Thomas Fuehner1,2, Isabelle Renger1, Tobias Welte2, Tobias Freundt1, Jens Gottlieb2. 1. Department of Respiratory Medicine, Siloah Hospital, Hannover, Germany. 2. Dept of Respiratory Medicine and German Centre for Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
Abstract
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global crisis challenging the worldwide healthcare systems. Many patients present with a mismatch of profound hypoxemia and few signs of respiratory distress (i.e., silent hypoxemia). This particular clinical presentation is often cited, but data are limited. MAIN BODY: We describe dyspnea sensation as assessed by using the BORG scale in pulmonary patients admitted to the emergency room during a 4-week period and transferred to the respiratory department of Siloah Hospital, Hannover, Germany. From October 1 to November 1, 2020, 82 patients with hypoxemia defined as oxygen demand to achieve an oxygen saturation (SpO2) ≥92% were included. In 45/82 (55%) patients, SARS-CoV-2 was detected by PCR on admission. Among non-COVID patients, exacerbation of COPD was the main diagnosis (15/37, 41%). All subjects rated their perceived dyspnea using the modified Borg CR10 scale. Patients in the non-COVID group suffered from more dyspnea on the modified Borg CR10 scale (median 1, IQR: 0-2 vs. median 5, IQR: 3-6, p < 0.001). In multivariate analysis, "silent hypoxemia" as defined by the dyspnea Borg CR10 scale ≥5 was independently associated with COVID-19 and presence of severe hypocapnia with an odds ratio of 0.221 (95% confidence interval 0.054, 0.907, p 0.036). CONCLUSION: Among pulmonary patients with acute hypoxemia defined as oxygen demand, patients suffering from COVID-19 experience less dyspnea compared to non-COVID patients. "Silent" hypoxemia was more common in COVID-19 patients.
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global crisis challenging the worldwide healthcare systems. Many patients present with a mismatch of profound hypoxemia and few signs of respiratory distress (i.e., silent hypoxemia). This particular clinical presentation is often cited, but data are limited. MAIN BODY: We describe dyspnea sensation as assessed by using the BORG scale in pulmonary patients admitted to the emergency room during a 4-week period and transferred to the respiratory department of Siloah Hospital, Hannover, Germany. From October 1 to November 1, 2020, 82 patients with hypoxemia defined as oxygen demand to achieve an oxygen saturation (SpO2) ≥92% were included. In 45/82 (55%) patients, SARS-CoV-2 was detected by PCR on admission. Among non-COVID patients, exacerbation of COPD was the main diagnosis (15/37, 41%). All subjects rated their perceived dyspnea using the modified Borg CR10 scale. Patients in the non-COVID group suffered from more dyspnea on the modified Borg CR10 scale (median 1, IQR: 0-2 vs. median 5, IQR: 3-6, p < 0.001). In multivariate analysis, "silent hypoxemia" as defined by the dyspnea Borg CR10 scale ≥5 was independently associated with COVID-19 and presence of severe hypocapnia with an odds ratio of 0.221 (95% confidence interval 0.054, 0.907, p 0.036). CONCLUSION: Among pulmonary patients with acute hypoxemia defined as oxygen demand, patients suffering from COVID-19 experience less dyspnea compared to non-COVID patients. "Silent" hypoxemia was more common in COVID-19 patients.
Authors: Maximilian Ackermann; Stijn E Verleden; Mark Kuehnel; Axel Haverich; Tobias Welte; Florian Laenger; Arno Vanstapel; Christopher Werlein; Helge Stark; Alexandar Tzankov; William W Li; Vincent W Li; Steven J Mentzer; Danny Jonigk Journal: N Engl J Med Date: 2020-05-21 Impact factor: 91.245
Authors: Min Lang; Avik Som; Dexter P Mendoza; Efren J Flores; Nicholas Reid; Denston Carey; Matthew D Li; Alison Witkin; Josanna M Rodriguez-Lopez; Jo-Anne O Shepard; Brent P Little Journal: Lancet Infect Dis Date: 2020-04-30 Impact factor: 25.071
Authors: Mercè Gasa; Yolanda Ruiz-Albert; Ana Cordoba-Izquierdo; Mikel Sarasate; Ester Cuevas; Guillermo Suarez-Quartin; Lidia Méndez; Julio-César Alfaro-Álvarez; Joan Sabater-Riera; Xosé L Pérez-Fernández; María Molina-Molina; Salud Santos Journal: Int J Environ Res Public Health Date: 2022-08-29 Impact factor: 4.614