Conservative management of Covid 19 associated hypoxemia

Voshaar, Thomas; Stais, Patrick; Köhler, Dieter; Dellweg, Dominic

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.