Voshaar Thomas, Stais Patrick, Köhler Dieter, Dellweg Dominic
Bethanien Hospital Moers, Moers, Germany.
Kloster Grafschaft, Schmallenberg, Germany.
ERJ Open Res. 2021 Mar 15;7(1). doi: 10.1183/23120541.00026-2021. eCollection 2021 Jan.
Invasive mechanical ventilation of hypoxaemic coronavirus disease 2019 (COVID-19) patients is associated with mortality rates of >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 hypoxaemia.
Data analysis was carried out of patients with positive PCR-testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), typical history, and symptoms and pulmonary infiltrates who exhibited oxygen saturation values of <93%.
We identified 78 patients who met the inclusion criteria. The oxygen saturation nadir was 84.4±6.5% for the whole group. 53 patients (68%) received nasal oxygen (group 1), 17 patients (22%) were treated with nasal high-flow continuous positive airway pressure (CPAP), noninvasive ventilation or a combination thereof (group 2), and eight 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 O·dL for the three respective groups. Overall mortality was 7.7%; the mortality of intubated patients was 50%. Overall, 93% of patients could be discharged on room air.
Permissive hypoxaemia 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.
2019年冠状病毒病（COVID-19）低氧血症患者进行有创机械通气的死亡率超过50%。我们评估了两家医院的临床结局数据，这两家医院就限制使用有创通气的预定义方案达成一致，其中插管决策基于临床表现和氧含量而非低氧血症程度。
对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）核酸检测呈阳性、有典型病史、症状及肺部浸润且氧饱和度值<93%的患者进行数据分析。
我们确定了78例符合纳入标准的患者。全组氧饱和度最低点为84.4±6.5%。53例患者（68%）接受鼻导管吸氧（第1组），17例患者（22%）接受经鼻高流量持续气道正压通气（CPAP）、无创通气或两者联合治疗（第2组），8例患者（10%）接受插管（第3组）。第1组的霍洛维茨指数为216±8，第2组为157±13，第3组为106±15。三组各自的氧含量分别为14.5±2.5、13.4±1.9和1,1.6±2.6 mL O·dL。总体死亡率为7.7%；插管患者的死亡率为50%。总体而言，93%的患者出院时可在室内空气中呼吸。
基于临床表现和氧含量来决定呼吸治疗水平的允许性低氧血症导致插管率低、总体死亡率低以及出院后需要吸氧的患者数量少。
