Oxygen provision to severely ill COVID-19 patients at the peak of the 2020 pandemic in a Swedish district hospital
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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.
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SciScore for 10.1101/2021.03.11.21253350: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Secondly, decisions on treatment limitations were important to the assignment of patients to the severe group in this study and such practices vary largely across countries. Of the study patients, 48% had a no-ICU-decision meaning that even if they deteriorated, they were kept in the general wards and received targeted oxygen treatment. …
SciScore for 10.1101/2021.03.11.21253350: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Secondly, decisions on treatment limitations were important to the assignment of patients to the severe group in this study and such practices vary largely across countries. Of the study patients, 48% had a no-ICU-decision meaning that even if they deteriorated, they were kept in the general wards and received targeted oxygen treatment. Although oxygen needs for this subgroup was also considerably lower than the WHO estimate (4.0 l/min), it is possible that in settings with other norms around treatment limitations, these patients may, at some point, have received ICU-treatments such as mechanical ventilation with substantially higher oxygen flow-rates. Thirdly, the flow-rates of oxygen provided to patients depend on target saturation and duration between treatment modifications. The patients in this study were cared for with defined targets and frequent saturation controls. In wards where oxygen flow is not – or cannot be – adjusted as frequently, oxygen flow-rates and target saturations may be higher to provide patients with a safe margin for avoiding hypoxia (41). While the optimal target saturation for hospitalised patients receiving oxygen is debated (42,43), the target range in Nyköping was set following the Surviving Sepsis Campaign guidelines (44). Our findings suggest that the oxygen need for severely ill COVID-19 patients may be lower than previously estimated. Future research using the methods described in this study in larger cohorts and from other settings would b...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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