ABSTRACT
Rationale Multiple anecdotal reports describe patients with COVID-19 presenting with what is referred to as silent hypoxemia (without dyspnea, tachypnea, or respiratory distress). However, there is a paucity of literature on this problem. We conducted a study to determine the prevalence of silent hypoxemia in patients with COVID-19 infection at presentation in the emergency department (ED) or on admission, and compared it with that of patients with pneumonia by any other etiology at Memorial Hermann Health System. In addition, we analyzed the differences between clinical, laboratory, hospital utilization, and mortality. Methods From electronic medical records, we identified pneumonia patients with a positive result for coronavirus on reverse transcriptasepolymerase chain reaction (RT-PCR) nasopharyngeal swab test, or diagnosis of pneumonia by influenza or any other etiology for one year, presenting to the ED or admitted to any MHHS hospital. We extracted age, sex, race/ethnicity, vital signs, oxygen saturation, intensive care unit (ICU) admission, and hospital stay for all patients. Results A total of 17,475 COVID-19 patients were compared with 2,343 patients with influenza/pneumonia of any etiology. The two groups were similar with respect to age, sex, and ethnicity. The frequency of silent hypoxemia was greater in the COVID-19 (n=232, 1.3%) group compared to influenza/pneumonia (n= 3, 0.13%) patients (p<0.001). For patients with an oxygen saturation < 90, the proportion who had silent hypoxemia was 11.7% (232/1981) in the COVID-19 patients and 2.6% (3/117) in the influenza and other viral pneumonia patients. Between COVID-19 patients admitted to the hospital, patients with symptomatic hypoxemia had a longer hospital stays (median: 11 days, IQR: 6-22) compared to those with silent hypoxemia (median: 8 days, IQR: 4-18) (p=0.001). The symptomatic hypoxemia group was more likely to be admitted to the ICU (n=457, 26.1%) compared to the silent hypoxemic patients (n=33, 15.5%) (p<0.001) and the mortality rate was higher (n=454, 26.0%) vs (36, 15.5%) (p=0.001). Conclusion The prevalence of silent hypoxemia for adults with viral pneumonia who were seen in the ED or hospitalized in a 17- hospital system in Houston, was higher in the COVID-19 infection patient group compared to patients with other pneumonias or any other etiology. Among the COVID-19 subjects, those with symptomatic hypoxemia had worse outcomes compared to those with silent hypoxemia. More studies are needed to confirm these findings.
ABSTRACT
Introduction: The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. The effect of the pandemic on children on home mechanical ventilation is unknown. We examined the impact of the pandemic on pediatric healthcare utilization in children on home mechanical ventilation. Methods: Between March 11 and December 1, 2020, we conducted a single center, retrospective analysis of 81 children, younger than 18 years old, on home mechanical ventilation who are followed at the UT Physicians High Risk Children's Clinic. Using the same cohort of patients, we compared healthcare utilization during the pandemic in 2020 to the same period in 2019. Results: We observed a massive decline in pediatric healthcare utilization during the pandemic year compared with the previous year. Emergency department total visits decreased by 70% (33 vs 10) (p<0.01). Total number of hospital admissions declined by 38% (52 vs 32) (p=0.03). The mean length of stay (LOS) in hospital admission was 6.7 days in 2019 and 5.3 days in 2020 (p=0.3). Similarly, pediatric intensive care unit (PICU) admissions reduced by 57% (30 vs 13) (P=0.04), and the mean PICU LOS was 7.5 days in 2019 and 6.0 days in 2020 (p=0.5). Mortality did not change during 2020 period (1 vs 0). Conclusions: Our data illustrate a significant improvement in pediatric hospital utilization and outcomes for children on home mechanical ventilation during the COVID-19 pandemic. We speculate that fewer medical office visits, increase in telehealth follow ups, school closures, social distancing, massive mask utilization, and increased hand washing during the pandemic year were protective factors that contributed to a lower hospitalization rate. However, we cannot fully exclude the possibilities of natural history of disease fluctuation, or regression to the mean phenomenon. More studies are needed to confirm the etiology of these findings.