Room to Breathe: The Impact of Oxygen Rationing on Health Outcomes in SARS-CoV2

Abstract

As the primary surge of coronavirus disease 2019 (COVID-19) wanes in many countries, it is important to reconsider best practice. More cases, probably the majority of cases, are yet to come. Hopefully, during this next phase, we will have more time, more resources, and more experience from which to affect better outcomes. Here, we examine the compromised oxygen strategy that many nations followed. We explore the evidence related to such strategies and discuss the potential mortality impact of delaying oxygen treatment in COVID-19 pneumonia.

Oxygen and Mortality in COVID-19 Pneumonia: A Comparative Analysis of Supplemental Oxygen Policies and Health Outcomes Across 26 Countries

“…It is also quite plausible, indeed quite likely, given that hypoxia is pro-inflammatory, the delay in correcting hypoxia leads to more severe disease. This of course raises the possibility that rationing, or a conservative oxygen approach, or a failure to provide access to supplemental oxygen in COVID-19 pneumonia, actually increases healthcare burden and resource consumption ( 19 ).…”

“…This will almost certainly add greater pressure on ICU facilities and increase morbidity and mortality. Conservative oxygen strategies are questionable at the best of times ( 19 ); with COVID-19, such strategies likely carry even greater harm. Optimal oxygen strategies have the additional benefit of identifying and observing these at-risk “silent hypoxia” patients.…”

Oxygen: Friend or foe in the COVID-19 battle

“…It may be used to wean patients off ventilatory support but its use on patients whose lungs have adapted to hypoxemia or who do not require invasive therapy may in turn lead to adverse consequences. (2) Overcorrecting hypoxemia may improve it in the short term, but its long term effects can lead to oxygen induced ARDS and ventilator associated lung injury. This data suggests that the lungs have a better chance of recovery from COVID-19 when exposed to less oxygenation and invasive ventilation.…”

“…(1) With the ongoing COVID-19 pandemic, oxygen utilization has been on the rise worldwide, with some countries often experiencing scarcity in such crucial times. (2) The goal of oxygen therapy in COVID-19, as with any other form of respiratory illness, is to treat hypoxia. The WHO has classified severe COVID-19 to have saturations less than 90% and thus warranting supplemental oxygen therapy.…”

Oxygen: Friend or foe in the COVID‐19 battle

“…With the ongoing COVID‐19 pandemic, oxygen utilization has been on the rise worldwide, with some countries often experiencing scarcity in such crucial times 2 …”