Oxygen provision to severely ill COVID-19 patients at the peak of the 2020 pandemic in a Swedish district hospital: medical records-based cohort study

Hvarfner, A.; Al-Djaber, A.; Ekstrom, H.; Enarsson, M.; Castegren, M.; Baker, T.; Schell, C. O.

Oxygen therapy is a low-cost and life-saving therapy for patients with COVID-19. Yet, it is a limited resource in many hospitals in low income countries and in the 2020 pandemic even hospitals in richer countries reported oxygen shortages. An accurate understanding of oxygen requirements is needed for capacity planning. The World Health Organization (WHO) estimates the average flow-rate of oxygen to severe COVID-19-patients to be 10 l/min. However, there is a lack of empirical hospital-based data about the oxygen provision to patients. This study aimed to estimate the oxygen provision to COVID-19 patients with severe disease in a Swedish district hospital. A retrospective, medical records-based cohort study was conducted in March to May 2020 in a Swedish district hospital. All adult patients with severe COVID-19, those who received oxygen in the ward and had no ICU-admission during their hospital stay, were included. Data were collected on the oxygen flow-rates provided to the patients throughout their stay in hospital, and summary measures of oxygen provision calculated. One-hundred and twenty six patients were included. Their median age was 70 years and 43% were female. On admission, 27% had a peripheral oxygen saturation of <=91% and 54% had a respiratory rate of >=25/min. The mean oxygen flow-rate to patients while receiving oxygen therapy was 3.0 l/min (SD 2.9) and the mean total volume of oxygen provided per patient admission was 16,000 l (SD 23,000). In conclusion, the provision of oxygen to severely ill COVID-19-patients was lower than previously estimated. Further research is required before global estimates are adjusted.