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Exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe COVID-19

The importance of exertional hypoxia without resting hypoxia in COVID-19 is unknown and may help objectively identify high-risk patients. Interventions may be initiated earlier with sufficient lead-time between development of exertional hypoxia and other outcome measures. We performed a retrospectiv...

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Autores principales: Bhasin, Ajay, Bregger, Melissa, Kluk, Mark, Park, Peter, Feinglass, Joe, Barsuk, Jeffrey
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994353/
https://www.ncbi.nlm.nih.gov/pubmed/33770368
http://dx.doi.org/10.1007/s11739-021-02708-w
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author Bhasin, Ajay
Bregger, Melissa
Kluk, Mark
Park, Peter
Feinglass, Joe
Barsuk, Jeffrey
author_facet Bhasin, Ajay
Bregger, Melissa
Kluk, Mark
Park, Peter
Feinglass, Joe
Barsuk, Jeffrey
author_sort Bhasin, Ajay
collection PubMed
description The importance of exertional hypoxia without resting hypoxia in COVID-19 is unknown and may help objectively identify high-risk patients. Interventions may be initiated earlier with sufficient lead-time between development of exertional hypoxia and other outcome measures. We performed a retrospective study of adult patients hospitalized with COVID-19 from March 1, 2020 to October 30, 2020 in an integrated academic medical system in the Chicagoland area. We analyzed patients who had daily exertional oximetry measurements taken. We defined exertional hypoxia as SpO2 < 90% with ambulation. We excluded patients who had first exertional oximetry measurements or first exertional hypoxia after the use of oxygen therapies. We determined the association of exertional hypoxia without resting hypoxia with the eventual need for nasal cannula or advanced oxygen therapies (defined as high flow nasal cannula, Bi-PAP, ventilator, or extracorporeal membrane oxygenation). We also calculated the time between development of exertional hypoxia and the need for oxygen therapies. Of 531 patients included, 132 (24.9%) had exertional hypoxia. Presence of exertional hypoxia was strongly associated with eventual use of nasal cannula (OR 4.8, 95% CI 2.8–8.4) and advanced oxygen therapy (IRR 7.7, 95% CI 3.4–17.5). Exertional hypoxia preceded nasal cannula use by a median 12.5 h [IQR 3.25, 29.25] and advanced oxygenation by 54 h [IQR 25, 82]. Exertional hypoxia without resting hypoxia may serve as an early, non-invasive physiologic marker for the likelihood of developing moderate to severe COVID-19. It may help clinicians triage patients and initiate earlier interventions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-021-02708-w.
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spelling pubmed-79943532021-03-26 Exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe COVID-19 Bhasin, Ajay Bregger, Melissa Kluk, Mark Park, Peter Feinglass, Joe Barsuk, Jeffrey Intern Emerg Med Im - Original The importance of exertional hypoxia without resting hypoxia in COVID-19 is unknown and may help objectively identify high-risk patients. Interventions may be initiated earlier with sufficient lead-time between development of exertional hypoxia and other outcome measures. We performed a retrospective study of adult patients hospitalized with COVID-19 from March 1, 2020 to October 30, 2020 in an integrated academic medical system in the Chicagoland area. We analyzed patients who had daily exertional oximetry measurements taken. We defined exertional hypoxia as SpO2 < 90% with ambulation. We excluded patients who had first exertional oximetry measurements or first exertional hypoxia after the use of oxygen therapies. We determined the association of exertional hypoxia without resting hypoxia with the eventual need for nasal cannula or advanced oxygen therapies (defined as high flow nasal cannula, Bi-PAP, ventilator, or extracorporeal membrane oxygenation). We also calculated the time between development of exertional hypoxia and the need for oxygen therapies. Of 531 patients included, 132 (24.9%) had exertional hypoxia. Presence of exertional hypoxia was strongly associated with eventual use of nasal cannula (OR 4.8, 95% CI 2.8–8.4) and advanced oxygen therapy (IRR 7.7, 95% CI 3.4–17.5). Exertional hypoxia preceded nasal cannula use by a median 12.5 h [IQR 3.25, 29.25] and advanced oxygenation by 54 h [IQR 25, 82]. Exertional hypoxia without resting hypoxia may serve as an early, non-invasive physiologic marker for the likelihood of developing moderate to severe COVID-19. It may help clinicians triage patients and initiate earlier interventions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-021-02708-w. Springer International Publishing 2021-03-26 2021 /pmc/articles/PMC7994353/ /pubmed/33770368 http://dx.doi.org/10.1007/s11739-021-02708-w Text en © Società Italiana di Medicina Interna (SIMI) 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Im - Original
Bhasin, Ajay
Bregger, Melissa
Kluk, Mark
Park, Peter
Feinglass, Joe
Barsuk, Jeffrey
Exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe COVID-19
title Exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe COVID-19
title_full Exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe COVID-19
title_fullStr Exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe COVID-19
title_full_unstemmed Exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe COVID-19
title_short Exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe COVID-19
title_sort exertional hypoxia in patients without resting hypoxia is an early predictor of moderate to severe covid-19
topic Im - Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994353/
https://www.ncbi.nlm.nih.gov/pubmed/33770368
http://dx.doi.org/10.1007/s11739-021-02708-w
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