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Oxygen Metabolism Score Directed Respiratory Support for 2019 Novel Coronavirus Pneumonia

30 Pages Posted: 1 Apr 2020

See all articles by Yuhao Liu

Yuhao Liu

Tongji University - Department of Critical Care Medicine

Feng Li

Tongji University - Department of Critical Care Medicine

Wei Jiang

Independent

Yunlou Zhu

Tongji University - Department of Critical Care Medicine

Hairong Fan

Tongji University - Department of Critical Care Medicine

Rui Tian

Shanghai Jiao Tong University (SJTU) - Department of Critical Care Medicine

Yinchuan Li

Shanghai Jiao Tong University (SJTU) - Department of Critical Care Medicine

Hongping Qu

Shanghai Jiao Tong University (SJTU) - Department of Critical Care Medicine

Yuan Gao

Shanghai Jiao Tong University (SJTU)

Bijie Hu

Fudan University - Department of Infectious Diseas

Lei Zhu

Fudan University - Department of Respiratory and Critical Care Medicine

Enqiang Mao

Shanghai Jiao Tong University (SJTU) - Department of Emergency

Wenhong Zhang

Fudan University - Department of Infectious Diseases

Hongzhou Lu

Fudan University - Department of Clinical Laboratory; Fudan University - Shanghai Public Health Clinical Center; Fudan University - Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS)

Sheng Wang

Tongji University - Department of Critical Care Medicine

Shanghai Novel Coronavirus PneumoniaWorking Group

More...

Abstract

Background: Hypoxemia caused by acute respiratory distress syndrome (ARDS) is a common feature of coronavirus disease 2019 (COVID-19). This study designed and evaluated the oxygen metabolism scoring system (OMSS) to quickly titrate the capability of COVID-19 patients to balance oxygen supply and demand.

Methods: Adult patients with confirmed COVID-19 pneumonia were enrolled in this single-centre study and divided into the standard therapy (n=151) and OMSS-directed therapy (n=159) groups according to their admission time. Radiological and laboratory findings, clinical events and outcomes were collected from patients’ medical records. OMSS consisted of four elements with a total score of 10: PaO2 /FiO2, chest imaging, serum lactate and ScvO2, and the scores were given according to the severity of these four parameters. The predictive efficiency of OMSS was validated retrospectively by receiver operating characteristic (ROC) curves.

Findings: The areas under ROC curves to predict the execution of conventional oxygen therapy, high-flow nasal cannula oxygen therapy (HFNC), invasive mechanical ventilation (IMV) and extracorporeal membrane oxygenation (ECMO) by OMSS were 0.85, 0.87, 0.97 and 0.99, respectively, and OMSS significantly shortened the time to implement HFNC, IMV and ECMO. Moreover, compared with standard therapy, OMSS-directed therapy resulted in markedly lower proportion of critical patients and organ damage, a shorter duration of IMV and ICU stay.

Interpretation: OMSS is an effective screening tool to assess the capability to maintain the balance of oxygen supply and consumption in COVID-19 patients by which physicians can shorten the reaction time to execute rational respiratory support therapies, thus preventing hypoxemia-associated negative events.

Funding Statement: This study was supported by the emergency project of Shanghai Science and Technology Commission (20411950200).

Declaration of Interests: All authors declare no competing interests.

Ethics Approval Statement: The study was approved by the SHPHC Ethics Committee (YJ2020-S028-02) and informed consent was declared exempt from the outbreak of COVID 2019.

Keywords: COVID-19; SARS-CoV-2; pneumonia; Hypoxia; acute respiratory distress syndrome; predictive score; triage; outcome; adult

Suggested Citation

Liu, Yuhao and Li, Feng and Jiang, Wei and Zhu, Yunlou and Fan, Hairong and Tian, Rui and Li, Yinchuan and Qu, Hongping and Gao, Yuan and Hu, Bijie and Zhu, Lei and Mao, Enqiang and Zhang, Wenhong and Lu, Hongzhou and Wang, Sheng and Group, Shanghai Novel Coronavirus PneumoniaWorking, Oxygen Metabolism Score Directed Respiratory Support for 2019 Novel Coronavirus Pneumonia (3/22/2020). Available at SSRN: https://ssrn.com/abstract=3559582 or http://dx.doi.org/10.2139/ssrn.3559582

Yuhao Liu

Tongji University - Department of Critical Care Medicine

China

Feng Li

Tongji University - Department of Critical Care Medicine

China

Wei Jiang

Independent

No Address Available
United States

Yunlou Zhu

Tongji University - Department of Critical Care Medicine

China

Hairong Fan

Tongji University - Department of Critical Care Medicine

China

Rui Tian

Shanghai Jiao Tong University (SJTU) - Department of Critical Care Medicine

Shanghai
China

Yinchuan Li

Shanghai Jiao Tong University (SJTU) - Department of Critical Care Medicine

Shanghai
China

Hongping Qu

Shanghai Jiao Tong University (SJTU) - Department of Critical Care Medicine

No 197, Rui Jin 2nd road
Shanghai, 200025
China

Yuan Gao

Shanghai Jiao Tong University (SJTU)

KoGuan Law School
Shanghai 200030, Shanghai 200052
China

Bijie Hu

Fudan University - Department of Infectious Diseas

Shanghai
China

Lei Zhu

Fudan University - Department of Respiratory and Critical Care Medicine

Shanghai, 200032
China

Enqiang Mao

Shanghai Jiao Tong University (SJTU) - Department of Emergency

Shanghai, 200025
China

Wenhong Zhang (Contact Author)

Fudan University - Department of Infectious Diseases ( email )

12 Central Urumqi Road
Shanghai, 200040
China

Hongzhou Lu

Fudan University - Department of Clinical Laboratory ( email )

2901 Caolang Road
Jinshan District
Shanghai, 201508
China

Fudan University - Shanghai Public Health Clinical Center ( email )

Shanghai
China

Fudan University - Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS) ( email )

138 Dong’an Rd
Shanghai, 200032
China

Sheng Wang

Tongji University - Department of Critical Care Medicine

China

No contact information is available for Shanghai Novel Coronavirus PneumoniaWorking Group

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