Respiratory Care Currents

 Published: August 18, 2021

By: Debbie Bunch

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Blood Thinners Help Subset of COVID-19 Patients

Researchers who published in The New England Journal of Medicine found that giving moderately ill patients hospitalized with COVID-19 full dose blood thinners can improve their chances of avoiding mechanical ventilation and leaving the hospital alive.  

The same, however, was not true for patients who were already critically ill and on respiratory and/or cardiovascular organ support. 

The study was conducted among 1,074 critically ill and 2,219 moderately ill patients hospitalized with COVID-19 in April of 2020. They received either a low or full dose of heparin for up to 14 days. Interim results in December of 2020 found no advantage for the full dose, but a month later, further analysis revealed a significant advantage for moderately ill patients.  

The National Heart, Lung, and Blood Institute (NHLBI) partly supported the research. “These results make for a compelling example of how important it is to stratify patients with different disease severity in clinical trials,” said NHLBI Director Gary H. Gibbons, MD. “What might help one subgroup of patients might be of no benefit, or even harmful, in another.”  

Endotracheal Tube Coating May Reduce Bacterial Infections

A recent study out of the Children’s Hospital of Philadelphia suggests a new type of antimicrobial coating may prevent bacterial infections caused by endotracheal tubes. In a proof of concept study, the polymer coating, which contains antimicrobial peptides (AMPs), small proteins that destabilize bacterial membranes and cause them to die, effectively killed bacteria for a week. When they tested the drug-eluting tube against airway microbes like S. epidermidis and S. pneumoniae, and human microbiome samples, significant antibacterial activity was also seen.  

Publishing their findings in The Laryngoscope, the investigators noted AMPs are unlikely to promote antimicrobial resistance, as happens with the use of antibiotics, and are less likely to disrupt the balance of good and bad bacteria.  

“We have created a novel device to modulate the upper-airway microbiome, which could be used to prevent bacterial infections during intubation and help prevent subglottic stenosis and other airway diseases,” said senior study author Riccardo Gottardi, PhD. “Not only does this technology work predictably and continuously over the normal duration of chronically intubated patients, but it is also fast and easy to produce and could easily be modulated to target any bacteria of interest.” 

Hospital at Home Program Saves Beds During Pandemic

Delivering hospital care at home can help hospitals deal with the overflow of patients that comes with a pandemic like COVID-19, conclude researchers from Brigham and Women’s Hospital. They looked at their provision of a hospital at home to 65 acutely ill patients between March and June of 2020. 

The patients were suffering from a range of conditions, including COPD and asthma, but did not test positive for COVID-19. The Home Hospital program provided them with daily in-home or remote visits from an attending general internist and two daily in-home visits from an RN. The patients could also access a physician 24 hours a day if needed, and connectivity allowed for continuous monitoring, video chats, and texting.  

In total, the patients accounted for 419 days of care, or about 5% of all medicine patients without COVID-19 treated at the two hospitals involved in the study during that time period.  

The study appeared in the Journal of General Internal Medicine 

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Protein Signatures Reveal Insights into Chronic Rejection in Lung Transplant Patients

Swedish researchers examined protein composition in lung tissue samples taken from four lung transplant patients with end-stage bronchiolitis obliterans syndrome (BOS). According to the researchers, protein signatures found in these remodeled airways could lead to new treatments.  

The study concluded that the obliterative bronchiolitis (OB) lesions were heterogeneous and differed within and among patients. However, the protein patterns in the lesions were correlated to pathways of extracellular matrix organization, tissue development, and wound healing processes.  

“This study shows a link between the morphological appearance of OB lesions in remodeled airways in lungs from patients suffering from end-stage BOS and their respective protein content, providing molecular and morphological insights into the development of chronic rejection after lung transplantation,” noted study author Gunilla Westergren-Thorsson, PhD. “Identifying the underlying initial cause of OB lesions in patients undergoing lung transplantation is key to developing therapies to reduce the chance of chronic allograft dysfunction.” 

The study was published by the American Journal of Pathology. 

Kids Mostly Spared from Long COVID

Children have weathered the COVID-19 storm much better than their parents and grandparents. Here’s some more good news from British researchers. Their study of daily health reports logged into an app by parents or caregivers of more than 250,000 kids age 5-17 — 7,000 of whom had symptoms of COVID-19 or a positive test — has found that only one in 20 of those affected by the virus went on to suffer symptoms for more than four weeks. 

By eight weeks, nearly all of them had fully recovered.  

Among the 1,734 children who had a clear start and endpoint to their symptoms and a positive COVID PCR test, the illness lasted an average of five days in kids age 5-11 and seven days in those age 12-17. 

The authors had previously studied long COVID-19 in adults, finding one in seven still had symptoms at four weeks, and one in 20 were ill for eight weeks or longer.  

The study was published by Lancet Child and Adolescent Health 

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Debbie Bunch

Debbie Bunch is an AARC contributor who writes feature articles, news stories, and other content for Newsroom, the AARC website, and associated emailed newsletters. In her spare time, she enjoys reading, traveling, photography, and spending time with her children and grandchildren. Connect with Debbie by email or on AARConnect or LinkedIn.

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