Silent Hypoxemia in the Emergency Department: A Retrospective Cohort of Two Clinical Phenotypes in Critical COVID-19 - Archive ouverte HAL Access content directly
Journal Articles Journal of Clinical Medicine Year : 2022

Silent Hypoxemia in the Emergency Department: A Retrospective Cohort of Two Clinical Phenotypes in Critical COVID-19

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Laure Abensur Vuillaume
Marc Noizet
  • Function : Author
Yannick Gottwalles
  • Function : Author
Tahar Chouihed
  • Function : Author
Charles-Eric Lavoignet
  • Function : Author
Lise Bérard
  • Function : Author
Lise Molter
  • Function : Author
Sarah Ugé
  • Function : Author
François Lefebvre
  • Function : Author
Pascal Bilbault
Pierrick Le Borgne

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.
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Dates and versions

hal-03811693 , version 1 (12-10-2022)

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Attribution - CC BY 4.0

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Karine Alamé, Elena Laura Lemaitre, Laure Abensur Vuillaume, Marc Noizet, Yannick Gottwalles, et al.. Silent Hypoxemia in the Emergency Department: A Retrospective Cohort of Two Clinical Phenotypes in Critical COVID-19. Journal of Clinical Medicine, 2022, 11 (17), pp.5034. ⟨10.3390/jcm11175034⟩. ⟨hal-03811693⟩

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