Chronic obstructive pulmonary disease (COPD) is a risk factor for death in patients admitted to intensive care units (ICUs) for respiratory support. Previous reports suggested higher mortality in COPD patients with COVID-19. It is yet unknown whether patients with COPD were treated differently compared to non-COPD patients. We compared the ventilation management and outcomes of invasive ventilation for COVID-19 in COPD patients versus non-COPD patients. This was a post hoc analysis of a nation-wide, observational study in the Netherlands. COPD patients were compared to non-COPD patients with respect to key ventilation parameters. The secondary endpoints included adjunctive treatments for refractory hypoxemia, and 28-day mortality. Of a total of 1090 patients, 88 (8.1%) were classified as having COPD. The ventilation parameters were not different between COPD patients and non-COPD patients, except for FiO2, which was higher in COPD patients. Prone positioning was applied more often in COPD patients. COPD patients had higher 28-day mortality than non-COPD patients. COPD had an independent association with 28-day mortality. In this cohort of patients who received invasive ventilation for COVID-19, only FiO2 settings and the use of prone positioning were different between COPD patients and non-COPD patients. COPD patients had higher mortality than non-COPD patients.
RATIONALE: Disturbed protein metabolism may result in malnutrition. A non-invasive low cost clinical tool to measure protein metabolism is lacking. Explorative research (n=1) with a newly developed non-invasive 13C-protein breath test suggested a decrease in protein oxidation after a protein restricted diet. Now, we aimed to test the effect of protein restriction in more subjects, to assess sensitivity of the test.METHODS: In this exploratory study, 14 healthy male subjects (23±3 y) participated. Habitual intake was assessed by a 4-day food diary. Next, subjects were instructed to use a 4-day isocaloric protein restricted diet (0.25 g protein/kg bw/day). After an overnight fast, a 30 g naturally enriched 13C-milk protein test drink was consumed, followed by collection of breath samples up to 330 min. Protein oxidation was analyzed by Isotope Ratio Mass Spectrometry. 24-h urine was collected on day 4 of the habitual diet, and on every day of the 4-day protein restricted diet, to assess actual change in protein intake.RESULTS: After the protein restricted diet, 30.2%±7.7 of the 30 g 13C-milk protein was oxidized over 330 min, compared to 30.6%±6.2 (NS) after the subject’s habitual diet (1.4±0.3 g protein/kg bw/day). Within subjects, both increase and decrease in oxidation was found. During the 4-day protein restricted diet, urinary urea:creatinine ratio decreased by 56%±10, consistent with a reduction in protein intake of 44%±15 (g/day) and 53%±12 (g/kg bw/day), based on urea and food diary, respectively.CONCLUSIONS: The breath test shows variation within subjects and between diets, which could be related to the sensitivity of the test. We cannot explain the variation by the measured variables. Alternatively, our results may implicate that in some of our subjects, protein intake did not sufficiently decrease to levels that could alter protein metabolism.
RATIONALE: Disturbed protein metabolism may result in malnutrition. A non-invasive low cost clinical tool to measure protein metabolism is lacking. Explorative research (n=1) with a newly developed non-invasive 13C-protein breath test suggested a decrease in protein oxidation after a protein restricted diet. Now, we aimed to test the effect of protein restriction in more subjects, to assess sensitivity of the test.METHODS: In this exploratory study, 14 healthy male subjects (23±3 y) participated. Habitual intake was assessed by a 4-day food diary. Next, subjects were instructed to use a 4-day isocaloric protein restricted diet (0.25 g protein/kg bw/day). After an overnight fast, a 30 g naturally enriched 13C-milk protein test drink was consumed, followed by collection of breath samples up to 330 min. Protein oxidation was analyzed by Isotope Ratio Mass Spectrometry. 24-h urine was collected on day 4 of the habitual diet, and on every day of the 4-day protein restricted diet, to assess actual change in protein intake.RESULTS: After the protein restricted diet, 30.2%±7.7 of the 30 g 13C-milk protein was oxidized over 330 min, compared to 30.6%±6.2 (NS) after the subject’s habitual diet (1.4±0.3 g protein/kg bw/day). Within subjects, both increase and decrease in oxidation was found. During the 4-day protein restricted diet, urinary urea:creatinine ratio decreased by 56%±10, consistent with a reduction in protein intake of 44%±15 (g/day) and 53%±12 (g/kg bw/day), based on urea and food diary, respectively.CONCLUSIONS: The breath test shows variation within subjects and between diets, which could be related to the sensitivity of the test. We cannot explain the variation by the measured variables. Alternatively, our results may implicate that in some of our subjects, protein intake did not sufficiently decrease to levels that could alter protein metabolism.
