Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection
We aimed to assess whether asymptomatic (“happy”) hypoxia was an identifiable physiological phenotype of COVID-19 acute respiratory distress syndrome (ARDS), and associated with need for ICU admission. We performed an observational cohort study of all adult patients admitted with hypoxaemic respirat...
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| Veröffentlicht in: | Respiratory medicine 2022-06, Vol.197, p.106858-106858, Article 106858 |
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| container_title | Respiratory medicine |
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| creator | Plummer, Nicholas Russell Fogarty, Andrew Shaw, Dominick Card, Timothy West, Joe Crooks, Colin |
| description | We aimed to assess whether asymptomatic (“happy”) hypoxia was an identifiable physiological phenotype of COVID-19 acute respiratory distress syndrome (ARDS), and associated with need for ICU admission.
We performed an observational cohort study of all adult patients admitted with hypoxaemic respiratory failure to a large acute hospital Trust serving the East Midlands, UK. Patients with confirmed COVID-19 were compared to those without. Physiological response to hypoxaemia was modelled using a linear mixed effects model.
Of 1,586 patients included, 75% tested positive for SARS-CoV-2. The ROX index was 2.08 min−1 lower (1.56–2.61, p |
| doi_str_mv | 10.1016/j.rmed.2022.106858 |
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We performed an observational cohort study of all adult patients admitted with hypoxaemic respiratory failure to a large acute hospital Trust serving the East Midlands, UK. Patients with confirmed COVID-19 were compared to those without. Physiological response to hypoxaemia was modelled using a linear mixed effects model.
Of 1,586 patients included, 75% tested positive for SARS-CoV-2. The ROX index was 2.08 min−1 lower (1.56–2.61, p < 0.001) in the COVID-19 cohort when adjusted for age and ethnicity, suggesting an enhanced respiratory response to hypoxia compared to the non-Covid-19 patients. There was substantial residual inter- and intra-patient variability in the respiratory response to hypoxaemia. 33% of the infected cohort required ICU, and of these 31% died within 60 days. ICU admission and mortality were both associated with an enhanced respiratory response for all degrees of hypoxaemia.
Patients with COVID-19 display a more symptomatic phenotype in response to hypoxaemia than those with other causes of hypoxaemic respiratory failure, however individual patients exhibit a wide range of responses. As such although asymptomatic hypoxaemia may be a phenomenon in any individual patient with hypoxaemic respiratory failure, it is no more frequently observed in those with SARS-CoV-2 infection than without.
•Patients with and without COVID-19 display a wide variation in their physiological response to hypoxaemia.•COVID-19 patients are no more physiologically “happy” in response to hypoxaemia, and actually have higher respiratory rates for any given SpO2/FiO2 Ratio.•Decreasing physiological “happiness” in response to hypoxaemia is associated with worse outcomes in COVID-19.•TThe ROX index may be a simple tool to discriminate patients at risk of adverse outcomes in COVID-19 from bedside observations.</description><identifier>ISSN: 0954-6111</identifier><identifier>EISSN: 1532-3064</identifier><identifier>DOI: 10.1016/j.rmed.2022.106858</identifier><identifier>PMID: 35490510</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>ARDS ; Clinical deterioration ; COVID-19 ; COVID-19 - complications ; Humans ; Hypoxaemia ; Hypoxia - etiology ; Original Research ; Respiratory Distress Syndrome - etiology ; Respiratory Insufficiency - complications ; SARS-CoV-2</subject><ispartof>Respiratory medicine, 2022-06, Vol.197, p.106858-106858, Article 106858</ispartof><rights>2022 Elsevier Ltd</rights><rights>Copyright © 2022 Elsevier Ltd. All rights reserved.</rights><rights>2022 Elsevier Ltd. All rights reserved. 2022 Elsevier Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-5b8ebd9bc61e801ee96e232d8a2860c20e78a4b16308e261ad6d0e18d9ba7d343</citedby><cites>FETCH-LOGICAL-c455t-5b8ebd9bc61e801ee96e232d8a2860c20e78a4b16308e261ad6d0e18d9ba7d343</cites><orcidid>0000-0003-4106-8469 ; 0000-0002-1135-9356 ; 0000-0002-1239-9253 ; 0000-0002-6794-6621</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.rmed.2022.106858$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35490510$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Plummer, Nicholas Russell</creatorcontrib><creatorcontrib>Fogarty, Andrew</creatorcontrib><creatorcontrib>Shaw, Dominick</creatorcontrib><creatorcontrib>Card, Timothy</creatorcontrib><creatorcontrib>West, Joe</creatorcontrib><creatorcontrib>Crooks, Colin</creatorcontrib><title>Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection</title><title>Respiratory medicine</title><addtitle>Respir Med</addtitle><description>We aimed to assess whether asymptomatic (“happy”) hypoxia was an identifiable physiological phenotype of COVID-19 acute respiratory distress syndrome (ARDS), and associated with need for ICU admission.
We performed an observational cohort study of all adult patients admitted with hypoxaemic respiratory failure to a large acute hospital Trust serving the East Midlands, UK. Patients with confirmed COVID-19 were compared to those without. Physiological response to hypoxaemia was modelled using a linear mixed effects model.
Of 1,586 patients included, 75% tested positive for SARS-CoV-2. The ROX index was 2.08 min−1 lower (1.56–2.61, p < 0.001) in the COVID-19 cohort when adjusted for age and ethnicity, suggesting an enhanced respiratory response to hypoxia compared to the non-Covid-19 patients. There was substantial residual inter- and intra-patient variability in the respiratory response to hypoxaemia. 33% of the infected cohort required ICU, and of these 31% died within 60 days. ICU admission and mortality were both associated with an enhanced respiratory response for all degrees of hypoxaemia.
Patients with COVID-19 display a more symptomatic phenotype in response to hypoxaemia than those with other causes of hypoxaemic respiratory failure, however individual patients exhibit a wide range of responses. As such although asymptomatic hypoxaemia may be a phenomenon in any individual patient with hypoxaemic respiratory failure, it is no more frequently observed in those with SARS-CoV-2 infection than without.
•Patients with and without COVID-19 display a wide variation in their physiological response to hypoxaemia.•COVID-19 patients are no more physiologically “happy” in response to hypoxaemia, and actually have higher respiratory rates for any given SpO2/FiO2 Ratio.•Decreasing physiological “happiness” in response to hypoxaemia is associated with worse outcomes in COVID-19.•TThe ROX index may be a simple tool to discriminate patients at risk of adverse outcomes in COVID-19 from bedside observations.</description><subject>ARDS</subject><subject>Clinical deterioration</subject><subject>COVID-19</subject><subject>COVID-19 - complications</subject><subject>Humans</subject><subject>Hypoxaemia</subject><subject>Hypoxia - etiology</subject><subject>Original Research</subject><subject>Respiratory Distress Syndrome - etiology</subject><subject>Respiratory Insufficiency - complications</subject><subject>SARS-CoV-2</subject><issn>0954-6111</issn><issn>1532-3064</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtvUzEQhS1ERUPhD7BAXrK5we_4SggJpTwqVeqiBbGzfO0JmejmOthOof8eRykVbLqyNPOd49E5hLzibM4ZN28387yFOBdMiDYwVtsnZMa1FJ1kRj0lM9Zr1RnO-Sl5XsqGMdYrxZ6RU6lVzzRnM_L9GkeYKl3f7dJv9BQLnVKlfqIY2xxX6IcRaFj77EOFjKVioDjRna_YgEJ_YV3T5dW3i_OO922zglAxTS_IycqPBV7ev2fk66ePN8sv3eXV54vlh8suKK1rpwcLQ-yHYDhYxgF6A0KKaL2whgXBYGG9GriRzIIw3EcTGXDbJH4RpZJn5P3Rd7cfWhqh3ZT96HYZtz7fueTR_b-ZcO1-pFvXM7XQatEM3twb5PRzD6W6LZYA4-gnSPvihNHWKG6lbKg4oiGnUjKsHr7hzB0qcRt3qMQdKnHHSpro9b8HPkj-dtCAd0cAWky3CNmV0KINEDG3LF1M-Jj_Hy8Cnik</recordid><startdate>20220601</startdate><enddate>20220601</enddate><creator>Plummer, Nicholas Russell</creator><creator>Fogarty, Andrew</creator><creator>Shaw, Dominick</creator><creator>Card, Timothy</creator><creator>West, Joe</creator><creator>Crooks, Colin</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4106-8469</orcidid><orcidid>https://orcid.org/0000-0002-1135-9356</orcidid><orcidid>https://orcid.org/0000-0002-1239-9253</orcidid><orcidid>https://orcid.org/0000-0002-6794-6621</orcidid></search><sort><creationdate>20220601</creationdate><title>Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection</title><author>Plummer, Nicholas Russell ; Fogarty, Andrew ; Shaw, Dominick ; Card, Timothy ; West, Joe ; Crooks, Colin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-5b8ebd9bc61e801ee96e232d8a2860c20e78a4b16308e261ad6d0e18d9ba7d343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>ARDS</topic><topic>Clinical deterioration</topic><topic>COVID-19</topic><topic>COVID-19 - complications</topic><topic>Humans</topic><topic>Hypoxaemia</topic><topic>Hypoxia - etiology</topic><topic>Original Research</topic><topic>Respiratory Distress Syndrome - etiology</topic><topic>Respiratory Insufficiency - complications</topic><topic>SARS-CoV-2</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Plummer, Nicholas Russell</creatorcontrib><creatorcontrib>Fogarty, Andrew</creatorcontrib><creatorcontrib>Shaw, Dominick</creatorcontrib><creatorcontrib>Card, Timothy</creatorcontrib><creatorcontrib>West, Joe</creatorcontrib><creatorcontrib>Crooks, Colin</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Respiratory medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Plummer, Nicholas Russell</au><au>Fogarty, Andrew</au><au>Shaw, Dominick</au><au>Card, Timothy</au><au>West, Joe</au><au>Crooks, Colin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection</atitle><jtitle>Respiratory medicine</jtitle><addtitle>Respir Med</addtitle><date>2022-06-01</date><risdate>2022</risdate><volume>197</volume><spage>106858</spage><epage>106858</epage><pages>106858-106858</pages><artnum>106858</artnum><issn>0954-6111</issn><eissn>1532-3064</eissn><abstract>We aimed to assess whether asymptomatic (“happy”) hypoxia was an identifiable physiological phenotype of COVID-19 acute respiratory distress syndrome (ARDS), and associated with need for ICU admission.
We performed an observational cohort study of all adult patients admitted with hypoxaemic respiratory failure to a large acute hospital Trust serving the East Midlands, UK. Patients with confirmed COVID-19 were compared to those without. Physiological response to hypoxaemia was modelled using a linear mixed effects model.
Of 1,586 patients included, 75% tested positive for SARS-CoV-2. The ROX index was 2.08 min−1 lower (1.56–2.61, p < 0.001) in the COVID-19 cohort when adjusted for age and ethnicity, suggesting an enhanced respiratory response to hypoxia compared to the non-Covid-19 patients. There was substantial residual inter- and intra-patient variability in the respiratory response to hypoxaemia. 33% of the infected cohort required ICU, and of these 31% died within 60 days. ICU admission and mortality were both associated with an enhanced respiratory response for all degrees of hypoxaemia.
Patients with COVID-19 display a more symptomatic phenotype in response to hypoxaemia than those with other causes of hypoxaemic respiratory failure, however individual patients exhibit a wide range of responses. As such although asymptomatic hypoxaemia may be a phenomenon in any individual patient with hypoxaemic respiratory failure, it is no more frequently observed in those with SARS-CoV-2 infection than without.
•Patients with and without COVID-19 display a wide variation in their physiological response to hypoxaemia.•COVID-19 patients are no more physiologically “happy” in response to hypoxaemia, and actually have higher respiratory rates for any given SpO2/FiO2 Ratio.•Decreasing physiological “happiness” in response to hypoxaemia is associated with worse outcomes in COVID-19.•TThe ROX index may be a simple tool to discriminate patients at risk of adverse outcomes in COVID-19 from bedside observations.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>35490510</pmid><doi>10.1016/j.rmed.2022.106858</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-4106-8469</orcidid><orcidid>https://orcid.org/0000-0002-1135-9356</orcidid><orcidid>https://orcid.org/0000-0002-1239-9253</orcidid><orcidid>https://orcid.org/0000-0002-6794-6621</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Access via ScienceDirect (Elsevier) |
| subjects | ARDS Clinical deterioration COVID-19 COVID-19 - complications Humans Hypoxaemia Hypoxia - etiology Original Research Respiratory Distress Syndrome - etiology Respiratory Insufficiency - complications SARS-CoV-2 |
| title | Silent hypoxia is not an identifiable characteristic in patients with COVID-19 infection |
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