Subclinical Hypoxemia in COVID-19 Patients: Physiological Rationale and Management in Neurotrauma Patients

COVID-19 is a heterogeneous disease.[1] Presenting itself with different faces, it makes the care and management of infected patients a challenge. As a result of rapid virtual interactions, leading to successful communication between physicians over the preceding months from all over the world, we now know multiple clinical manifestations and the pathophysiological impact of this disease.[2] The physiological rationale and current evidence of subclinical hypoxemia in COVID-19 patients will be briefly discussed with regard to traumatic brain injury (TBI).

Two important aspects in the management of the patient with TBI are the timely correction of hypotension and hypoxemia. Both alterations have been related to increased mortality in patients with TBI.[3] [4] Galwankar et al propose an interesting algorithm for the approach and management of subclinical hypoxemia in COVID-19 patients;[5] the application of this scheme will allow an easy management of patients with this physiological alteration of important clinical repercussion. Davis et al report that hypoxemia and hyperoxemia are deleterious situations that impact the outcome of patients with TBI.[6]

Although intubation based on hypoxemia is debatable as the only criterion, since patients with COVID-19 frequently present with this condition.[7] The low-arterial oxygen from the physiological point of view and its impact on brain physiology generates concern. However, we must consider that many patients with TBI are carriers of associated acute pathologies (thorax trauma) and comorbidities (chronic obstructive pulmonary disease [COPD], heart disease) that make the scenario very complex.

Although we know little about the effect of subclinical hypoxemia in patients with TBI, we suggest the following recommendations: All patients with TBI should be considered as a carrier of COVID-19 until it is ruled out by laboratory studies; the timely stabilization of physiological parameters is essential to avoid collateral injury to the brain; and COVID-19 testing should be mandatory in all patients with neurotrauma. Further studies are required to elucidate the role of subclinical hypoxemia in COVID-19 and neurotrauma.

Conflict of Interest

None declared.

• References

• 1 Stawicki SP, Jeanmonod R, Miller AC. et al. The 2019–2020 Novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: a joint American college of academic international medicine-world academic council of emergency medicine multidisciplinary COVID-19 working group statement. J Glob Infect Dis 2020; 12: 47-93
• 2 Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysi-ology: a review. Clin Immunol 2020; 215 (e-pub ahead of print) DOI: 10.1016/j.clim.2020.108427.
• 3 Jeremitsky E, Omert L, Dunham CM, Protetch J, Rodriguez A. Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. J Trauma 2003; 54 (02) 312-319
• 4 Chi JH, Knudson MM, Vassar MJ. et al. Prehospital hypoxia affects outcome in patients with traumatic brain injury: a prospective multicenter study. J Trauma 2006; 61 (05) 1134-1141
• 5 Galwankar SC, Paladino L, Gaieski DF. et al. Management algorithm for subclinical hypoxemia in coronavirus disease-2019 patients: intercepting the “silent killer”. . J Emerg Trauma Shock 2020; 13: 110-113
• 6 Davis DP, Meade W, Sise MJ. et al. Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury. J Neurotrauma 2009; 26 (12) 2217-2223
• 7 Tobin MJ. Basing respiratory management of COVID-19 on physiological principles. Am J Respir Crit Care Med 2020; 201 (11) 1319-1320

Publikationsverlauf

Artikel online veröffentlicht:
09. Oktober 2020