Covid-19 med stille hypoksemi

Ottestad, William; Seim, Mari; Mæhlen, Jens Otto

doi:10.4045/tidsskr.20.0299

Cited by 103 publications

(106 citation statements)

References 5 publications

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“…10 Ottestad et al first reported this entity in an elderly man with COVID-19 who developed rapidly progressive respiratory failure with severe hypoxia, although having no significant respiratory distress at presentation. 3 Later, Wilkerson et al described a 72-year-old man with COVID-19 who presented with minimal respiratory symptoms and very low oxygen saturation; the patient eventually died due to progressive respiratory decompensation and multiorgan dysfunction. 16 The unusual clinical picture of hypoxia out of proportion to the respiratory distress in our patient and the aforementioned review of literature emphasise the importance of identifying the subtle clinical signs which are often missed.…”

Section: Discussionmentioning

confidence: 99%

Silent hypoxia: a frequently overlooked clinical entity in patients with COVID-19

et al. 2020

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COVID-19 caused by SARS-CoV-2 may present with a wide spectrum of symptoms ranging from mild upper respiratory tract infection like illness to severe pneumonia and death. Patients may have severe hypoxaemia without proportional features of respiratory distress, also known as ‘silent’ or ‘apathetic’ hypoxia. We present a case of a 56-year-old man with COVID-19 who presented to the fever clinic of our institution with fever and cough without any respiratory distress but low oxygen saturation. The patient deteriorated over the next 2 days but eventually recovered of his illness in due course of time. This case demonstrates ‘silent hypoxia’ as a possible presentation in COVID-19 and emphasises the importance of meticulous clinical examination including oxygen saturation measurements in suspected or confirmed patients.

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Section: Discussionmentioning

confidence: 99%

Silent hypoxia: a frequently overlooked clinical entity in patients with COVID-19

et al. 2020

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“…Another key area that can be monitored using data from EMS systems during the COVID-19 pandemic is the detection of "silent hypoxia". Reports from China, and later Italy, the US, and Norway, have described many COVID-19 patients who initially present with hypoxemia without signs of respiratory distress ("silent hypoxemia") and later go on to develop respiratory failure [18][19][20][21] . It is possible that this kind of hypoxemia, and subsequent rapid decompensation 22 , could result in mortality before patients are able to access EMS or hospital services, especially in areas were health systems are saturated or patients are not able to quickly access healthcare services when decompensation occurs.…”

Section: Introductionmentioning

confidence: 99%

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Friedman

Calderón-Villarreal

Bojorquez

et al. 2020

Preprint

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Objective: Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of COVID-19 affected populations, especially in low-and-middle-income countries (LMICs) with less rapid and reliable vital statistic registration systems. Although official COVID-19 statistics in Mexico report almost exclusively in-hospital mortality events, excess out-of-hospital mortality has been identified in other settings, including one EMS study in Italy that showed a 58% increase. EMS and hospital reports from several countries have suggested that silent hypoxemia-low oxygen saturation (SpO2) in the absence of dyspnea-is associated with COVID-19 outbreaks. It is unclear, however, how these phenomena can be generalized to LMICs. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many LMIC settings. Methods:We calculated numbers of weekly out-of-hospital deaths and respiratory cases seen by EMS in Tijuana, and estimate the difference between peak-epidemic rates (during April 14 th -May 11 th ) and forecasted 2014-2019 trends. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status (SES), and examined for changing demographic or clinical features, including mean (SpO2).Results: An estimated 194.7 (95%CI: 135.5-253.9) excess out-of-hospital deaths events occurred, representing an increase of 145% (70%-338%) compared to forecasted trends. During the same window, only 8 COVID-19-positive, out-of-hospital deaths were reported in official statistics. This corresponded with a rise in respiratory cases of 274% (119%-1142%), and a drop in mean SpO2 to 77.7%, from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-SES areas, although respiratory cases were more concentrated in high-SES areas.Conclusions: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in LMICs. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly threefold greater magnitude than increases reported using EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine if excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of healthcare. We also found evidence of worsening rates of hypoxemia among respiratory patients seen by EMS, suggesting a rise in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed that social disparities in out-of-hospital death that warrant monitoring and amelioration.

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“…Over 80% of COVID-19 patients in the intensive care unit have severe hypoxemia 7 . A kind of "silent hypoxia" in which COVID-19 patients deteriorate rapidly without warning and develop respiratory failure has been described 8 . Hypoxia indicates an imbalance of oxygen delivery to tissues and leads to compromised function, which is quantitatively related to organ, tissue and even cell type 9 .…”

Section: Introductionmentioning

confidence: 99%

Increased expression of hypoxia-induced factor 1α mRNA and its related genes in myeloid blood cells from critically ill COVID-19 patients

Taniguchi‐Ponciano

Vadillo

Mayani

et al. 2020

Preprint

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Since its emergence, in December 2019, COVID-19 has resulted in more than 12 million people infected and has killed more than 570000. Hypoxemia has been identified as one of the main clinical manifestations of this disease, especially in severe cases. We have previously reported that in critically ill COVID-19 patients there is a shift towards an immature myeloid profile in peripheral blood cells, including band neutrophils, immature monocytes, metamyelocytes, monocyte-macrophages, monocytoid precursors, and promyelocytes-myelocytes, which, together with mature monocytes and segmented neutrophils, comprise the vast majority of blood cells in these patients. Such an immature myeloid profile may be the result of a physiological response known as emergency myelopoiesis. In the present study, we performed scRNAseq from leukocytes from five critically ill COVID-19 patients and characterized the expression of hypoxia-inducible factor1α (HIF1α) mRNA and its transcriptionally regulated genes. HIF1α is a master transcription factor involved in the cellular response to hypoxia. We herein report that these cellular subsets express high levels of HIF1α mRNA and several of their transcriptional targets, including those related to inflammation, such as CXCL8, CXCR1, CXCR2, and CXCR4; those potentially involved in virus sensing, such as TLR2 and TLR4; and those related to metabolism, such as SLC2A3, PFKFB3, PGK1, GAPDH and SOD2. The up-regulation and participation of HIF1α in relevant events such as inflammation, immunometabolism, and TLR make it a potential molecular marker for COVID-19 severity and, interestingly, could represent a potential target for molecular therapy.

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Covid-19 med stille hypoksemi

Cited by 103 publications

References 5 publications

Silent hypoxia: a frequently overlooked clinical entity in patients with COVID-19

Silent hypoxia: a frequently overlooked clinical entity in patients with COVID-19

Excess Out-Of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of EMS Data in the COVID-19 Crisis in Tijuana, Mexico

Increased expression of hypoxia-induced factor 1α mRNA and its related genes in myeloid blood cells from critically ill COVID-19 patients

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