Background and objectives The timing of invasive mechanical ventilation (IMV) is controversial in COVID-19 patients with acute respiratory hypoxemia. The study aimed to develop a novel predictor called cumulative oxygen deficit (COD) for the risk stratification. Methods The study was conducted in four designated hospitals for treating COVID-19 patients in Jingmen, Wuhan, from January to March 2020. COD was defined to account for both the magnitude and duration of hypoxemia. A higher value of COD indicated more oxygen deficit. The predictive performance of COD was calculated in multivariable Cox regression models. Results A number of 111 patients including 80 in the non-IMV group and 31 in the IMV group were included. Patients with IMV had substantially lower PaO2 (62 (49, 89) vs. 90.5 (68, 125.25) mmHg; p < 0.001), and higher COD (−6.87 (−29.36, 52.38) vs. −231.68 (−1040.78, 119.83) mmHg·day) than patients without IMV. As compared to patients with COD < 0, patients with COD > 30 mmHg·day had higher risk of fatality (HR: 3.79, 95% CI [2.57–16.93]; p = 0.037), and those with COD > 50 mmHg·day were 10 times more likely to die (HR: 10.45, 95% CI [1.28–85.37]; p = 0.029). Conclusions The study developed a novel predictor COD which considered both magnitude and duration of hypoxemia, to assist risk stratification of COVID-19 patients with acute respiratory distress.

中文翻译：

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累积氧亏缺是 COVID-19 呼吸窘迫患者有创机械通气时间的新预测因子

背景和目的 有创机械通气 (IMV) 的时机在 COVID-19 急性呼吸性低氧血症患者中存在争议。该研究旨在开发一种新的预测因子，称为累积缺氧 (COD)，用于风险分层。方法 该研究于 2020 年 1 月至 2020 年 3 月在武汉荆门的四家定点医院治疗 COVID-19 患者进行。定义 COD 以考虑低氧血症的程度和持续时间。COD 值越高表明缺氧越严重。在多变量 Cox 回归模型中计算 COD 的预测性能。结果共纳入111例患者，其中非IMV组80例，IMV组31例。IMV 患者的 PaO2 显着降低 (62 (49, 89) vs. 90.5 (68, 125.25) mmHg；p < 0.001)，COD 较高 (-6.87 (-29.36, 52.38) 与 -231.68 (-1040.78, 119.83) mmHg·day) 比没有 IMV 的患者。与 COD < 0 的患者相比，COD > 30 mmHg·day 的患者死亡风险更高（HR：3.79，95% CI [2.57–16.93]；p = 0.037），COD > 50 mmHg·day 的患者死亡风险更高死亡的可能性高 10 倍（HR：10.45, 95% CI [1.28–85.37]；p = 0.029）。结论 该研究开发了一种新的 COD 预测因子，它同时考虑了低氧血症的程度和持续时间，以帮助对 COVID-19 急性呼吸窘迫患者进行风险分层。p = 0.029）。结论 该研究开发了一种新的 COD 预测因子，它同时考虑了低氧血症的程度和持续时间，以帮助对 COVID-19 急性呼吸窘迫患者进行风险分层。p = 0.029）。结论 该研究开发了一种新的 COD 预测因子，它同时考虑了低氧血症的程度和持续时间，以帮助对 COVID-19 急性呼吸窘迫患者进行风险分层。