Senior Resident, Department of Pulmonary Medicine and Environmental Pollution Research Centre (EPRC), Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra.
Professor and Head, Department of Pulmonary Medicine and Environmental Pollution Research Centre (EPRC), Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra;Corresponding Author.
J Assoc Physicians India. 2021 Jun;69(6):11-12.
Platypnoea-Orthodeoxia syndrome (POS) is the presence of postural hypoxaemia along with breathlessness in recumbent position. It is an uncommon syndrome with elusive pathophysiologic mechanisms. We observed POS in patients of moderate COVID-19 who required hospital admission to our indoor facility and oxygen supplementation when saturation was documented in sitting and supine positions for evaluation of platypnea.
We conducted an observational, cross sectional, retrospective analysis of pulse oximetry readings of patients with stage 2 COVID-19 admitted in ward during the period from 15th May 2020 to 30th May 2020. The difference in the peripheral oxygen saturation in sitting and supine positions, documented as a routine standard of care, especially in patients with platypnea, was calculated and demographic details and co-morbidities were noted from indoor record forms.
Of the 53 patients of stage 2 COVID-19 who were included in the study, 15 (28%) had platypnoea-orthodeoxia syndrome at the time of presentation and 18(33.9%) patients with platypnoea had ≥ 3% desaturation in sitting position as compared to supine position. Rest of the 20 (37.7%) patients had neither platypnoea nor orthodeoxia. All the patients presenting with platypnoea-orthodeoxia required oxygen therapy during the course of treatment. Amongst the 33 patients who were hypoxic and required oxygen supplementation, 15 patients (45.4%) had oxygen saturation of ≥94% in the supine position at presentation.
Platypnoea-orthodeoxia syndrome is common in patients with stage 2 COVID 19 infection who require oxygen therapy. POS can be easily documented by using pulse oximeter without the need of any specialised equipment. Hence, we propose that documentation of POS at the time of admission in primary health care or resource depleted settings would help in successful triage of the patients needing oxygen therapy. We also propose that oxygen saturation in sitting position be documented as far as possible. Further clinical studies are necessary to validate this observation.
体位性低氧血症伴卧位呼吸困难的平胸呼吸-正性氧合（POS）综合征是一种不常见的综合征，其病理生理机制难以捉摸。我们在需要住院和补充氧气的中度 COVID-19 患者中观察到 POS，这些患者的饱和度在坐姿和仰卧位时进行评估，以确定平胸呼吸。
我们对 2020 年 5 月 15 日至 2020 年 5 月 30 日期间在病房住院的 2 期 COVID-19 患者的脉搏血氧仪读数进行了观察性、横断面、回顾性分析。在常规护理标准中，特别是在有平胸呼吸的患者中，记录了坐姿和仰卧位的外周血氧饱和度差异，并从室内记录表格中记录了人口统计学细节和合并症。
在纳入研究的 53 名 2 期 COVID-19 患者中，15 名（28%）在就诊时患有平胸呼吸-正性氧合综合征，18 名（33.9%）有平胸呼吸的患者在坐姿时的饱和度下降≥3%，而仰卧位时则下降。其余 20 名（37.7%）患者既没有平胸呼吸也没有正性氧合。所有出现平胸呼吸-正性氧合的患者在治疗过程中都需要吸氧。在 33 名需要吸氧的缺氧患者中，15 名（45.4%）在就诊时的仰卧位时血氧饱和度≥94%。
需要吸氧的 2 期 COVID-19 感染患者中，平胸呼吸-正性氧合综合征很常见。POS 可以通过使用脉搏血氧仪轻松记录，而无需任何特殊设备。因此，我们建议在初级保健或资源匮乏的环境中在入院时记录 POS，以便成功对需要吸氧的患者进行分诊。我们还建议尽可能记录坐姿时的血氧饱和度。还需要进一步的临床研究来验证这一观察结果。
