lockie
- St Andrews War Memorial Hospital, Brisbane, Australia
| | | | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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