Happy hypoxia in critical COVID‐19 patient: A case report in Tangerang, Indonesia

Widysanto, Allen; Wahyuni, Titis Dewi; Simanjuntak, Leonardo; Sunarso, S.; Siahaan, Sylvia Sagita; Haryanto, Hori; Pandrya, C. O.; Aritonang, Ronald Christian Agustinus; Sudirman, Taufik; Christina, Natalia M.; Adhiwidjaja, Budhi; Gunawan, C.; Angela, Angela

doi:10.14814/phy2.14619

Cited by 18 publications

(26 citation statements)

References 14 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Instead, our study suggests that blunted ventilatory control in the face of hypoxemia (i.e. “silent hypoxemia”) is additionally deleterious in COVID-19 [ 19 , 20 , 22 , 34 , 35 ]. Nonetheless, our findings suggest that breath-holding duration may be a clinically important biomarker for identifying risk of subsequent respiratory failure regardless of the underlying mechanisms.…”

Section: Discussionmentioning

confidence: 85%

“…In principle, breath-holding is expected to yield rapid desaturation in those with early gas exchange deficits (V/Q heterogeneity and reduced functional lung gas volumes [ 16 – 18 ]) beyond baseline SpO 2 . Moreover, in the context of anecdotal reports of “silent hypoxemia” (disproportionate tolerance of hypoxemia) as a characteristic of COVID-19 [ 19 , 20 ], we and others [ 21 , 22 ] considered that blunted ventilatory control (reduced chemosensitivity) may be an adverse neurophysiological consequence of infection, and could feasibly predispose to respiratory failure. By contrast, others have suggested that a robust ventilatory responses may promote patient self-inflicted lung injury (P-SILI) [ 23 , 24 ], although this notion remains contentious [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Breath-holding as a novel approach to risk stratification in COVID-19

et al. 2021

View full text Add to dashboard Cite

Background Despite considerable progress, it remains unclear why some patients admitted for COVID-19 develop adverse outcomes while others recover spontaneously. Clues may lie with the predisposition to hypoxemia or unexpected absence of dyspnea (‘silent hypoxemia’) in some patients who later develop respiratory failure. Using a recently-validated breath-holding technique, we sought to test the hypothesis that gas exchange and ventilatory control deficits observed at admission are associated with subsequent adverse COVID-19 outcomes (composite primary outcome: non-invasive ventilatory support, intensive care admission, or death). Methods Patients with COVID-19 (N = 50) performed breath-holds to obtain measurements reflecting the predisposition to oxygen desaturation (mean desaturation after 20-s) and reduced chemosensitivity to hypoxic-hypercapnia (including maximal breath-hold duration). Associations with the primary composite outcome were modeled adjusting for baseline oxygen saturation, obesity, sex, age, and prior cardiovascular disease. Healthy controls (N = 23) provided a normative comparison. Results The adverse composite outcome (observed in N = 11/50) was associated with breath-holding measures at admission (likelihood ratio test, p = 0.020); specifically, greater mean desaturation (12-fold greater odds of adverse composite outcome with 4% compared with 2% desaturation, p = 0.002) and greater maximal breath-holding duration (2.7-fold greater odds per 10-s increase, p = 0.036). COVID-19 patients who did not develop the adverse composite outcome had similar mean desaturation to healthy controls. Conclusions Breath-holding offers a novel method to identify patients with high risk of respiratory failure in COVID-19. Greater breath-hold induced desaturation (gas exchange deficit) and greater breath-holding tolerance (ventilatory control deficit) may be independent harbingers of progression to severe disease.

show abstract

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Breath-holding as a novel approach to risk stratification in COVID-19

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Adenosine, a pluripotent RNA nucleoside, is exported from cells in response to hypoxia-inducible factor-1-α–sensed local tissue hypoxia ( Ohta and Sitkovsky, 2001 ; Sitkovsky et al, 2004 ; Bours et al, 2006 ; Aggarwal et al, 2013 ; Nowak-Machen et al, 2013 ; Hatfield et al, 2014 ; Sharma et al, 2016 ; Widysanto et al, 2020 ). Adenosine, a building block of energy metabolism, is vital to normal physiology, it is anti-inflammatory, and it modulates vascular tone as well as localized tissue blood flow ( Ohta and Sitkovsky, 2001 ; Sitkovsky et al, 2004 ; Bours et al, 2006 ; Aggarwal et al, 2013 ; Nowak-Machen et al, 2013 ; Hatfield et al, 2014 ; Sharma et al, 2016 ; Widysanto et al, 2020 ). It is vital to energy production and storage through phosphorylated di- and triphosphate molecules in the Krebs cycle.…”

Section: Discussionmentioning

confidence: 99%

“…Cells use this energy, but particularly erythrocytes carry a great deal of adenosine and release it at sites of low flow or upon cellular shear and in so doing, autoregulate localized blood flow. Various proteins and nucleoside transporters are important in the constant flux in and out of cells as well as the maintenance, metabolism, and equilibrium of extracellular and intracellular levels of adenosine ( Ohta and Sitkovsky, 2001 ; Sitkovsky et al, 2004 ; Bours et al, 2006 ; Aggarwal et al, 2013 ; Nowak-Machen et al, 2013 ; Hatfield et al, 2014 ; Raj et al, 2014 ; Sharma et al, 2016 ; Correale et al, 2020 ; Geiger et al, 2020 ; Widysanto et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Can Inhaled Adenosine Attenuate COVID-19?

Spiess

Sitkovsky

Correale³

et al. 2021

Front. Pharmacol.

View full text Add to dashboard Cite

This case report demonstrates a small repetition of the case series carried out in Italy wherein inhaled adenosine was administered to patients experiencing severe and worsening coronavirus disease-2019 (COVID-19). The two cases are important not only because they were the first of their type in the United States, but also because both patients were DNR/DNI and were therefore expected to die. Study repetition is vitally important in medicine. New work in pharmacology hypothesizes that adenosine-regulator proteins may play a role in the pathogenesis of COVID-19 infection. Furthermore, adenosine, by interacting with cell receptor sites, has pluripotent effects upon inflammatory cells, is anti-inflammatory, and is important in tissue hypoxia signaling. Inhaled adenosine is potentially safe; thousands have received it for asthmatic challenge testing. The effects of adenosine in these two cases were rapid, positive, and fit the pharmacologic hypotheses (as seen in prior work in this journal) and support its role as a therapeutic nucleoside.

show abstract

“…As such, in normal cases, hypoxia is a prevalent symptom in patients with lung diseases such as pneumonia whose lungs are filled with fluid or cannot expel carbon dioxide efficiently [2], [8], which cause various symptoms such as difficulty in breathing, accelerated heart rate or pulse, changes in skin color, and/or the loses of body balance. However, COVID-19 patients with silent hypoxia have no apparent symptoms of this respiratory distress and often seem clinically well [9], which confuses the doctor [10]. The current pandemic of COVID-19 has invited scholars across disciplines to contribute to a better clinical approach to the handling of this virus.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine for silent hypoxia: Improving the reliability and accuracy of Max30100-based system

Sari

Gani

Yusuf

et al. 2021

IJEECS

View full text Add to dashboard Cite

This study aims to design, assess, and improve the reliability of the telemedicine-based system for examination and monitoring of the symptoms of silent hypoxia–an extraordinary symptom of COVID-19. We design a telemedicine system for heart rate and oxygen saturation measurement which consists of a photoplethysmograph Max30100 sensor, NodeMCU microcontroller, real-time clock module, firebase realtime database, and Android-based mobile application. The designed system is tested through a comparative test with a commercially available oximeter. A total of 85 experiments from 40 participants in two different positions were conducted. Our analysis shows the accuracy rate of the Max30100 measurement is 97.11% and 98.84%, for heart rate and oxygen saturation (SpO2), respectively. Bland Altman was used to appraising and visualizing the agreement between the two measurement devices. We further apply calibration to improve the accuracy of the collected data through linear regression, which reveals 97.14% and 99% accuracy data for heart rate and SpO2, respectively. Finally, a series of end-to-end remote testing is successfully conducted representing the real-life scenario of the telemedicine system. Overall, the designed system attains a reliable option for a telemedicine-based system for examination of the symptoms of silent hypoxia.

show abstract

Happy hypoxia in critical COVID‐19 patient: A case report in Tangerang, Indonesia

Cited by 18 publications

References 14 publications

Breath-holding as a novel approach to risk stratification in COVID-19

Breath-holding as a novel approach to risk stratification in COVID-19

Case Report: Can Inhaled Adenosine Attenuate COVID-19?

Telemedicine for silent hypoxia: Improving the reliability and accuracy of Max30100-based system

Contact Info

Product

Resources

About