Telerehabilitation for Post-Hospitalized COVID-19 Patients: A Proof-of-Concept Study During a Pandemic.

PURPOSE: Telerehabilitation could prevent sequelae from COVID-19. We aimed to assess the feasibility of telerehabilitation; describe pulmonary and functional profiles of COVID-19 patients; and explore the effect of telerehabilitation on improving pulmonary symptoms and quality of life. METHODS: We conducted a pre-experimental, pre-post pilot study. We recruited COVID-19 patients who had returned home following hospitalization. The intervention included eight weeks of supervised physiotherapy sessions. We documented technological issues, success of recruitment strategies, and participants' attendance to supervised sessions. We measured the impact of pulmonary symptoms on quality of life and functional health. RESULTS: We scheduled 64 supervised sessions with seven participants with few technological issues. Initial scores showed that pulmonary symptoms moderately to highly impacted quality of life. At eight weeks, all patients had improved from 10 to 45 points on the EuroQol-Visual Analog Scale (EQ-VAS) instrument, indicating clinical significance. CONCLUSION: We developed and administered a telerehabilitation intervention during a global pandemic that targets key symptoms of the relevant disease.

Early Evidence of Sepsis-Associated Hyperperfusion-A Study of Cerebral Blood Flow Measured With MRI Arterial Spin Labeling in Critically Ill Septic Patients and Control Subjects.

OBJECTIVES: Mechanisms underlying sepsis-associated encephalopathy remain unclear, but reduced cerebral blood flow, alone or in conjunction with altered autoregulation, is reported as a potential contributor. We compared cerebral blood flow of control subjects and vasopressor-dependent septic patients. DESIGN: Randomized crossover study. SETTING: MRI with arterial spin labeling. PATIENTS: Ten sedated septic patients on mechanical ventilation (four with controlled chronic hypertension) and 12 control subjects (six with controlled chronic hypertension) were enrolled. Mean ± SD ages were 61.4 ± 10.2 and 44.2 ± 12.8 years, respectively (p = 0.003). Mean Acute Physiology and Chronic Health Evaluation II score of septic patients at ICU admission was 27.7 ± 6.6. INTERVENTIONS: To assess the potential confounding effects of sedation and mean arterial pressure, we measured cerebral blood flow with and without sedation with propofol in control subjects and at a target mean arterial pressure of 65 mm Hg and greater than or equal to 75 mm Hg in septic patients. The sequence of sedation versus no sedation and mean arterial pressure targets were randomized. MEASUREMENTS AND MAIN RESULTS: In septic patients, cerebral blood flow measured at a mean arterial pressure target of 65 mm Hg (40.4 ± 10.9 mL/100 g/min) was not different from cerebral blood flow measured at a mean arterial pressure target of greater than or equal to 75 mm Hg (41.3 ± 9.8 mL/100 g/min; p = 0.65). In control subjects, we observed no difference in cerebral blood flow measured without and with sedation (24.8 ± 4.2 vs 24.9 ± 5.9 mL/100 g/min; p = 0.93). We found no interaction between chronic hypertension and the effect of sedation or mean arterial pressure targets. Cerebral blood flow measured in sedated septic patients (mean arterial pressure target 65 mm Hg) was 62% higher than in sedated control subjects (p = 0.001). CONCLUSIONS: In septic patients, cerebral blood flow was higher than in sedated control subjects and did not vary with mean arterial pressure targets. Further research is required to understand the clinical significance of cerebral hyperperfusion in septic patients on vasopressors and to reassess the neurologic effects of current mean arterial pressure targets in sepsis.

[Evaluation of circadian variation of blood pressure by ambulatory blood pressure monitoring in an elderly diabetic population with or without orthostatic hypotension]. / Évaluation des variations circadiennes de la tension artérielle par monitorage ambulatoire de la pression artérielle dans une population âgée diabétique atteinte ou non d'hypotension orthostatique.

Orthostatic hypotension is frequently observed in the elderly population and has been previously identified as a significant risk factor for increased mortality. The link between this condition and increased mortality could be due to an abnormal circadian pattern of blood pressure. The absence of a physiological nocturnal decrease in blood pressure is termed the non-dipping pattern. This abnormality is relatively frequent in elderly people suffering from orthostatic hypotension, but its prevalence in the diabetic geriatric population is unknown. The purpose of this study is to compare blood pressure profiles on ambulatory blood pressure monitoring (ABPM) in a sample of elderly diabetic subjects suffering from orthostatic hypotension with those without postural hypotension. One hundred and ninety-eight patients were recruited by mail. The presence or absence of orthostatic hypotension was determined. They all subsequently underwent ABPM. One hundred and thirty-one of our subjects (68%) suffered from orthostatic hypotension; of these, 76% had a non-dipping pattern on ABPM, compared with 74% of the subjects not suffering from orthostatic hypotension (P = NS). This study thus demonstrates the high prevalence of orthostatic hypotension in an elderly diabetic population. On the other hand, we could not demonstrate a correlation between the non-dipping pattern and the presence of orthostatic hypotension. This is in contrast with previous work done in a non-diabetic elderly population. Further studies are needed to determine the effect of diabetes on blood pressure.