Updated guidance on the management of COVID-19:from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.status: Published onlin

978-119 Abnormal Left Ventricular Volume Response to Upright Exercise in Patients with Pulmonary Hypertension: Resolution Following Lung Transplantation

Upright exercise in normals is accompanied by an increase in indexed left ventricular end-diastolic volume (LVEDVI) which is felt to enhance cardiac output via the Frank-Starling mechanism. To assess whether an inability to increase LVEDVI during exercise may exist in pts with pulmonary hypertension (PHTN), we examined data from right heart catheterization and rest and exercise first-pass radionuclide ventriculography (RVG) in 55 pts referred for lung transplantation (LTX) evaluation. Grp 1 (n=16; 46±3 yrs. mean±SEM) had pulmonary vascular resistance (PVR)≥250 dynes-sec/cm5 (mean 452±44); Grp 2 (n=39; 48±2 yrs) had PVR<250 dynes-sec/cm5 (mean 179±6). Pulmonary capillary wedge pressure did not differ between groups (8.2±1.0 vs. 7.2±0.6 mmHg). Right ventricular ejection fraction (RVEF) at rest (0.35±0.02 vs. 0.39±0.01; P<0.05) and exercise (0.36±0.02 vs. 0.42±0.01; p<0.005) were lower in Grp 1. All pts reached a pulmonary limit to exercise; exercise capacity. as determined by maximal oxygen consumption or watts achieved. did not differ between groups. Rest and exercise heart rate. indexed LV stroke volume. and LVEF did not differ between groups. Rest Ire) and exercise (ex) LVEDVI. and the change in LVEDVI with exercise. were as follows:Grp1Grp2reLVEDVI (ml/m2)69.9±4.469.6±2.2 NSexLVEDVI (ml/m2)70.5±3.482.2±2.6*ΔLVEDVI (ml/m2)0.5±2.512.6±2.1*Grp 1 vs. Grp 2*p < 0.0119 pts (11 Grp 1.8 Grp 2) underwent LTX with follow-up rest and exercise RVG 15±2 mos later. Following LTX. there was no difference between the groups in exercise capacity or LVEF. and no longer a difference in RVEF or in the ability to increase LVEDVI with exercise.ConclusionPts with PHTN have an abnormal LVEDVI response to upright exercise which may contribute to their exercise intolerance. This abnormality resolves following LTX