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Oxygen saturation in pregnant individuals with COVID-19: Time for re-appraisal?

ABSTRACT: Managing pregnant individuals with acute respiratory disease secondary to Coronavirus disease 2019 has been a challenge. Most professional societies including the Society for Maternal Fetal Medicine recommend keeping oxygen saturation greater than or equal to 95% in pregnant individuals. Reaching this target has been increasingly difficult in some patients, especially with the latest wave of the virus attributed to the delta variant. In the absence of strong data, and in the setting of reassuring fetal status, we propose maintaining maternal oxygen saturation between 92-96% for admitted patients with acute respiratory failure requiring supplemental oxygen. This may prevent unnecessary invasive interventions that might not be of maternal or fetal benefit, specifically at very preterm gestational ages.

SUBMITTER: Eid J

PROVIDER: S-EPMC8675122 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe current target oxygen saturation range for patients with COVID-19 recommended by the National Institutes of Health is 92-96%.Main bodyThis article critically examines the evidence guiding current target oxygen saturation recommendation for COVID-19 patients, and raises important concerns in the extrapolation of data from the two studies stated to be guiding the recommendation. Next, it examines the influence of hypoxia on upregulation of ACE2 (target receptor for SARS-CoV-2 entry) expression, with supporting transcriptomic analysis of a publicly available gene expression profile dataset of human renal proximal tubular epithelial cells cultured in normoxic or hypoxic conditions. Finally, it discusses potential implications of specific clinical observations and considerations in COVID-19 patients on target oxygen saturation, such as diffuse systemic endothelitis and microthrombi playing an important pathogenic role in the wide range of systemic manifestations, exacerbation of hypoxic pulmonary vasoconstriction in the setting of pulmonary vascular endothelitis/microthrombi, the phenomenon of "silent hypoxemia" with some patients presenting to the hospital with severe hypoxemia disproportional to symptoms, and overburdened health systems and public health resources in many parts of the world with adverse implications on outpatient monitoring and early institution of oxygen supplementation.ConclusionsThe above factors and analyses, put together, call for an urgent exploration and re-evaluation of target oxygen saturation in COVID-19 patients, both in the inpatient and outpatient settings. Until data from such trials become available, where possible, it may be prudent to target an oxygen saturation at least at the upper end of the recommended 92-96% range in COVID-19 patients both in the inpatient and outpatient settings (in patients that are normoxemic at pre-COVID baseline). Home pulse oximetry, tele-monitoring, and earlier institution of oxygen supplementation for hypoxemic COVID-19 outpatients could be beneficial, where public health resources allow for their implementation.

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Oxygen saturation in pregnant individuals with COVID-19: Time for re-appraisal?

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