{
    "abstract": "Despite critical hypoxemia, Covid-19 patients may present without proportional signs of respiratory distress. We report three patients with critical respiratory failure due to Covid-19, in which all presented with severe hypoxemia refractory to supplemental oxygen therapy. We discuss possible strategies for ventilatory support in the emergency pre-hospital setting, and point out some pitfalls regarding the management of these patients. Guidelines for pre-hospital care of critically ill Covid-19 patients cannot be established based on the current evidence base, and we have to apply our understanding of respiratory physiology and mechanics in order to optimize respiratory support.\nThree cases with similar clinical presentation were identified within the Norwegian national helicopter emergency medical service (HEMS) system. The HEMS units are manned by a consultant anaesthesiologist. Patient's next of kin and the Regional committee for medical and health research ethics approved the publication of this report.\nPatients with Covid-19 and severe hypoxemia may pose a considerable challenge for the pre-hospital emergency medical services. Intubation may be associated with a high risk of complications in these patients and should be carried out with diligence when considered necessary. The following interventions are worth considering in Covid-19 patients with refractory hypoxemia before proceeding to intubation. First, administering oxygen via a tight fitting BVM with an oxygen flow rate that exceeds the patient's ventilatory minute volume. Second, applying continuous positive airway pressure, while simultaneously maintaining a high FiO",
    "authors": [
        {
            "affiliation": "Air Ambulance Department, Oslo University Hospital, Oslo, Norway. jmaehlen@hotmail.com.\nDepartment of Anesthesiology, Akershus University Hospital, Sykehusveien 25, 1478, L\u00f8renskog, Norway. jmaehlen@hotmail.com.",
            "firstname": "Jens Otto",
            "initials": "JO",
            "lastname": "M\u00e6hlen"
        },
        {
            "affiliation": "Air Ambulance Department, Vestre Viken, \u00c5l, Norway.",
            "firstname": "Roger",
            "initials": "R",
            "lastname": "Mikalsen"
        },
        {
            "affiliation": "Air Ambulance Department, Oslo University Hospital, Oslo, Norway.",
            "firstname": "Hans Julius",
            "initials": "HJ",
            "lastname": "Heimdal"
        },
        {
            "affiliation": "Air Ambulance Department, Oslo University Hospital, Oslo, Norway.\nDepartment of Research and development, Norwegian Air Ambulance Foundation, Oslo, Norway.\nFaculty of Health Sciences, University of Stavanger, Stavanger, Norway.",
            "firstname": "Marius",
            "initials": "M",
            "lastname": "Rehn"
        },
        {
            "affiliation": "Air Ambulance Department, Oslo University Hospital, Oslo, Norway.\nDepartment of Research and development, Norwegian Air Ambulance Foundation, Oslo, Norway.\nFaculty of Medicine, University of Oslo, Oslo, Norway.",
            "firstname": "Jostein S",
            "initials": "JS",
            "lastname": "Hagemo"
        },
        {
            "affiliation": "Air Ambulance Department, Oslo University Hospital, Oslo, Norway.",
            "firstname": "William",
            "initials": "W",
            "lastname": "Ottestad"
        }
    ],
    "conclusions": "Patients with Covid-19 and severe hypoxemia may pose a considerable challenge for the pre-hospital emergency medical services. Intubation may be associated with a high risk of complications in these patients and should be carried out with diligence when considered necessary. The following interventions are worth considering in Covid-19 patients with refractory hypoxemia before proceeding to intubation. First, administering oxygen via a tight fitting BVM with an oxygen flow rate that exceeds the patient's ventilatory minute volume. Second, applying continuous positive airway pressure, while simultaneously maintaining a high FiO",
    "copyrights": null,
    "doi": "10.1186/s13049-021-00831-3\n10.1148/radiol.2020200274\n10.1111/acem.13994\n10.1016/j.rmed.2013.02.004\n10.3357/AMHP.5173.2018\n10.1111/anae.15054\n10.1186/s13613-019-0618-4\n10.1186/s13613-020-00650-2\n10.1016/0883-9441(91)90002-B\n10.1056/NEJMoa1214103\n10.1097/RLI.0000000000000670\n10.1086/425357",
    "journal": "Scandinavian journal of trauma, resuscitation and emergency medicine",
    "keywords": [
        "Case series",
        "Covid-19",
        "Hypoxemia",
        "Non-invasive ventilation",
        "Prehospital"
    ],
    "methods": null,
    "publication_date": "2021-01-14",
    "pubmed_id": "33436033\n32171076\n32471783\n32378842\n33128800\n32362340\n32437596\n32114094\n32027573\n32320506\n32291463\n23490227\n30487024\n32221970\n32519064\n32189136\n32430410\n32312571\n23419338\n23688302\n32091414\n15546092",
    "results": null,
    "title": "Pre-hospital critical care management of severe hypoxemia in victims of Covid-19: a case series.",
    "xml": "<Element 'PubmedArticle' at 0x7885059139c0>"
}