Silent hypoxaemia in COVID-19: Journey through ICU

Abstract

Silent hypoxia is a well-known entity associated with SARSCoV-2 [1,2]. It is a condition where despite the patient being hypoxic, they do not show any signs and symptoms of respiratory distress [2]. Hypoxia can only be detected either by pulse oximetry reading or through blood gas analysis. These patients may have variable radiological appearances on presentation. Many studies have shown silent hypoxia has a high incidence of 20-40% with patients with SARS-CoV-2 pneumonia [2,3]. Some patients need intensive care support and some recover without any supports. Here we present a series of chest radiographs of a patient presented with silent hypoxia. A previously well 53 year old male presented to a COVID-19 treatment facility with a positive antigen testing. At the time of admission, the patient was well with a respiratory rate of 16/min and stable haemodynamics. There were no other signs and symptoms of respiratory distress. His routine pulse oximetry reading was 66% with an arterial oxygen partial pressure of 56 mmHg. The first chest radiograph showed an extensive air space opacification (Figure 1). The appearance was so severe and did not match with his clinical picture. An entity of silent hypoxia was diagnosed, and he was admitted to the Intensive care unit and started on face mask oxygen through 60% venturi.