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. 2024 Aug 26;16(8):e67809.
doi: 10.7759/cureus.67809. eCollection 2024 Aug.

The Comparative Impact of Liberal Versus Conservative Oxygenation in Critically Ill COVID-19 Patients: A Retrospective Study

Deepak Singla  1 , Priya Tk  2 , Anirban B Adhikary  1 , Dhatri Jonna  1 , Mishu Mangla  3
Affiliations

The Comparative Impact of Liberal Versus Conservative Oxygenation in Critically Ill COVID-19 Patients: A Retrospective Study

Deepak Singla et al. Cureus. .

Abstract

Objectives Whether a higher or lower partial pressure of oxygen (PaO2) could impact outcomes in patients with coronavirus disease 2019 (COVID-19) remains a matter of debate. So, we planned this retrospective analysis to determine if a higher or lower partial pressure of oxygen in blood had any effect on outcomes in COVID-19 patients. Material and method The records of COVID-19 patients from the beginning of 2020 to the end of 2022 were scanned. Patients were sub-grouped into two groups based on the partial pressure of oxygen (PaO2) values on arterial blood gas (ABG), i.e., high PaO2 group, PaO2 value of 80-100 mm Hg, and low PaO2 group, PaO2 value of 60-80 mm Hg for the first 48 hours after the initiation of oxygenation and/or mechanical ventilation. The two groups were compared in terms of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen (FiO2) concentration (P/F ratio), Sequential Organ Failure Assessment (SOFA) score at presentation and after 48 hours, and clinical outcomes, including mortality, time of mortality, extubation, acute kidney injury (AKI), and change in Glasgow Coma Scale (GCS). Results SOFA score was significantly higher in the low PaO2 group as compared to the high PaO2 group both at baseline (4.59 {1.79} versus 5.51 {1.15}; p-value: 0.005) and at 48 hours (3.06 {1.39} versus 5.11 {2.13}; p-value: 0.007). However, the change in SOFA score over 48 hours did not achieve statistical significance (-1.000 {0.97} versus 0.53 {2.34}; p-value: 0.257). Out of a total of 37 patients, 21 patients died in the high PaO2 group, while 18 patients died in the low PaO2 group. Conclusion Our study highlights that targeting either low or high arterial oxygen content while considering oxygen therapy for COVID-19 patients did not significantly alter the outcomes.

Keywords: acute kidney injury; covid-19; glasgow coma scale; lactates; oxygen inhalation therapy; sequential organ failure assessment score.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. The Institutional Ethics Committee of the All India Institute of Medical Sciences, Rishikesh, issued approval AIIMS/IEC/24/297. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) flow diagram
COVID-19, coronavirus disease 2019; GOLD, Global Initiative for Chronic Obstructive Lung Disease; SOFA, Sequential Organ Failure Assessment; ABG, arterial blood gas; PaO2, partial pressure of oxygen; FiO2, fraction of inspiratory oxygen; h/o, history of
Figure 2
Figure 2. Mean FiO2 (A), PaO2 (B), and PaO2/FiO2 (C) in the high PaO2 and low PaO2 groups over the first 48 hours
FiO2, fraction of inspiratory oxygen; PaO2, partial pressure of oxygen
Figure 3
Figure 3. A Kaplan-Meier curve with a log-rank test
ICU: intensive care unit
See this image and copyright information in PMC

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