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Conservative management of COVID-19 associated hypoxaemia

BACKGROUND: Invasive mechanical ventilation of hypoxaemic coronavirus disease 2019 (COVID-19) patients is associated with mortality rates of >50%. We evaluated clinical outcome data of two hospitals that agreed on a predefined protocol for restrictive use of invasive ventilation where the decisio...

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Autores principales: Voshaar, Thomas, Stais, Patrick, Köhler, Dieter, Dellweg, Dominic
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848791/
https://www.ncbi.nlm.nih.gov/pubmed/33738306
http://dx.doi.org/10.1183/23120541.00026-2021
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author Voshaar, Thomas
Stais, Patrick
Köhler, Dieter
Dellweg, Dominic
author_facet Voshaar, Thomas
Stais, Patrick
Köhler, Dieter
Dellweg, Dominic
author_sort Voshaar, Thomas
collection PubMed
description BACKGROUND: Invasive mechanical ventilation of hypoxaemic coronavirus disease 2019 (COVID-19) patients is associated with mortality rates of >50%. We evaluated clinical outcome data of two hospitals that agreed on a predefined protocol for restrictive use of invasive ventilation where the decision to intubate was based on the clinical presentation and oxygen content rather than on the degree of hypoxaemia. METHOD: Data analysis was carried out of patients with positive PCR-testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), typical history, and symptoms and pulmonary infiltrates who exhibited oxygen saturation values of <93%. RESULTS: We identified 78 patients who met the inclusion criteria. The oxygen saturation nadir was 84.4±6.5% for the whole group. 53 patients (68%) received nasal oxygen (group 1), 17 patients (22%) were treated with nasal high-flow continuous positive airway pressure (CPAP), noninvasive ventilation or a combination thereof (group 2), and eight patients (10%) were intubated (group 3). The Horovitz index was 216±8 for group 1, 157±13 for group 2 and 106±15 for group 3. Oxygen content was 14.5±2.5, 13.4±1.9 and 11.6±2.6 mL O(2)·dL(−1) for the three respective groups. Overall mortality was 7.7%; the mortality of intubated patients was 50%. Overall, 93% of patients could be discharged on room air. CONCLUSION: Permissive hypoxaemia where decisions for the level of respiratory therapy were based on the clinical presentation and oxygen content resulted in low intubation rates, low overall mortality and a low number of patients who require oxygen after discharge.
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spelling pubmed-78487912021-02-02 Conservative management of COVID-19 associated hypoxaemia Voshaar, Thomas Stais, Patrick Köhler, Dieter Dellweg, Dominic ERJ Open Res Original Articles BACKGROUND: Invasive mechanical ventilation of hypoxaemic coronavirus disease 2019 (COVID-19) patients is associated with mortality rates of >50%. We evaluated clinical outcome data of two hospitals that agreed on a predefined protocol for restrictive use of invasive ventilation where the decision to intubate was based on the clinical presentation and oxygen content rather than on the degree of hypoxaemia. METHOD: Data analysis was carried out of patients with positive PCR-testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), typical history, and symptoms and pulmonary infiltrates who exhibited oxygen saturation values of <93%. RESULTS: We identified 78 patients who met the inclusion criteria. The oxygen saturation nadir was 84.4±6.5% for the whole group. 53 patients (68%) received nasal oxygen (group 1), 17 patients (22%) were treated with nasal high-flow continuous positive airway pressure (CPAP), noninvasive ventilation or a combination thereof (group 2), and eight patients (10%) were intubated (group 3). The Horovitz index was 216±8 for group 1, 157±13 for group 2 and 106±15 for group 3. Oxygen content was 14.5±2.5, 13.4±1.9 and 11.6±2.6 mL O(2)·dL(−1) for the three respective groups. Overall mortality was 7.7%; the mortality of intubated patients was 50%. Overall, 93% of patients could be discharged on room air. CONCLUSION: Permissive hypoxaemia where decisions for the level of respiratory therapy were based on the clinical presentation and oxygen content resulted in low intubation rates, low overall mortality and a low number of patients who require oxygen after discharge. European Respiratory Society 2021-03-15 /pmc/articles/PMC7848791/ /pubmed/33738306 http://dx.doi.org/10.1183/23120541.00026-2021 Text en Copyright ©The authors 2021 http://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org)
spellingShingle Original Articles
Voshaar, Thomas
Stais, Patrick
Köhler, Dieter
Dellweg, Dominic
Conservative management of COVID-19 associated hypoxaemia
title Conservative management of COVID-19 associated hypoxaemia
title_full Conservative management of COVID-19 associated hypoxaemia
title_fullStr Conservative management of COVID-19 associated hypoxaemia
title_full_unstemmed Conservative management of COVID-19 associated hypoxaemia
title_short Conservative management of COVID-19 associated hypoxaemia
title_sort conservative management of covid-19 associated hypoxaemia
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848791/
https://www.ncbi.nlm.nih.gov/pubmed/33738306
http://dx.doi.org/10.1183/23120541.00026-2021
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