Laura Gochicoa-Rangel, Santiago C. Arce, Carlos Aguirre-Franco, Wilmer Madrid-Mejía, Mónica Gutiérrez-Clavería, Lorena Noriega-Aguirre, Patricia Schonffeldt-Guerrero, Agustín Acuña-Izcaray, Arturo Cortés-Telles, Luisa Martínez-Valdeavellano, Federico Isaac Hernández-Rocha, Omar Ceballos-Zúñiga, Rodrigo Del Rio Hidalgo, Sonia Sánchez, Erika Meneses-Tamayo, and Iván Chérrez-Ojeda; and on Behalf of the Respiratory Physiology Project in COVID-19 (FIRCOV). Effect of altitude on respiratory functional status in COVID-19 survivors: results from a Latin American Cohort-FIRCOV. High Alt Med Biol 24:37-48, 2023. Persistent symptoms and lung function abnormalities are common in COVID-19 survivors. Objectives: To determine the effect of altitude and other independent variables on respiratory function in COVID-19 survivors. Methods: Analytical, observational, cross-sectional cohort study done at 13 medical centers in Latin America located at different altitudes above sea level. COVID-19 survivors were invited to perform pulmonary function tests at least 3 weeks after diagnosis. Results: 1,368 participants (59% male) had mild (20%), moderate (59%), and severe (21%) disease. Restriction by spirometry was noted in 32%; diffusing capacity of the lung for carbon monoxide (DLCO) was low in 43.7%; and 22.2% walked less meters during the 6-minute walk test (6-MWT). In multiple linear regression models, higher altitude was associated with better spirometry, DLCO and 6-MWT, but lower oxygen saturation at rest and during exercise. Men were 3 times more likely to have restriction and 5.7 times more likely to have a low DLCO. Those who had required mechanical ventilation had lower DLCO and walked less during the 6-MWT. Conclusions: Men were more likely to have lower lung function than women, even after correcting for disease severity and other factors. Patients living at a higher altitude were more likely to have better spirometric patterns and walked farther but had lower DLCO and oxygen saturation.
Altitude , COVID-19 , Humans , Male , Female , Latin America , Cross-Sectional Studies , Functional Status , Pulmonary Diffusing Capacity , Lung
BACKGROUND: SARS-CoV-2 seems to affect the regulation of pulmonary perfusion. Hypoperfusion in areas of well-aerated lung parenchyma results in a ventilation-perfusion mismatch that can be characterized using subtraction computed tomography angiography (sCTA). This study aims to evaluate the efficacy of oral sildenafil in treating COVID-19 inpatients showing perfusion abnormalities in sCTA. METHODS: Triple-blinded, randomized, placebo-controlled trial was conducted in Chile in a tertiary-care hospital able to provide on-site sCTA scans and ventilatory support when needed between August 2020 and March 2021. In total, 82 eligible adults were admitted to the ED with RT-PCR-confirmed or highly probable SARS-COV-2 infection and sCTA performed within 24 h of admission showing perfusion abnormalities in areas of well-aerated lung parenchyma; 42 were excluded and 40 participants were enrolled and randomized (1:1 ratio) once hospitalized. The active intervention group received sildenafil (25 mg orally three times a day for seven days), and the control group received identical placebo capsules in the same way. Primary outcomes were differences in oxygenation parameters measured daily during follow-up (PaO2/FiO2 ratio and A-a gradient). Secondary outcomes included admission to the ICU, requirement of non-invasive ventilation, invasive mechanical ventilation (IMV), and mortality rates. Analysis was performed on an intention-to-treat basis. RESULTS: Totally, 40 participants were enrolled (20 in the placebo group and 20 in the sildenafil group); 33 [82.5%] were male; and median age was 57 [IQR 41-68] years. No significant differences in mean PaO2/FiO2 ratios and A-a gradients were found between groups (repeated-measures ANOVA p = 0.67 and p = 0.69). IMV was required in 4 patients who received placebo and none in the sildenafil arm (logrank p = 0.04). Patients in the sildenafil arm showed a significantly shorter median length of hospital stay than the placebo group (9 IQR 7-12 days vs. 12 IQR 9-21 days, p = 0.04). CONCLUSIONS: No statistically significant differences were found in the oxygenation parameters. Sildenafil treatment could have a potential therapeutic role regarding the need for IMV in COVID-19 patients with specific perfusion patterns in sCTA. A large-scale study is needed to confirm these results. TRIAL REGISTRATION: Sildenafil for treating patients with COVID-19 and perfusion mismatch: a pilot randomized trial, NCT04489446, Registered 28 July 2020, https://clinicaltrials.gov/ct2/show/NCT04489446 .
COVID-19 Drug Treatment , COVID-19 , Sildenafil Citrate , Vasodilator Agents , Administration, Oral , Adult , Aged , COVID-19/physiopathology , Female , Humans , Male , Middle Aged , Pilot Projects , Sildenafil Citrate/administration & dosage , Treatment Outcome , Vasodilator Agents/administration & dosage , Ventilation-Perfusion Ratio
The six-minute walk test has been shown as a very useful tool in the functional assessment of patients with chronic respiratory diseases enclosing patients with pulmonary hypertension. Methodological standardization of this test is fundamental for interpreting its results, as well as for using it in the short and long-term clinical follow up of our patients. The purpose of these guidelines is justly to spread out in our country the proper way to perform this useful test. In this context, indications, contraindications, limitations, security measures and detailed instructions about how to carry out, how to report and how to interpret the 6 minute walk test are described in these guidelines.
La prueba de caminata de 6 minutos ha demostrado ser una herramienta muy útil en la evaluación funcional de los pacientes con enfermedades respiratorias crónicas, incluyendo pacientes con hipertensión pulmonar. Para su correcta interpretación y uso clínico en el seguimiento de pacientes, es fundamental estandarizar la técnica. El propósito de este instructivo es justamente difundir a nivel nacional, la manera de efectuar esta técnica en forma correcta. En este contexto, este instructivo describe las indicaciones, contraindicaciones, limitaciones, medidas de seguridad y entrega detalles sobre la ejecución, informe e interpretación de la prueba de caminata de 6 minutos.
Humans , Lung Diseases, Obstructive/physiopathology , Exercise Test/standards , Lung Diseases, Obstructive/diagnosis , Patient Selection , Practice Guidelines as Topic , Respiratory Function Tests/standards , Walking
Considerando la frecuencia con que la EPOC estable debe ser enfrentada en el nivel primario, en esta exposición se propone en forma esquemática a través de texto y diagramas de flujo una secuencia simplificada para el diagnóstico, etapificación, evaluación funcional y tratamiento de esta condición en sus diversas etapas. Las recomendaciones se circunscriben a los métodos y procedimientos cuya eficacia tiene un respaldo adecuado en la experiencia clínica y en las publicaciones y que, además, son factibles de aplicar en nuestro medio
Humans , Lung Diseases, Obstructive/diagnosis , Adrenergic beta-Agonists , Cholinergic Antagonists/therapeutic use , Dyspnea , Lung Diseases, Obstructive/drug therapy , Lung Diseases, Obstructive/rehabilitation , Lung Diseases, Obstructive/therapy , Severity of Illness Index , Smoking Cessation , Spirometry , Oxygen Inhalation Therapy/methods
Se revisa in extenso la necesidad de evaluación objetiva de la función pulmonar en el preoperatorio de cirugía torácica, en especial cuando se trata de cirugía resectiva pulmonar; definiendo los índices de alto riesgo quirúrgico de acuerdo a la literatura actual
Humans , Preoperative Care , Thoracic Surgery
