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Conservative management of Covid 19 associated hypoxemia

Thomas Voshaar, Patrick Stais, Dieter Köhler, Dominic Dellweg
ERJ Open Research 2021; DOI: 10.1183/23120541.00026-2021
Thomas Voshaar
1Bethanien hospital Moers, Moers, Germany
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Patrick Stais
1Bethanien hospital Moers, Moers, Germany
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Dieter Köhler
2Kloster Grafschaft, Schmallenberg, Germany
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Dominic Dellweg
2Kloster Grafschaft, Schmallenberg, Germany
3Philipps University Marburg, Marburg, Germany
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  • For correspondence: d.dellweg@fkkg.de
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  • FIGURE 1
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    FIGURE 1

    Escalation sequence (CPAP=continuous positive airway pressure).

  • FIGURE 2
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    FIGURE 2

    Distribution of the highest level of respiratory support that was delivered to the patient (NHF=nasal high-flow, CPAP=continuous positive airway pressure, NIV=non-invasive ventilation).

  • FIGURE 3
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    FIGURE 3

    SaO2 Nadir of the respective treatment groups (NHF=nasal high-flow, CPAP=continuous positive airway pressure, NIV=non-invasive ventilation).

  • FIGURE 4
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    FIGURE 4

    Lowest reported Horovitz index of the respective treatment groups (NHF=nasal high-flow, CPAP=continuous positive airway pressure, NIV=non-invasive ventilation).

  • FIGURE 5
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    FIGURE 5

    Lowes measured oxygen content of the respective treatment groups (NHF=nasal high-flow, CPAP=continuous positive airway pressure, NIV=non-invasive ventilation).

  • FIGURE 6
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    FIGURE 6

    Outcome / respiratory support at discharge according to the maximal respiratory support received (NHF=nasal high-flow, CPAP=continuous positive airway pressure, NIV=non-invasive ventilation).

Tables

  • Figures
  • TABLE 1

    Basic demographic data and pre-existing comorbidities (sd=standard deviation)

    Number of patients78
    Male (%)56.4
    Caucasian (%)100
    Age (years±sd)65±14
    BMI (kg·m−2±sd)29.4±4.9
    Active smoker16.7%
    Former Smoker46.2%
    Non smoker37.2%
    Hypertension70.5%
    Diabetes19.2%
    Coronary artery disease21.8%
    Asthma17.9%
    COPD10.3%
    Malignancy21.8%
  • TABLE 2

    Demographic, physiological and laboratory data according to treatment groups

    only oxygen
    (1) N=53
    NHF/CPAP/NIV
    (2) N=17
    invasive MV
    (3) N=8
    Age65±1562±1373±9
    BMI29.4±5.229.6±5.129.1±2.5
    LOS (days)10.1±6.7(2,3)19.3±11.8(1,3)34±26.9(1,2)
    temperature °C38.3±1(2)39.1±0.9 (1)39.1±0.5
    SaO2 (%)93.1±3.7(3)91.6±6(3)85.4±10.6 (1,2)
    respiratory rate /min20.6±4.4(2)25.7±6.7 (1)23.5±7.6
    heart rate /min90±2099±1695±21
    RR systolic (mmHg)118±21110±22103±23
    RR diastolic (mmHg)69±1168±1063±13
    Hemoglobin nadir (mg·dL−1)12.4±1.912.1±211±2.4
    Leucocytes nadir /µL5745±27325724±26025512±1629
    Lymphocytes nadir/µL986±2015553±262469±342
    LDH max (U·L−1)405±129(2,3)562±260(1,3)741±190(1,2)
    BNP max (pg·mL−1)1773±3086669±895(3)5258±7659(2)
    CRP max (mg·dL−1)10.9±7.1(2,3)21.6±9.2(1)26.4±12.3(1)
    PCT max (ng·mL−1)0.9±2(3)0.8±1.2(3)3±2.9(1,2)
    Creatinine max (mg·dL−1)1.25±0.62(3)1±0.3(3)2.6±1.4(1,2)
    D-Dimer max (ng·mL−1)1530±1575(3)2698±24646574±5321(1)
    Troponin max (µg·L−1)28.5±39(3)25.9±33.1(3)467±1047(1,2)
    PO2 nadir (mmHg)54.5±1147.8±10.545.9±6.8

    LOS: length of (hospital) stay; SaO2: oxygen saturation; RR: blood pressure; LDH: lactate dehydrogenase; BNP: brain natriuretic peptide; CRP: C-reactive protein; PCT: procalcitonin; PO2: partial pressure of oxygen; nadir: lowest measured value; max: maximal measured value. Number in brackets indicate significant differences to the respective column (p<0.05).

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    Conservative management of Covid 19 associated hypoxemia
    Thomas Voshaar, Patrick Stais, Dieter Köhler, Dominic Dellweg
    ERJ Open Research Jan 2021, 00026-2021; DOI: 10.1183/23120541.00026-2021

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    Conservative management of Covid 19 associated hypoxemia
    Thomas Voshaar, Patrick Stais, Dieter Köhler, Dominic Dellweg
    ERJ Open Research Jan 2021, 00026-2021; DOI: 10.1183/23120541.00026-2021
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