Analysis of the news of September 28, 2022

High flow oxygen no better than standard O2 in COVID respiratory failure

High-flow oxygen did not significantly reduce death rates beyond those of standard oxygen therapy in COVID-19 patients with respiratory failure, according to a multicenter randomized clinical trial published yesterday in JAMA.

In an ongoing trial, researchers recruited 711 patients with COVID-19 respiratory failure in 1 of 34 intensive care units (ICUs) in France from January to December 2021, with a final follow-up on March 5. 2022.

Patients were randomly assigned to receive either high-flow oxygen via nasal cannula (357 patients) or standard oxygen therapy via non-rebreathing mask (354) for a median duration of 4 days. The average age of the patients was 61 years old and 30% were women.

The 28-day mortality rates were 10% in the high-flow oxygen group and 11% in the standard oxygen recipients, a difference not statistically significant. But the rate of intubation was significantly lower in high-flow oxygen recipients than in those receiving standard oxygen (45% versus 53%).

The most common adverse event was ventilator-associated pneumonia (58% in high-flow group versus 53% in standard oxygen recipients).

The authors said that although high-flow oxygen did not significantly reduce the mortality rate, the reduction in the risk of intubation and the need for invasive mechanical ventilation may be an important outcome. “It may also help avoid the use of critical care ventilators in resource-limited settings during a pandemic,” they wrote.

In a related comment, Alistair Nichol, PhD, of University College Dublin, and Cecilia O’Kane, PhD, and Daniel McAuley, MD, both of Queen’s University Belfast, said future trials should incorporate different types of COVID-19 patients to determine which subgroups are most likely to benefit or be harmed by different oxygen therapies.

In the meantime, the results of this study “will reassure clinicians in these times of reduced availability of certain noninvasive respiratory support strategies during peak COVID-19 hospitalizations,” they wrote. “Careful consideration should be given to the potential for complications with each approach, as well as patient preference and tolerance of the chosen therapy.”
Sep 27 JAMA study and comment

New blood test aims to predict who will have long COVID

In a small study today in eBioMedicineUniversity College London researchers show that a blood sample taken at the time of COVID-19 infection could predict who would develop persistent symptoms up to 1 year later using precise protein measurements.

To conduct the study, the researchers looked at blood plasma samples from 54 UK healthcare workers who had confirmed COVID-19 infection, taken weekly for 6 weeks in the spring of 2020. These samples were compared to samples of 102 healthcare workers who were uninfected during the same period.

Using targeted mass spectrometry, the researchers found abnormally high levels of 12 out of 91 proteins studied among people infected with SARS-CoV-2. The degree of protein elevation was correlated with the increase in symptoms. They found that abnormal levels of 20 proteins, most related to anti-coagulant and anti-inflammatory processes, were predictive of persistent symptoms 1 year after infection.

“Our study shows that even mild or asymptomatic Covid-19 disrupts the protein profile in our blood plasma,” first author Gabriella Captur, MD, PhD, said in an academic press release. “This means that even mild Covid-19 affects normal biological processes dramatically, for at least six weeks after infection.”

The authors said a larger independent study was needed to corroborate these findings. Lead author Wendy Heywood, PhD, said: “If we can identify people who are at risk of developing long Covid, that opens the door to trying treatments such as antivirals at this early stage of infection, to see if this can reduce the risk of Covid long later.”
Sep 28 eBioMedicine
study
September 28 University College London
Press release

Texas confirms CWD in Limestone County for the first time

Texas officials have confirmed chronic wasting disease (CWD) for the first time in Limestone County at a farm that raises deer in captivity, according to a press release issued last week by the Texas Animal Health Commission (TAHC). ).

Four deer at the facility tested positive for CWD on Sept. 5 in testing by the Texas A&M Veterinary Medical Diagnostic Laboratory in College Station. The National Veterinary Services Laboratory in Ames, Iowa, confirmed CWD in two of these samples on September 13 and will soon complete testing on the other two samples. Officials from the Texas Parks and Wildlife Department (TPWD) and TAHC have taken steps to secure the facility and notify other ranching facilities that have received deer or shipped deer to this facility in the past 5 years, the TAHC said.

“TPWD and TAHC take this situation very seriously,” said John Silovsky, TPWD wildlife director. “Fortunately, these positive cases were caught early and we have a good spread of samples across the facility.

“At this time, CWD appears to be contained in a single enclosure at the facility. Animal health and wildlife officials will continue to investigate to determine the extent of the disease at the facility and to mitigate risk to CWD-susceptible species from Texas.”

TPWD officials are developing surveillance area boundaries that may include parts of Limestone, Hill, Freestone and Navarro counties.

Chronic wasting disease is a deadly prion disease that is spread between cervids such as deer, moose, and elk through contaminated environments, deer 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 infected animals. The disease has been detected in 30 US states.
September 23 TAHC Press release