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VOLUME 25 , ISSUE 2 ( February, 2021 ) > List of Articles

CASE SERIES

Systemic Oxygen Utilization in Severe COVID-19 Respiratory Failure: A Case Series

Rajeev K Garg, Tara Kimbrough, Wajahat Lodhi, Ivan DaSilva

Keywords : Acute respiratory distress syndrome, COVID-19, Hyperoxia, Hypoxia

Citation Information : Garg RK, Kimbrough T, Lodhi W, DaSilva I. Systemic Oxygen Utilization in Severe COVID-19 Respiratory Failure: A Case Series. Indian J Crit Care Med 2021; 25 (2):215-218.

DOI: 10.5005/jp-journals-10071-23722

License: CC BY-NC 4.0

Published Online: 22-02-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Management of hypoxemia in patients with severe COVID-19 respiratory failure is based on the guideline recommendations for specific SpO2 targets. However, limited data exist on systemic O2 utilization. The objective of this study was to examine systemic O2 utilization in a case series of patients with this disease. Patients and methods: Between March 24, and April 9, 2020, 8 patients intubated for severe COVID-19 respiratory failure had near-simultaneous drawing of arterial blood gas (ABG), central venous blood gas (cVBG), and central venous oxygen saturation (ScvO2) at a mean of 6.1 days into hospitalization. Three patients were managed with indirect cardiac output (CO) monitoring by FloTrac sensor and Vigileo monitor (Edwards Lifesciences, Irvine, CA). The oxygen extraction index (OEI; SaO2-ScvO2/SaO2) and oxygen extraction fraction (OEF; CaO2-CvO2/CaO2 × 100) were calculated. Values for hyperoxia (ScvO2 ≥ 90%), normoxia (ScvO2 71–89%), and hypoxia (ScvO2 ≤ 70%) were based on the literature. Mean values were calculated. Results: The mean partial pressure of oxygen (PaO2) was 102 with a mean fraction of inspired O2 (FiO2) of 44%. One patient was hyperoxic with a reduced OEI (17%). Five patients were normoxic, but 2 had a reduced OEF (mean 15.9%). Two patients were hypoxic but had increased systemic O2 utilization based on OEF or OEI. Conclusion: In select patients with severe COVID-19 respiratory failure, O2 delivery (DO2) was found to exceed O2 utilization. SpO2 targets based on systemic O2 utilization may help in reducing oxygen toxicity, especially in the absence of anaerobic metabolism. Further data are needed on the prevalence of systemic O2 utilization in COVID-19.


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  1. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020;46:854–887. DOI: 10.1007/s00134-020-06022-5.
  2. Chu DK, Kim LH, Young PJ, Zamiri N, Almenawer SA, Jaeschke R, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet 2018;391(10131):1693–1705. DOI: 10.1016/S0140-6736(18)30479-3.
  3. Reinhart K, Rudolph T, Bredle DL, Hannemann L, Cain SM. Comparison of central-venous to mixed-venous oxygen saturation during changes in oxygen supply/demand. Chest 1989;95(6):1216–1221. DOI: 10.1378/chest.95.6.1216.
  4. Pope JV, Jones AE, Gaieski DF, Arnold RC, Trzeciak S, Shapiro NI. Multicenter study of central venous oxygen saturation (ScvO(2)) as a predictor of mortality in patients with sepsis. Ann Emerg Med 2010;55(1):40–46.e1. DOI: 10.1016/j.annemergmed.2009.08.014.
  5. Kopterides P, Bonovas S, Mavrou I, Kostadima E, Zakynthinos E, Armaganidis A. Venous oxygen saturation and lactate gradient from superior vena cava to pulmonary artery in patients with septic shock. Shock 2009;31(6):562–568. DOI: 10.1097/SHK.0b013e31818bb8d8.
  6. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017;45(3):486–552. DOI: 10.1097/CCM.0000000000002255.
  7. Mekontso-Dessap A, Castelain V, Anguel N, Bahloul M, Schauvliege F, Richard C, et al. Combination of venoarterial PCO2 difference with arteriovenous O2 content difference to detect anaerobic metabolism in patients. Intensive Care Med 2002;28(3):272–277. DOI: 10.1007/s00134-002-1215-8.
  8. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342(18):1301–1308. DOI: 10.1056/NEJM200005043421801.
  9. Helmerhorst HJ, Schultz MJ, van der Voort PH, Bosman RJ, Juffermans NP, de Jonge E, et al. Self-reported attitudes versus actual practice of oxygen therapy by ICU physicians and nurses. Ann Intensive Care 2014;4:23. DOI: 10.1186/s13613-014-0023-y.
  10. Suzuki S, Eastwood GM, Peck L, Glassford NJ, Bellomo R. Current oxygen management in mechanically ventilated patients: a prospective observational cohort study. J Crit Care 2013;28(5): 647–654. DOI: 10.1016/j.jcrc.2013.03.010.
  11. Kallet RH, Matthay MA. Hyperoxic acute lung injury. Respir Care 2013;58(1):123–141. DOI: 10.4187/respcare.01963.
  12. Helmerhorst HJ, Roos-Blom MJ, van Westerloo DJ, de Jonge E. Association between arterial hyperoxia and outcome in subsets of critical illness: a systematic review, meta-analysis, and meta-regression of cohort studies. Crit Care Med 2015;43(7):1508–1519. DOI: 10.1097/CCM.0000000000000998.
  13. Couzin-Frankel J. The mystery of the pandemic's ‘happy hypoxia’. Science 2020;368(6490):455–456. DOI: 10.1126/science.368.6490.455.
  14. Bourgonje AR, Abdulle AE, Timens W, Hillebrands JL, Navis GJ, Gordijn SJ, et al. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol 2020;251(3):228–248. DOI: 10.1002/path.5471.
  15. Singh KK, Chaubey G, Chen JY, Suravajhala P. Decoding SARS-CoV-2 hijacking of host mitochondria in COVID-19 pathogenesis. Am J Physiol Cell Physiol 2020;319(2):C258–C267.DOI: 10.1152/ajpcell.00224.2020.
  16. Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, et al. Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 2002;360(9328):219–223. DOI: 10.1016/S0140-6736(02)09459-X.
  17. Walley KR. Use of central venous oxygen saturation to guide therapy. Am J Respir Crit Care Med 2011;184(5):514–520. DOI: 10.1164/rccm.201010-1584CI.
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