Conservative management of Covid 19 associated hypoxemia

Background Invasive mechanical ventilation of hypoxemic Covid 19 patients is associated with mortality rates of more than 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 hypoxemia.

Method Data analysis of patients with positive PCR-testing for SARS-CoV-2, typical history, and symptoms and pulmonary infiltrates who exhibited oxygen saturation values of less than 93%.

Results We identified 78 patients who met the inclusion criteria. The SaO2 nadir was 84.4±6.5% for the whole group. Fifty-three patients (68%) received nasal oxygen (group1), 17 patients (22%) were treated with nasal high-flow, CPAP, non-invasive ventilation, or a combination thereof (group 2) and 8 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·dL⁻¹ for the three respective groups. Overall mortality was 7.7%, the mortality of intubated patients was 50%. 93% of patients could be discharged on room air.

Conclusion Permissive hypoxemia 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.