Caution against precaution: A case report on silent hypoxia in COVID-19

Lari, Ali; Alherz, Mohammad; Nouri, Abdullah; Botras, Lotfi; Taqi, Salah

doi:10.1016/j.amsu.2020.11.007

Cited by 11 publications

(12 citation statements)

References 11 publications

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“…There was a global increase in the reported infection rate and mortality [ 3 , 12 , 13 ]. However, literature reported many patients with COVID-19 presenting with silent hypoxia [ [14] , [15] , [16] ]. It is important to know the risk factors and the causes contributing to the presentation of silent hypoxia in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Predictors and clinical outcomes of silent hypoxia in COVID-19 patients, a single-center retrospective cohort study

Alhusain¹,

Alromaih²,

Alhajress³

et al. 2021

Journal of Infection and Public Health

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Background Patients with COVID-19 usually present with fever and respiratory symptoms such as cough, sputum production, and dyspnea. However, they may suffer from severe hypoxemia without a clinical correlation with the respiratory symptoms, also known as silent or apathetic hypoxia. The aim of the study was to assess the predictors and clinical outcomes of COVID-19 patients without dyspnea. Methods A single-center retrospective cohort study, based on data extracted from the electronic hospital information system, with COVID-19 patients over a 10-month period in Riyadh, Saudi Arabia. Results Of the COVID-19 patients presenting at the Emergency Department with a SpO2 < 90%, 13% had silent hypoxia. The majority of the patients required BiPAP, 34% were intubated and 60% were admitted to an intensive care unit. There was no association between dyspnea and gender, age group, body mass index, or comorbidity. Cough, fever, and chronic cardiac diseases were predictive for dyspnea in a regression analysis. There was no difference in the clinical outcome between patients with silent dyspnea or dyspnea. Age and obesity were significantly associated with a decrease in survival, and an increase in the initial SpO2 increased survival. Conclusion Patients with cardiac disease are more likely to present with silent hypoxia. The SpO2 saturation in COVID-19 may be an independent predictor of survival. Silent hypoxia in COVID-19 patients does not appear to have an association with increase in mortality.

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Section: Discussionmentioning

confidence: 99%

Predictors and clinical outcomes of silent hypoxia in COVID-19 patients, a single-center retrospective cohort study

Alhusain¹,

Alromaih²,

Alhajress³

et al. 2021

Journal of Infection and Public Health

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“…He did not require ventilator support [ 8 ]. Lari et al reported another case of a 66-year-old patient who had silent hypoxemia who eventually needed high flow oxygen therapy and NIV [ 9 ]. Similar to our first patient, this patient had also shown multiple episodes of silent hypoxemia at the time of weaning from oxygen therapy.…”

Section: Discussionmentioning

confidence: 99%

Different Outcomes of “Silent Hypoxia” in Patients with COVID-19 Pneumonia: A Case Series and Literature Review

Ratnayake¹,

Kumarihamy²,

Gunaratne³

et al. 2021

Case Reports in Critical Care

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COVID-19 has been declared a pandemic since March 2020 and it has been responsible for millions of deaths worldwide. The SARS-CoV-2 causes a spectrum of diseases mainly affecting the respiratory system. It can also complicate other systems causing thromboembolic phenomena and myocardial ischaemia. An entity of hypoxia has been described in these patients which show no clinical signs and symptoms of respiratory distress despite being extremely hypoxic. This is called silent or happy hypoxia. The exact mechanism for this is not known. We report 4 cases which had similar presentations of silent hypoxia but had different course of illness and different outcomes. All 4 patients did not show any signs of respiratory distress, but had oxygen saturation less than 82%. 3 of them needed intensive care unit support for oxygen therapy and subsequently needed noninvasive ventilation. Only one required invasive ventilation. The fourth patient did not require intensive care support. The patient who required invasive ventilation succumbed due to severe COVID pneumonia whereas the other 3 patients were discharged from the hospital. Silent hypoxemia can go undetected in COVID-19 patients particularly in the time of a pandemic. This case series highlights the importance of meticulous clinical examination including oxygen saturation measurements in suspected or confirmed patients with COVID-19. The course of illness can be different in different populations, and this needs further clinical evidence.

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“…Though there are few case reports describing the perplexing entity -'silent hypoxia', there are a handful of cohort studies which have described the demographic, clinical and laboratory findings in such patients. 10,19,20 . Brouqui P et al 4 in their retrospective study, analyzed data from March 3rd to April 27 th , 2020 using dyspnea status, oxygen saturation, blood gas analysis, and low dose computed tomography scan reports.…”

Section: Discussionmentioning

confidence: 99%

Silent Hypoxia in Coronavirus disease-2019: Is it more dangerous?-A retrospective cohort study

Sirohiya

Elavarasi

Sagiraju

et al. 2021

Preprint

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Background Hypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Silent hypoxia is characterized by the presence of hypoxia without dyspnea. Silent hypoxia has been shown to affect the outcomes in previous studies. Research Question Are the outcomes in patients presenting with silent hypoxia different from those presenting with dyspneic hypoxia? Study design and Methods This was a retrospective study of a cohort of patients with SARS-CoV-2 infection who were hypoxic at presentation. Clinical, laboratory and treatment parameters in patients with silent hypoxia and dyspneic hypoxia were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality. Results Among 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO2<94% at the time of presentation. 174 (21.45%) did not have dyspnea since the onset of COVID-19 symptoms. 5.2% of patients were completely asymptomatic for COVID-19 and were found to be hypoxic only on pulse oximetry. The case fatality rate in patients with silent hypoxia was 45.4% as compared to 40.03% in dyspneic hypoxic patients (P=0.202). The odds ratio of death was 1.1 (95% CI 0.41-2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment, and in-hospital complications, which did not reach statistical significance (P=0.851). Interpretation Silent hypoxia may be the only presenting feature of COVID-19. Since the case fatality rate is comparable between silent and dyspneic hypoxia, it should be recognized early and treated as aggressively. Since home isolation is recommended in patients with COVID-19, it is essential to use pulse oximetry at the home setting to identify these patients.

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Caution against precaution: A case report on silent hypoxia in COVID-19

Cited by 11 publications

References 11 publications

Predictors and clinical outcomes of silent hypoxia in COVID-19 patients, a single-center retrospective cohort study

Predictors and clinical outcomes of silent hypoxia in COVID-19 patients, a single-center retrospective cohort study

Different Outcomes of “Silent Hypoxia” in Patients with COVID-19 Pneumonia: A Case Series and Literature Review

Silent Hypoxia in Coronavirus disease-2019: Is it more dangerous?-A retrospective cohort study

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