Guha Niyogi Subhrashis, Agarwal Ritesh, Suri Vikas, Malhotra Pankaj, Jain Divya, Puri Goverdhan Dutt
Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
Pulmonary Medicine, PGIMER, Chandigarh, India.
Trends Anaesth Crit Care. 2021 Aug;39:5-9. doi: 10.1016/j.tacc.2021.04.007. Epub 2021 May 18.
The crisis of critical care resource allocation during the novel coronavirus infectious disease 2019 (COVID-19) pandemic has underscored the importance of triage. COVID-19 is associated with increased hypoxemia and desaturation on exertion. We hypothesized that desaturation after 1-min sit-to-stand test (1MSTS), a validated field exercise test can serve as a potential marker for triage of COVID 19 patients.
Subjects with proven COVID 19 without hypoxemia on ambient air at presentation underwent the 1MSTS. The demographic details, clinical profile, pre and post-test vitals and pulse oximetric saturation was recorded and they were followed up for outcome throughout the hospital stay and after discharge.
55 mild cases of COVID-19 and 6 cases of recovering severe COVID-19 were included. The mild cohort had a median age of 35 years (IQR, 27-41.5) and a median hospital stay of 16 days (IQR 14,20). The severe cohort had a median age of 47.5 years (IQR, 42.3,54.3) and median intensive care and hospital stays of respectively 9 (IQR, 7.5,9) and 23.5 (IQR, 21.5,27) days. The two cohorts showed median desaturations of 0% (IQR, 0.5-1) and 5.5% (IQR, 4.3-6) respectively. No subjects in the mild cohort needed oxygen therapy or escalation of care to intensive care.
Significant desaturation after 1-MSTSin severe COVID 19 patients demonstrates the potential role of 1-MSTS both in triage for planning care and as a discharge criteria from intensive care unit. However, larger prospective studies are warranted for its evaluation and establishment of relevant cut-offs.
2019年新型冠状病毒感染疾病(COVID-19)大流行期间,重症监护资源分配危机凸显了分诊的重要性。COVID-19与运动时低氧血症和血氧饱和度降低有关。我们假设,1分钟坐立试验(1MSTS)(一种经过验证的现场运动试验)后出现的血氧饱和度降低可作为COVID-19患者分诊的潜在标志物。
确诊为COVID-19且就诊时在室内空气中无低氧血症的受试者接受1MSTS。记录人口统计学细节、临床特征、测试前后的生命体征和脉搏血氧饱和度,并在整个住院期间和出院后对其进行随访以了解结局。
纳入55例轻度COVID-19病例和6例康复中的重症COVID-19病例。轻度组的中位年龄为35岁(四分位间距,27-41.5),中位住院时间为16天(四分位间距14,20)。重症组的中位年龄为47.5岁(四分位间距,42.3,54.3),中位重症监护和住院时间分别为9天(四分位间距,7.5,9)和23.5天(四分位间距,21.5,27)。两组的中位血氧饱和度降低分别为0%(四分位间距,0.5-1)和5.5%(四分位间距,4.3-6)。轻度组中没有受试者需要吸氧治疗或升级为重症监护。
重症COVID-19患者在1-MSTS后出现显著的血氧饱和度降低,表明1-MSTS在规划护理的分诊以及作为重症监护病房出院标准方面都具有潜在作用。然而,需要进行更大规模的前瞻性研究来评估并确定相关临界值。