Ali Albarrati

Frailty: A global measure of the multisystem impact of COPD

Chronic obstructive pulmonary disease (COPD) is a multisystem disease that resembles the accumulation of multiple impairments seen in aging. A comprehensive geriatric assessment (CGA) captures multisystem deficits, from which a frailty index (FI) can be derived. We hypothesized that patients with COPD would be frailer than a comparator group free from respiratory disease. In this cross-sectional analysis, the CGA questionnaire was completed and used to derive an FI in 520 patients diagnosed with COPD and 150 comparators. All subjects were assessed for lung function, body composition, 6-minute walking distance (6MWD), and handgrip strength. Patients completed validated questionnaires on health-related quality of life and respiratory symptoms. Patients and comparators were similar in age, gender, and body mass index, but patients had a greater mean ± SD FI 0.16 ± 0.08 than comparators 0.05 ± 0.03. In patients, a stepwise linear regression 6MWD (β = −0.43), number of comorbidities (β = −0.38), handgrip (β = −0.11), and number of exacerbations (β = 0.11) were predictors of frailty (all p < 0.01). This large study suggests patients with COPD are frailer than comparators. The FI derived from the CGA captures the deterioration of multiple systems in COPD and provides an overview of impairments, which may identify individuals at increased risk of morbidity and mortality in COPD.

Utility of Timed Up and Go in Outpatient Cardiology Clinics

PURPOSE The aim of the study was to examine if the Timed Up and Go (TUG) Test would be a feasible, reproducible, and valid measure in patients post-coronary artery bypass grafting (CABG). DESIGN Cross-sectional study, controls and patients post-CABG, outpatient clinic. METHODS Participants performed the TUG Test and the 6-Minute Walking Distance (6MWD) Test. Reliability was measured within observer on two occasions. FINDINGS Patients and controls were similar in age. The patients had greater TUG mean (SD) of 14.4 seconds (4.9 seconds) and lower 6MWD of 358 m (76 m) compared with TUG of 8.2 seconds (2.7 seconds) and 6MWD of 487 m (56 m) in controls. In patients, intraclass correlation for the TUG was .98 (95% CI [.96, .98]) between the measurements. In patients, there was a high correlation between the TUG Test and the 6MWD Test, r = -.70, p < .001. CONCLUSION The TUG Test demonstrated to be a feasible, reproducible, and valid measure in patients post-CABG. CLINICAL RELEVANCE The TUG Test could serve as a screening tool for physical performance inside clinics.

Effect of Upright and Slouched Sitting Postures on the Respiratory Muscle Strength in Healthy Young Males

Objective The present study compared the effects of upright and slouched sitting postures on the respiratory muscle strength in healthy young males. Methods A total of 35 adult male subjects aged 18–35 years participated in this study. Respiratory muscle strength was determined by measurement of sniff nasal inspiratory pressure (SNIP) using a MicroRPM device in the upright and slouched sitting positions. The subjects were asked to perform the pulmonary function test including peak expiratory flow (PEF), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio at baseline. Body composition was also determined. Results There was a significant difference of SNIP score between upright sitting and slouched sitting positions (p = 0.04). The mean difference of SNIP score between upright sitting and slouched sitting positions was 8.7 cmH2O. Significant correlations were found between SNIP in upright sitting and FEV1% predicted values [R = .651], SNIP in slouched sitting and FEV1% predicted values [R = .579], and SNIP in upright sitting and SNIP in slouched sitting positions [R = .926] (p < 0.05 for all). There were no significant correlations between SNIP scores, demographic variables, and other baseline clinical data (p > 0.05). Conclusions The slouched sitting position had a lower SNIP score compared to upright sitting position suggesting a reduced diaphragm tension and movement as a result of altered body posture.

Effect of Different Head-Neck Postures on the Respiratory Function in Healthy Males

Normal respiration is a very intricate function that comprises mechanical as well as nonmechanical components. It is shown to be affected by various factors including age, lifestyle, disease, and change in posture. With the increased use of hand held devices, everyone is prone to poor sitting postures like forward head posture. The purpose of this study was to evaluate the effect of assumed forward head posture and torticollis on the diaphragm muscle strength. A sample of 15 healthy males, aged 18-35 years, was recruited for this study. All subjects performed spirometry to measure the forced expiratory volume in 1 second (FEV1), the forced vital capacity (FVC), and FEV1/FVC ratio. SNIP was measured during upright sitting, induced forward head posture, and torticollis. Subjects mean age (SD) was 23(6) years. The SNIP score of the subjects during sitting with FHP was lower as compared to that during upright sitting. It decreased significantly during induced right torticollis position. This is the first study exploring the impact of different head and neck positions on respiratory function. Alteration of head and neck positions had an immediate negative impact on respiratory function. Clinicians should be prompted to assess respiratory function when assessing individuals with mal-posture.

Transient liver dysfunction increases surgical site infections after coronary surgery

Background Surgical site infections can have a significant impact on cardiac surgical outcome. The liver plays an important role in infection prevention. This study aimed to retrospectively determine whether transient postoperative liver dysfunction after coronary bypass surgery increased surgical site infections. Methods A modified version of the Schindl scoring scale for liver dysfunction was adapted to objectively quantify transient liver dysfunction in the first 7 days after on-pump coronary artery bypass grafting. A retrospective analysis of clinical outcomes at 30 months postoperatively was performed on data of 575 patients who underwent coronary artery bypass between 2014 and 2016. The patients were categorized into a liver dysfunction group (Schindl score ≥ 4) and a non-liver dysfunction group (Schindl score < 4). Results The liver dysfunction group (47.3%) had significantly more patients who were obese, current smokers, and had diabetes, renal impairment, and peripheral vascular disease. Surgical site infections occurred predominantly in the liver dysfunction group (12.1% vs. 0.3%, p < 0.001). The independent predictors of surgical site infection were liver dysfunction, body mass index > 30 kg m−2, and coronary bypass surgery combined with other cardiac procedures. Conclusions Surgical wound infections can be precipitated by multiple factors before, during, and after coronary bypass surgery. Transient liver dysfunction in the perioperative period is associated with an increased rate of surgical infections even after adjusting for known risk factors. Considering this factor as well as other known risks may help to identify and stratify patients with a potentially higher risk of surgical site infections.

Topical Ice Slush Adversely Affects Sniff Nasal Inspiratory Force After Coronary Bypass Surgery

BACKGROUND Topical cooling with ice slush as an adjunct for myocardial protection during cardiac surgery has been shown to cause freezing injury of the phrenic nerves. This can cause diaphragmatic dysfunction and respiratory complications. METHODS Twenty (n=20) male patients between the ages of 40 and 60 years were equally randomised to undergo elective coronary artery bypass grafting (CABG) with either cold cardioplegic arrest with topical ice slush cooling or cold cardioplegic arrest without the use of ice slush. The sniff nasal inspiratory force (SNIF) was used to compare inspiratory muscle strength. RESULTS There was no difference in the preoperative SNIF in the two randomised groups. In the immediate postoperative period, the ice slush group had worse SNIF (33.5±9.6cm H2O versus 47.8±12.2cm H2O; p=0.009). The pre-home discharge SNIF was still significantly lower for the ice slush group despite a noted improvement in SNIF recovery in both groups (38.3±10.6cm H2O versus 53.5±13.2cm H2O; p=0.011). Two patients in the ice slush group had left diaphragmatic dysfunction with none in the control group. CONCLUSION The use of topical ice slush is associated with freezing injury of the phrenic nerves. This will adversely affect the inspiratory muscle force which may lead to respiratory complications after surgery.

P74 A Novel Measure of Physical Exercise Capacity in COPD: Abstract 74 Table 1

Introduction Chronic obstructive pulmonary disease (COPD) is associated with progressive impairment of physical performance. However, determination of physical performance in routine clinical practise is difficult due to limited resources. This study compared the timed up and go (TUG) test and a range of assessments of physical performance, easily applied in the routine care of COPD, with the 6 minute walk test (6MWT). Method As part of a longitudinal study of comorbidities in COPD, sub-maximal physical performance was examined in 300 patients and 50 comparators using the 6MWT. The TUG test, spirometry, COPD assessment test (CAT), St George’s Respiratory Questionnaire (SGRQ) and gait speed were also determined. Gait speed was determined by dividing 6MWTd istance by time. Results Patients and comparators were similar in age, BMI and gender. There were between group differences in 6MWT, TUG and gait speed (Table 1), ANOVA showed a difference between comparators and the GOLD stages of COPD for all these variables (all p<0.01). The TUG time differed across BMI categories in COPD but not comparators (ANOVA p=0.007 and p=0.195 respectively). The TUG time was inversely related to 6MWT (r=0.64, p<0.0001), gait speed (r=0.63, p<0.0001)and lung function (r=0.15, p<0.01), and directly to the activity (r=0.35, p<0.0001)and total SGRQ scores (r=0.35, p<0.0001) and CAT (r=0.39, p<0.0001). Stepwise regression analysis, adjusted for age and BMI, indicated that TUG time, SGRQ activity score and CAT score explained 73% of variance in 6MWT in patients, with lung function excluded from the analysis. Abstract 74 Table 1 Clinical characteristics of patients and comparators Mean±SD COPD Comparator P value Age (years) 66±7 65±8 0.198 BMI (kg/m2) 28±5.4 27.9±7 0.844 FEV1% pred 54±19.6 103±14.8 <0.0001 6MWT (m) 291±111 472±80 <0.0001 TUG (sec) 11.4±3.9 8.2±1.3 <0.0001 Gait Speed (m/min) 48.5±18.5 78.6±13.4 <0.0001 Conclusions The TUG time identified the difference in physical performance between patients and comparators and also across GOLD categories. In the elderly the TUG test has been used as an indicator of physical performance, being an integrated measure of gait speed, balance and functional capacity. It appears to apply in the same way to the physical deficits in COPD and also to link to health related quality of life. The application of TUG test and validated questionnaires may be a useful measure of physical performance, which because of its rapidity and ease of application could be used in assessments in clinical practise.