Department of Medicine, Division of Hospital Medicine, Northwestern Memorial Hospital, Feinberg School of Medicine, 211 E. Ontario, Suite 700, Chicago, IL, 60611, USA.
Department of Pediatrics, Division of Hospital Based Medicine, Ann & Robert H Lurie Children's Hospital, Feinberg School of Medicine, Chicago, IL, USA.
Intern Emerg Med. 2021 Nov;16(8):2097-2103. doi: 10.1007/s11739-021-02708-w. Epub 2021 Mar 26.
The importance of exertional hypoxia without resting hypoxia in COVID-19 is unknown and may help objectively identify high-risk patients. Interventions may be initiated earlier with sufficient lead-time between development of exertional hypoxia and other outcome measures. We performed a retrospective study of adult patients hospitalized with COVID-19 from March 1, 2020 to October 30, 2020 in an integrated academic medical system in the Chicagoland area. We analyzed patients who had daily exertional oximetry measurements taken. We defined exertional hypoxia as SpO2 < 90% with ambulation. We excluded patients who had first exertional oximetry measurements or first exertional hypoxia after the use of oxygen therapies. We determined the association of exertional hypoxia without resting hypoxia with the eventual need for nasal cannula or advanced oxygen therapies (defined as high flow nasal cannula, Bi-PAP, ventilator, or extracorporeal membrane oxygenation). We also calculated the time between development of exertional hypoxia and the need for oxygen therapies. Of 531 patients included, 132 (24.9%) had exertional hypoxia. Presence of exertional hypoxia was strongly associated with eventual use of nasal cannula (OR 4.8, 95% CI 2.8-8.4) and advanced oxygen therapy (IRR 7.7, 95% CI 3.4-17.5). Exertional hypoxia preceded nasal cannula use by a median 12.5 h [IQR 3.25, 29.25] and advanced oxygenation by 54 h [IQR 25, 82]. Exertional hypoxia without resting hypoxia may serve as an early, non-invasive physiologic marker for the likelihood of developing moderate to severe COVID-19. It may help clinicians triage patients and initiate earlier interventions.
运动性低氧而无休息性低氧在 COVID-19 中的重要性尚不清楚，它可能有助于客观地识别高危患者。通过在运动性低氧和其他结果指标之间有足够的提前期，可能更早地开始干预。我们对 2020 年 3 月 1 日至 2020 年 10 月 30 日期间在芝加哥地区综合学术医疗系统住院的 COVID-19 成年患者进行了回顾性研究。我们分析了每天接受运动性血氧仪测量的患者。我们将运动性低氧定义为活动时 SpO2<90%。我们排除了首次进行运动性血氧测量或首次在使用氧疗后出现运动性低氧的患者。我们确定了运动性低氧而无休息性低氧与最终需要鼻导管或高级氧疗（定义为高流量鼻导管、双相气道正压通气、呼吸机或体外膜肺氧合）之间的关联。我们还计算了从出现运动性低氧到需要氧疗之间的时间。在纳入的 531 例患者中，有 132 例（24.9%）出现运动性低氧。存在运动性低氧与最终使用鼻导管（比值比 4.8，95%置信区间 2.8-8.4）和高级氧疗（风险比 7.7，95%置信区间 3.4-17.5）强烈相关。运动性低氧中位数先于鼻导管使用 12.5 小时（IQR 3.25-29.25），先于高级氧疗使用 54 小时（IQR 25-82）。运动性低氧而无休息性低氧可能成为一种早期的、非侵入性的生理标志物，提示发生中重度 COVID-19 的可能性。它可能有助于临床医生对患者进行分诊并更早地开始干预。
