BackgroundInvasive 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.MethodData 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%.ResultsWe 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.ConclusionPermissive 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.

We would like to thank W. Windisch and colleagues for their recognition of our work. Their comments refer to the Early View version of our article, which was immediately uploaded upon acceptance but is not the final, copy-edited version. Unfortunately, there were some technical formatting changes between our submitted version and the version that was uploaded to the ERJ Open Research website. In table 2, for instance, temperature, saturation, respiratory rate, heart rate, and systolic and diastolic blood pressure refer to measurements taken on admission under room air conditions, which explains why the saturation values differ from the nadir oxygen saturation values shown in figure 3.

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Gemeinsam die digitale Zukunft gestalten Vertreter*innen der Deutschen Atemwegsliga e. V., des Verbandes Pneumologischer Kliniken e. V. (VPK), von Alpha1-Deutschland e. V. und der Arbeitsgruppe eHealth des Fördervereins der Deutschen Atemwegsliga e. V. diskutieren im November 2020 im Rahmen eines Online-Workshops den gesundheitspolitischen Rahmen und Anwendungsmöglichkeiten von Telemedizin und Digitalen Gesundheitsanwendungen (DiGA) im Fachgebiet Pneumologie. Im Oktober 2020 hatte die Deutsche Atemwegsliga e. V. bereits eine Pressekonferenz unter das Thema Digitale Medizin in der Pneumologie gestellt.

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