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Silent Hypoxemia in the Emergency Department: A Retrospective Cohort of Two Clinical Phenotypes in Critical COVID-19.
Alamé, Karine; Lemaitre, Elena Laura; Abensur Vuillaume, Laure; Noizet, Marc; Gottwalles, Yannick; Chouihed, Tahar; Lavoignet, Charles-Eric; Bérard, Lise; Molter, Lise; Gennai, Stéphane; Ugé, Sarah; Lefebvre, François; Bilbault, Pascal; Le Borgne, Pierrick.
  • Alamé K; Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
  • Lemaitre EL; CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France.
  • Abensur Vuillaume L; Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
  • Noizet M; CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France.
  • Gottwalles Y; Emergency Department, Regional Hospital of Metz-Thionville, 57700 Hayange, France.
  • Chouihed T; Emergency Department, Mulhouse Hospital, 68100 Mulhouse, France.
  • Lavoignet CE; Emergency Department, Colmar Hospital, 68000 Colmar, France.
  • Bérard L; Emergency Department, Nancy University Hospital, 54000 Nancy, France.
  • Molter L; Centre d'Investigations Cliniques-1433, and INSERM U1116, F-CRIN INI-CRCT, Université de Lorraine, 54000 Nancy, France.
  • Gennai S; CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France.
  • Ugé S; Emergency Department, Nord Franche Comté Hospital, 90400 Trévenans, France.
  • Lefebvre F; CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France.
  • Bilbault P; Emergency Department, Haguenau Hospital, 67504 Haguenau, France.
  • Le Borgne P; Emergency Department, Verdun Hospital, 55100 Verdun, France.
J Clin Med ; 11(17)2022 Aug 27.
Article in English | MEDLINE | ID: covidwho-2006083
ABSTRACT

INTRODUCTION:

Understanding hypoxemia, with and without the clinical signs of acute respiratory failure (ARF) in COVID-19, is key for management. Hence, from a population of critical patients admitted to the emergency department (ED), we aimed to study silent hypoxemia (Phenotype I) in comparison to symptomatic hypoxemia with clinical signs of ARF (Phenotype II).

METHODS:

This multicenter study was conducted between 1 March and 30 April 2020. Adult patients who were presented to the EDs of nine Great-Eastern French hospitals for confirmed severe or critical COVID-19, who were then directly admitted to the intensive care unit (ICU), were retrospectively included.

RESULTS:

A total of 423 critical COVID-19 patients were included, out of whom 56.1% presented symptomatic hypoxemia with clinical signs of ARF, whereas 43.9% presented silent hypoxemia. Patients with clinical phenotype II were primarily intubated, initially, in the ED (46%, p < 0.001), whereas those with silent hypoxemia (56.5%, p < 0.001) were primarily intubated in the ICU. Initial univariate analysis revealed higher ICU mortality (29.2% versus 18.8%, p < 0.014) and in-hospital mortality (32.5% versus 18.8%, p < 0.002) in phenotype II. However, multivariate analysis showed no significant differences between the two phenotypes regarding mortality and hospital or ICU length of stay.

CONCLUSIONS:

Silent hypoxemia is explained by various mechanisms, most physiological and unspecific to COVID-19. Survival was found to be comparable in both phenotypes, with decreased survival in favor of Phenotype II. However, the spectrum of silent to symptomatic hypoxemia appears to include a continuum of disease progression, which can brutally evolve into fatal ARF.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Year: 2022 Document Type: Article Affiliation country: Jcm11175034

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Year: 2022 Document Type: Article Affiliation country: Jcm11175034