Nocturnal hypoxemia and oxygen desaturation events in neutropenic patients with sepsis or pneumonia

Eiff, M. von; Gröne, Eva; Herbort, Cp; Zühlsdorf, M.; Loo, Joan

doi:10.1007/bf01720726

Cited by 1 publication

(1 citation statement)

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“…Any component of hypoxic pulmonary vasoconstriction and further exacerbation of pulmonary hypertension in this setting is best avoided. Further to this point, nocturnal drop in oxygen saturation is a well-known phenomenon [ 26 ], is common in patients with primary pulmonary hypertension [ 27 ], and has also been demonstrated in patients with pneumonia and sepsis [ 28 ]. Nocturnal hypoxemia could therefore potentially further exacerbate reflex pulmonary vasoconstriction as well as peripheral tissue hypoxia in patients with COVID-19 pneumonia.…”

Section: Main Bodymentioning

confidence: 99%

Considerations for target oxygen saturation in COVID-19 patients: are we under-shooting?

Shenoy

Luchtel

Gulani

2020

BMC Med

114

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Background: The current target oxygen saturation range for patients with COVID-19 recommended by the National Institutes of Health is 92-96%. Main body: This article critically examines the evidence guiding current target oxygen saturation recommendation for COVID-19 patients, and raises important concerns in the extrapolation of data from the two studies stated to be guiding the recommendation. Next, it examines the influence of hypoxia on upregulation of ACE2 (target receptor for SARS-CoV-2 entry) expression, with supporting transcriptomic analysis of a publicly available gene expression profile dataset of human renal proximal tubular epithelial cells cultured in normoxic or hypoxic conditions. Finally, it discusses potential implications of specific clinical observations and considerations in COVID-19 patients on target oxygen saturation, such as diffuse systemic endothelitis and microthrombi playing an important pathogenic role in the wide range of systemic manifestations, exacerbation of hypoxic pulmonary vasoconstriction in the setting of pulmonary vascular endothelitis/microthrombi, the phenomenon of "silent hypoxemia" with some patients presenting to the hospital with severe hypoxemia disproportional to symptoms, and overburdened health systems and public health resources in many parts of the world with adverse implications on outpatient monitoring and early institution of oxygen supplementation. Conclusions: The above factors and analyses, put together, call for an urgent exploration and re-evaluation of target oxygen saturation in COVID-19 patients, both in the inpatient and outpatient settings. Until data from such trials become available, where possible, it may be prudent to target an oxygen saturation at least at the upper end of the recommended 92-96% range in COVID-19 patients both in the inpatient and outpatient settings (in patients that are normoxemic at pre-COVID baseline). Home pulse oximetry, tele-monitoring, and earlier institution of oxygen supplementation for hypoxemic COVID-19 outpatients could be beneficial, where public health resources allow for their implementation.

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Section: Main Bodymentioning

confidence: 99%