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An Evolving Clinical Need: Discordant Oxygenation Measurements of Intubated COVID-19 Patients.
Rubano, Jerry A; Maloney, Lauren M; Simon, Jessica; Rutigliano, Daniel N; Botwinick, Isadora; Jawa, Randeep S; Shapiro, Marc J; Vosswinkel, James A; Talamini, Mark; Kaushansky, Kenneth.
  • Rubano JA; Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA. Jerry.Rubano@stonybrookmedicine.edu.
  • Maloney LM; Department of Emergency Medicine, Stony Brook Medicine, Stony Brook, NY, USA.
  • Simon J; Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.
  • Rutigliano DN; Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA.
  • Botwinick I; Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA.
  • Jawa RS; Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA.
  • Shapiro MJ; Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA.
  • Vosswinkel JA; Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA.
  • Talamini M; Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, HSC T18-040, Stony Brook Medicine, Stony Brook, NY, 11794, USA.
  • Kaushansky K; Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA.
Ann Biomed Eng ; 49(3): 959-963, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1064528
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
2. 2019 novel coronavirus CAUSES COVID-19
Subject
2019 novel coronavirus
Predicate
CAUSES
Object
COVID-19
3. Arterial blood sampling METHOD_OF Evaluation
Subject
Arterial blood sampling
Predicate
METHOD_OF
Object
Evaluation
4. Transcutaneous oxygen monitoring METHOD_OF Evaluation
Subject
Transcutaneous oxygen monitoring
Predicate
METHOD_OF
Object
Evaluation
5. Arteries LOCATION_OF Oxygen content
Subject
Arteries
Predicate
LOCATION_OF
Object
Oxygen content
6. Oximetr DIAGNOSES C0391841
Subject
Oximetr
Predicate
DIAGNOSES
Object
C0391841
7. Discordance PROCESS_OF Patients
Subject
Discordance
Predicate
PROCESS_OF
Object
Patients
8. Fingers PART_OF Patients
Subject
Fingers
Predicate
PART_OF
Object
Patients
9. Oximetr NEG_DIAGNOSES C0391841
Subject
Oximetr
Predicate
NEG_DIAGNOSES
Object
C0391841
10. Oxygen content PROCESS_OF Patients
Subject
Oxygen content
Predicate
PROCESS_OF
Object
Patients
11. Acute Hypoxemic Respiratory Failure PROCESS_OF Patients
Subject
Acute Hypoxemic Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
12. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
13. 2019 novel coronavirus CAUSES COVID-19
Subject
2019 novel coronavirus
Predicate
CAUSES
Object
COVID-19
14. Arterial blood sampling METHOD_OF Evaluation
Subject
Arterial blood sampling
Predicate
METHOD_OF
Object
Evaluation
15. Transcutaneous oxygen monitoring METHOD_OF Evaluation
Subject
Transcutaneous oxygen monitoring
Predicate
METHOD_OF
Object
Evaluation
16. Arteries LOCATION_OF Oxygen content
Subject
Arteries
Predicate
LOCATION_OF
Object
Oxygen content
17. Oximetry, Pulse DIAGNOSES Oxygen content
Subject
Oximetry, Pulse
Predicate
DIAGNOSES
Object
Oxygen content
18. Discordance PROCESS_OF Patients
Subject
Discordance
Predicate
PROCESS_OF
Object
Patients
19. Fingers PART_OF Patients
Subject
Fingers
Predicate
PART_OF
Object
Patients
20. Oximetry, Pulse NEG_DIAGNOSES Oxygen content
Subject
Oximetry, Pulse
Predicate
NEG_DIAGNOSES
Object
Oxygen content
21. Oxygen content PROCESS_OF Patients
Subject
Oxygen content
Predicate
PROCESS_OF
Object
Patients
22. Acute Hypoxemic Respiratory Failure PROCESS_OF Patients
Subject
Acute Hypoxemic Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
ABSTRACT
Since the first appearance of the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) earlier this year, clinicians and researchers alike have been faced with dynamic, daily challenges of recognizing, understanding, and treating the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2. Those who are moderately to severely ill with COVID-19 are likely to develop acute hypoxemic respiratory failure and require administration of supplemental oxygen. Assessing the need to initiate or titrate oxygen therapy is largely dependent on evaluating the patient's existing blood oxygenation status, either by direct arterial blood sampling or by transcutaneous arterial oxygen saturation monitoring, also referred to as pulse oximetry. While the sampling of arterial blood for measurement of dissolved gases provides a direct measurement, it is technically challenging to obtain, is painful to the patient, and can be time and resource intensive. Pulse oximetry allows for non-invasive, real-time, continuous monitoring of the percent of hemoglobin molecules that are saturated with oxygen, and usually closely predicts the arterial oxygen content. As such, it was particularly concerning when patients with severe COVID-19 requiring endotracheal intubation and mechanical ventilation within one of our intensive care units were observed to have significant discordance between their predicted arterial oxygen content via pulse oximetry and their actual measured oxygen content. We offer these preliminary observations along with our speculative causes as a timely, urgent clinical need. In the setting of a COVID-19 intensive care unit, entering a patient room to obtain a fresh arterial blood gas sample not only takes exponentially longer to do given the time required for donning and doffing of personal protective equipment (PPE), it involves the consumption of already sparce PPE, and it increases the risk of viral exposure to the nurse, physician, or respiratory therapist entering the room to obtain the sample. As such, technology similar to pulse oximetry which can be applied to a patients finger, and then continuously monitored from outside the room is essential in preventing a particularly dangerous situation of unrealized hypoxia in this critically-ill patient population. Additionally, it would appear that conventional two-wavelength pulse oximetry may not accurately predict the arterial oxygen content of blood in these patients. This discordance of oxygenation measurements poses a critical concern in the evaluation and management of the acute hypoxemic respiratory failure seen in patients with COVID-19.
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Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen / Respiration, Artificial / Blood Gas Analysis / COVID-19 Type of study: Prognostic study Limits: Humans Language: English Journal: Ann Biomed Eng Year: 2021 Document Type: Article Affiliation country: S10439-020-02722-7

Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen / Respiration, Artificial / Blood Gas Analysis / COVID-19 Type of study: Prognostic study Limits: Humans Language: English Journal: Ann Biomed Eng Year: 2021 Document Type: Article Affiliation country: S10439-020-02722-7