High flow oxygen is no better than standard O2 In COVID respiratory failure
High-flow oxygen did not reduce mortality significantly more than standard oxygen therapy in COVID-19 patients with respiratory failure, according to a multicenter randomized clinical trial published yesterday. JAMA.
In the ongoing trial, researchers enrolled 711 patients with COVID-19 respiratory failure in 1 of 34 intensive care units (ICUs) in France between January and December 2021, with final follow-up on March 5, 2022.
Patients were randomly assigned to receive either high-flow oxygen via a nasal cannula (357 patients) or standard oxygen therapy via a non-rebreathing mask (354) for 4 days. The average age of patients is 61 years, 30% are women.
Mortality rates at 28 days were 10% in the high-flow oxygen group and 11% in the standard oxygen recipients, a nonstatistically significant difference. However, the intubation rate was significantly lower in high-flow oxygen recipients than in those receiving standard oxygen (45% vs. 53%).
The most common adverse event was ventilator-associated pneumonia (58% of the high-flow group, 53% of those receiving standard oxygen).
Although high-flow oxygen does not significantly reduce mortality, the reduction in the risk of intubation and the need for invasive mechanical ventilation may be an important outcome, the authors said. “It may also help prevent the use of ICU ventilators in resource-limited settings during a pandemic,” they said.
In a related comment, Alistair Nichol, PhD, of University College Dublin, and Cecilia O’Kane, PhD, and Daniel McAuley, PhD, of Queen’s University Belfast, said future trials should be combined to identify different types of COVID-19 patients. which subgroups are more likely to benefit or be harmed by different oxygen treatments.
In the meantime, the results of this study “will provide some reassurance for clinicians during periods when the availability of some noninvasive respiratory support strategies is reduced during increases in COVID-19 hospitalizations,” they said. “Special consideration should be given to potential complications with each approach, as well as patient preferences and tolerability of the chosen therapy.”
September 27 JAMA to learn and comment
New blood test aims to predict who will get COVID long-term
Today in a little research eBioMedicineResearchers at University College London show that a blood sample taken during a COVID-19 infection can predict who will develop persistent symptoms for up to 1 year by accurately measuring proteins.
To conduct the study, researchers looked at blood plasma samples from 54 British healthcare workers with confirmed COVID-19 infections taken weekly over a 6-week period in spring 2020. Those samples were compared with the samples of 102 medical workers. not infected in the same period.
Using targeted mass spectrometry, the researchers found that 12 of the 91 proteins studied were abnormally elevated among people infected with SARS-CoV-2. The degree to which the protein level rises is associated with increased symptoms. They found that abnormal levels of 20 proteins most associated with anti-clotting and anti-inflammatory processes predicted persistent symptoms 1 year after infection.
“Our study shows that even mild or asymptomatic Covid-19 disrupts the profile of proteins in our blood plasma,” said first author Gabriella Captur, MD, PhD, in a university press release. “This means that even mild Covid-19 dramatically affects normal biological processes for at least six weeks after infection.”
A larger, independent study is needed to confirm these findings, the authors said. Lead author Wendy Heywood, PhD, said: “If we can identify people who are likely to develop Covid over a long period of time, it opens the door to testing treatments such as antiviral drugs at this early, primary infection stage to see if they can reduce the risk of contracting the virus after long-term Covid. .”
September 28 eBioMedicine to learn
28 September University College London press release
Limestone County, Texas Approves First-Ever PHC
Texas officials late last week confirmed the first case of chronic wasting disease (CWD) at a captive deer farm in Limestone County, according to a news release from the Texas Animal Health Commission (TAHC).
Four deer at the facility tested positive for UHD on Sept. 5 by the Texas A&M Veterinary Medical Diagnostic Laboratory in College Station. The National Veterinary Services Laboratory in Ames, Iowa, confirmed two of those samples as having CWD on September 13 and will complete testing of the other two soon. Texas Parks and Wildlife Department (TPWD) and TAHC officials have taken steps to secure the facility and notify other breeding operations that have received or sent deer to the facility in the past 5 years, TAHC said.
“TPWD and TAHC are taking this situation very seriously,” said TPWD wildlife director John Silowski. “Fortunately, these positive cases were detected early and we have a good sample distribution across the facility.
“Currently, CWD appears to be contained in a pen within the facility. Animal health and wildlife officials will continue investigations to determine the extent of disease within the facility and reduce risks to Texas’ CWD-susceptible species.”
TPWD officials are developing control zone boundaries that could include parts of Limestone, Hill, Freestone and Navarro counties.
CWD is a fatal prion disease that spreads among carcasses such as deer, moose, and elk through contaminated environments, antler velvet, and bodily fluids and tissues. Although the disease is not known to infect humans, some experts fear it could one day cause a disease similar to bovine spongiform encephalopathy (“mad cow disease”). Health officials warn against eating meat from sick animals. The disease has been detected in 30 states of the United States.
September 23 TAHC news release