Oxygen provision to severely ill COVID-19 patients at the peak of the 2020 pandemic in a Swedish district hospital

Abstract

Oxygen is a low-cost and life-saving therapy for patients with COVID-19. Yet, it is a limited resource in many hospitals in low income countries and in the 2020 pandemic even hospitals in richer countries reported oxygen shortages. An accurate understanding of oxygen requirements is needed for capacity planning. The World Health Organization estimates the average flow-rate of oxygen to severe COVID-19-patients to be 10 l/min. However, there is a lack of empirical data about the oxygen provision to patients. This study aimed to estimate the oxygen provision to COVID-19 patients with severe disease in a Swedish district hospital. A retrospective, medical records-based cohort study was conducted in March to May 2020 in a Swedish district hospital. All adult patients with severe COVID-19 –those who received oxygen in the ward and had no ICU-admission during their hospital stay–were included. Data were collected on the oxygen flow-rates provided to the patients throughout their hospital stay, and summary measures of oxygen provision calculated. One-hundred and twenty-six patients were included, median age was 70 years and 43% were female. On admission, 27% had a peripheral oxygen saturation of ≤91% and 54% had a respiratory rate of ≥25/min. The mean oxygen flow-rate to patients while receiving oxygen therapy was 3.0 l/min (SD 2.9) and the mean total volume of oxygen provided per patient admission was 16,000 l (SD 23,000). In conclusion, the provision of oxygen to severely ill COVID-19-patients was lower than previously estimated. Further research is required before global estimates are adjusted.

Hospital readiness for the provision of care to critically ill patients in Tanzania - an indepth cross-sectional study

“…Critical illness is estimated to affect around [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45](2) million adults annually -mostly in low-and middle-income countries (LMICs) (3,4). In the COVID-19 pandemic, the burden increased and critical illness rose up the global health agenda (5). The mortality rate of critical illness is high -ranging between 13-85% (5)(6)(7).…”

Cytosolic PCNA interacts with S100A8 and controls an inflammatory subset of neutrophils in COVID-19

“…Each patient gave written informed consent and was classified into different clinical severity groups (Table 1) depending on a multifactorial score taking into account oxygen requirement. 34–36 Blood from COVID-19 patients and from healthy donors (HD) obtained from the Etablissement Francais du Sang was collected in EDTA-vacuum or in dry tubes for serum collection. Neutrophils were isolated in LPS-free dextran sedimentation and Ficoll (Histopaque-1077 ® , Sigma-Aldrich) centrifugation, as previously described.…”

Towards definitions of critical illness and critical care using concept analysis

“… 5–7 In the COVID-19 pandemic, there have been great efforts to describe, scale-up and improve care for critically ill patients throughout the world, 5 7 and a lack of agreement around the concept of critical care has hampered these efforts. 8 9 …”

“…Studies have focused on care provided in hospital locations such as in intensive care or emergency units, which exclude both the care provided in hospitals lacking such units, and the care of critically ill patients in general hospital wards 5–7. In the COVID-19 pandemic, there have been great efforts to describe, scale-up and improve care for critically ill patients throughout the world,5 7 and a lack of agreement around the concept of critical care has hampered these efforts 8 9…”