Pulse oximeter readings arent perfect. An official website of the United States government. Our website services, content, and products are for informational purposes only. Altogether, the findings suggest that a combination of all three factors are likely to be responsible for the severe cases of low oxygen in some COVID-19 patients. (2022). But exactly how that domino effect occurs has not been clear until now. We Can Print Them, Human-Approved Medication Brings Back 'Lost' Memories in Mice, See No Evil: People Find Good in Villains, Clinical Trial Reveals New Treatment Option for COVID-19, Why Drug Used to Treat Critically Ill COVID-19 Patients May Only Benefit Males, COVID-19: Enzyme Targeted by Virus Also Influences Gut Inflammation, Further Evidence Does Not Support Hydroxychloroquine for Patients With COVID-19, CCPA/CPRA: Do Not Sell or Share My Information. Monitoring your oxygen level with a pulse oximeter if you have COVID-19 can help determine if it falls too low. A systematic review and meta-analysis. Common causes of hypoxemia include: Anemia. When we breathe in air, our lungs transmit oxygen into tiny blood vessels called capillaries. The saturation level can range anywhere between 94-100. These blood clots in the large and small arteries of the heart cut off its supply of oxygen. 1 In most patients who die of acute covid-19, the initial illness advances insidiously, sometimes with . However, if the use of nitric oxide does not improve a patients oxygenation, it should be tapered quickly to avoid rebound pulmonary vasoconstriction, which may occur when nitric oxide is discontinued after prolonged use. Why did outbreaks of severe acute respiratory syndrome occur in some hospital wards but not in others? If you're not sure what "fully vaccinated" means these days, our guide can help. Nonhospitalized Adults: General Management, Nonhospitalized Adults: Therapeutic Management, Hospitalized Adults: Therapeutic Management, Nonhospitalized Children: Therapeutic Management, Hospitalized Children: Therapeutic Management, Hospitalized Pediatric Patients: Therapeutic Management of MIS-C, Pharmacologic Interventions for Critically Ill Patients, Introduction to Critical Care for Children, Clinical Spectrum of SARS-CoV-2 Infection, https://www.ncbi.nlm.nih.gov/pubmed/32160661, https://www.ncbi.nlm.nih.gov/pubmed/29726345, https://www.ncbi.nlm.nih.gov/pubmed/35679133, https://www.ncbi.nlm.nih.gov/pubmed/35793817, https://www.ncbi.nlm.nih.gov/pubmed/25981908, https://www.ncbi.nlm.nih.gov/pubmed/28780231, https://www.ncbi.nlm.nih.gov/pubmed/33764378, https://www.ncbi.nlm.nih.gov/pubmed/35072713, https://www.ncbi.nlm.nih.gov/pubmed/34874419, https://www.ncbi.nlm.nih.gov/pubmed/22563403, https://www.ncbi.nlm.nih.gov/pubmed/17366443, https://s3.amazonaws.com/cdn.smfm.org/media/2734/SMFM_COVID_Management_of_COVID_pos_preg_patients_2-2-21_(final).pdf, https://www.ncbi.nlm.nih.gov/pubmed/32928787, https://www.ncbi.nlm.nih.gov/pubmed/23688302, https://www.ncbi.nlm.nih.gov/pubmed/28459336, https://www.ncbi.nlm.nih.gov/pubmed/32189136, https://www.ncbi.nlm.nih.gov/pubmed/32412581, https://www.ncbi.nlm.nih.gov/pubmed/32412606, https://www.ncbi.nlm.nih.gov/pubmed/32320506, https://www.ncbi.nlm.nih.gov/pubmed/34425070, https://www.ncbi.nlm.nih.gov/pubmed/20197533, https://www.ncbi.nlm.nih.gov/pubmed/32222812, https://www.ncbi.nlm.nih.gov/pubmed/32329799, https://www.ncbi.nlm.nih.gov/pubmed/32505186, https://www.ncbi.nlm.nih.gov/pubmed/32227758, https://www.ncbi.nlm.nih.gov/pubmed/32442528, https://www.ncbi.nlm.nih.gov/pubmed/32348678, https://www.ncbi.nlm.nih.gov/pubmed/32432896, https://www.ncbi.nlm.nih.gov/pubmed/29068269, https://www.ncbi.nlm.nih.gov/pubmed/29043837, https://www.ncbi.nlm.nih.gov/pubmed/27347773, For adults with COVID-19 and acute hypoxemic respiratory failure despite conventional oxygen therapy, the Panel recommends starting therapy with HFNC oxygen; if patients fail to respond, NIV or intubation and mechanical ventilation should be initiated, For adults with COVID-19 and acute hypoxemic respiratory failure who do not have an indication for endotracheal intubation and for whom HFNC oxygen is not available, the Panel recommends performing a closely monitored trial of NIV, For adults with persistent hypoxemia who require HFNC oxygen and for whom endotracheal intubation is not indicated, the Panel recommends a trial of awake prone positioning. The potential harm of maintaining an SpO2 <92% was demonstrated during a trial that randomly assigned patients with ARDS who did not have COVID-19 to either a conservative oxygen strategy (target SpO2 88% to 92%) or a liberal oxygen strategy (target SpO2 96%).1 The trial was stopped early due to futility after enrolling 205 patients, but increased mortality was observed at Day 90 in the conservative oxygen strategy arm (between-group risk difference 14%; 95% CI, 0.7% to 27%), and a trend toward increased mortality was observed at Day 28 (between-group risk difference 8%; 95% CI, -5% to 21%). "Low blood-oxygen levels have been a significant problem in COVID-19 patients," said study lead Shokrollah Elahi, associate professor in the Faculty of Medicine & Dentistry. If a patient can't make it to the number 10 (or seven seconds) without another breath, it's likely their oxygen level has . University of Alberta Faculty of Medicine & Dentistry. COVID-19 is a respiratory infection. They found, using computer modeling of the lungs, that this could incite silent hypoxia, but alone it is likely not enough to cause oxygen levels to drop as low as the levels seen in patient data. My SPO2 is fluctuate between 89 to 99 and more constant between 92/95. It's an electronic device that clips onto a patient's finger to measure heart rate and oxygen saturation in his or her red blood cellsthe device is useful in assessing patients with lung disease. At levels below 90%, the brain may not get sufficient oxygen, and patients might start experiencing confusion, lethargy or other mental disruptions. When your lungs are inflamed due to a severe infection like COVID-19, you may take in less oxygen with each breath. Keeping up with COVID-19 booster eligibility can be tough. It requires the patient to take a breath and try counting to 30. The oxygen in your blood also helps your cells create energy. We avoid using tertiary references. Our family followed all the rules and somehow, all five of us tested positive, got sick and struggled to recover from COVID-19. In . Congenital heart defects in children. The novel coronavirus has changed how we live and breathe. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Read More. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. As discussed above, oxygen is important for the body to function. As you recover, youll transition from intubation to a nasal cannula and tank oxygen. As a family in New Jersey, we have been at the epicenter of the U.S. COVID-19 outbreak. In some cases, you might be discharged from the hospital with portable oxygen, home oxygen tanks, and a nasal cannula. The Sars CoV-2 virus causes Covid-19 pneumonia and hypoxaemia. Add your information below to receive daily updates. As immature red blood cells are destroyed by the virus, the body is unable to replace mature red blood cells, and the ability to transport oxygen in the bloodstream is impaired. For many people, COVID-19 is a mild illness that resolves on its own. Symptoms of a low blood oxygen level include: The primary treatment for low oxygen levels is oxygen therapy. Data with the National Clinical Registry for Covid-19 shows a new emerging trend . If you have a chronic health condition that affects your lungs, blood, or circulation, regularly tracking your oxygen saturation is important. Similarly, you could have a low blood oxygen level and not have COVID-19. The RECOVERY-RS trial was an adaptive randomized controlled trial that was essentially conducted as 2 separate trials that compared NIV and HFNC oxygen to the same conventional oxygen therapy control group.8 The trial was stopped early and enrolled fewer than a third of the planned sample size of 4,002 participants. Digestive symptoms, like stomach pain, might be among the earliest symptoms of COVID-19 that you experience. Mortality was higher among patients who were treated with incremental PEEP titration recruitment maneuvers than among those who were treated with traditional recruitment maneuvers, but this difference was not statistically significant (risk ratio 1.06; 95% CI, 0.971.17). Oxygen therapy gets oxygen into your bloodstream and helps take the pressure off your lungs so that you recover from COVID-19. They found, using computer modeling of the lungs, that this could incite silent hypoxia, but alone it is likely not enough to cause oxygen levels to drop as low as the levels seen in patient data. Immature red blood cells are highly susceptible to COVID-19 infection. First, dexamethasone suppresses the response of the ACE2 and TMPRSS2 receptors to SARS-CoV-2 in immature red blood cells, reducing the opportunities for infection. The typical accuracy rate for prescription oximeters is 4% below or above a reading. In early September, the All India Institute of Medical Sciences released a report that showed several patients succumbing to the Covid-19 infection due to sudden cardiac arrest and silent hypoxia that went unnoticed as there is no visible breathing distress. The study has also shed light on why the anti-inflammatory drug dexamethasone has been an effective treatment for those with the virus. The problem is that immature red blood cells do not transport oxygen -- only mature red blood cells do. In most people, the body needs a minimum of 95% of oxygen in the blood to function ably. In addition, 90-day mortality was higher in both the conventional oxygen therapy arm (HR 2.01; 95% CI, 1.013.99) and the NIV arm (HR 2.50; 95% CI, 1.314.78) than in the HFNC oxygen arm. Fortunately, blood oxygen levels can be easily monitored at home with a pulse oximeter. If someone has COVID-19, a pulse oximeter may help them keep watch over their health and know if they need to seek medical care. This is actually a good thing that our lungs have evolved to do, because it forces blood to instead flow through lung tissue replete with oxygen, which is then circulated throughout the rest of the body. Get the latest science news in your RSS reader with ScienceDaily's hourly updated newsfeeds, covering hundreds of topics: Keep up to date with the latest news from ScienceDaily via social networks: Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Low blood oxygentechnically, hypoxaemia but usually referred to as hypoxiacan be defined as a measured oxygen saturation below 94% in the absence (or below 88% in the presence) of chronic lung disease. Elahi further added, "Because of that, we thought one potential mechanism might be that Covid-19 impacts red blood cell production.". Respiratory parameters in patients with COVID-19 after using noninvasive ventilation in the prone position outside the intensive care unit. Effect of helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure: the HENIVOT randomized clinical trial. Resurrected Supernova Provides Missing-Link, Bald Eagles Aren't Fledging as Many Chicks, Ultracool Dwarf Binary Stars Break Records, Deflecting Asteroids to Protect Planet Earth, Quantum Chemistry: Molecules Caught Tunneling, Shark from Jurassic Period Highly Evolved. NIV refers to the delivery of either continuous positive airway pressure (CPAP) or bilevel positive airway pressure (e.g., BiPAP) through a noninvasive interface, such as a face mask or nasal mask. Intubation helps keep your airways open so that oxygen can get to your body. Do not rely on an oximeter to determine a COVID-19 diagnosis. Those low oxygen levels can can irreparably damage vital organs if gone undetected for too long. The most recent research on the Omicron variant suggests it lives longer on surfaces than previous coronavirus variants. It can be helpful to assess blood oxygen levels in patients when they are walking if that level is normal when they are sitting, a new study suggests. Yes. There was substantial crossover between the arms, but an inverse probability weighting analysis that corrected for the bias that this may have introduced did not change the results.8 Adverse events were more common in the NIV arm. His blood pressure was fluctuating. Therefore, the pertinent clinical question is whether HFNC oxygen or NIV should be used in situations where a patient fails to respond to conventional oxygen therapy. To get more reliable data on blood oxygen levels in people with darker skin, its best to take regular readings throughout the day and to keep a record. Luckily, putting Elahi's findings into practice doesn't require significant changes in the way COVID-19 patients are being treated now. Unfortunately, we found out first-hand that you can do everything right and you can still get infected. We use the latest interactive tools, graphics, live webinars and events, interviews, medical imagery, and more. Can a COVID-19 Vaccine Increase Your Risk of Shingles? Regarding the individual components of the composite endpoint, the incidence of intubation by Day 28 was lower in the awake prone positioning arm than in the standard care arm (HR for intubation 0.75; 95% CI, 0.620.91). "New study may help explain low oxygen levels in COVID-19 patients: Researchers find SARS-CoV-2 infects immature red blood cells, reducing oxygen in the blood and impairing immune response." Options for providing enhanced respiratory support include using high-flow nasal canula (HFNC) oxygen, noninvasive ventilation (NIV), intubation and mechanical ventilation, or extracorporeal membrane oxygenation. All rights reserved. Briel M, Meade M, Mercat A, et al. The primary endpoint was a composite of endotracheal intubation or death within 30 days. Furthermore, the Panel recognizes that for patients who need more oxygen support than a conventional nasal cannula can provide, most clinicians will administer oxygen via HFNC and subsequently progress to NIV if needed. Can Probiotics Help Prevent or Treat COVID-19 Infection? Original Study APSF statement on pulse oximetry and skin tone. Sun Q, Qiu H, Huang M, Yang Y. If a person believes that they are experiencing low oxygen levels, they should contact a medical professional as soon as possible. Sartini C, Tresoldi M, Scarpellini P, et al. . Learn how it feels and how to manage it. 4. Treating low oxygen levels at the hospital, How to raise your oxygen level at home when you have COVID-19, cdc.gov/coronavirus/2019-ncov/videos/oxygen-therapy/Basics_of_Oxygen_Monitoring_and_Oxygen_Therapy_Transcript.pdf, medlineplus.gov/lab-tests/blood-oxygen-level/, lung.org/media/press-releases/pulse-oximeter-covid-19, apsf.org/article/apsf-statement-on-pulse-oximetry-and-skin-tone/. Clinicians should monitor patients for known side effects of higher levels of PEEP, such as barotrauma and hypotension. "Data from China suggested . Learn how this happens and if you can prevent it. Note: Content may be edited for style and length. The only way to know for sure if you have COVID-19 is to get tested. Gebistorf F, Karam O, Wetterslev J, Afshari A. The patients in the HFNC oxygen arm had more ventilator-free days (mean 24 days) than those in the conventional oxygen therapy arm (mean 22 days) or the NIV arm (mean 19 days; P = 0.02). HAPPY HYPOXIA IN COVID-19. Management considerations for pregnant patients with COVID-19. If your oxygen saturation (oxygen level) is low when you have symptoms of COVID-19, it might mean you have severe illness Hold . Some coronavirus patients have experienced what some experts have described as levels of blood oxygen that are incompatible with life. Disturbingly, Suki says that many of these patients showed little to no signs of abnormalities when they underwent lung scans. Cookie Policy. When the team began exploring why dexamethasone had such an effect, they found two potential mechanisms. These causes include impaired blood flow and blood oxygenation in the lungs. The lungs of patients requiring mechanical ventilation due to COVID-19 are so inflamed that oxygen is not able . Now, among the patients who are suffering from COVID-19, it has been noted that most . In the prepandemic PROSEVA study of patients with moderate or severe early ARDS (PaO2/FiO2 <150 mm Hg) who required mechanical ventilation, the patients who were randomized to undergo prone positioning for 16 hours per day had improved survival compared to those who remained in the supine position throughout their course of mechanical ventilation.14 A meta-analysis evaluated the results of the PROSEVA study and 7 other randomized controlled trials that investigated the use of prone positioning in people with ARDS.29 A subgroup analysis revealed that mortality was reduced among patients who remained prone for 12 hours per day when compared with patients who remained in the supine position (risk ratio 0.74; 95% CI, 0.560.99). 1. Patients with severe disease typically require supplemental oxygen and should be monitored closely for worsening respiratory status, because some patients may progress to acute respiratory distress syndrome (ARDS). Oxygen levels in covid-19. Get your query answered 24*7 only on | Practo Consult . And because oxygen levels can fluctuate, consider taking measurements a few times a day. (Credit: Go Nakamura/Getty Images). Its important to seek emergency medical care if: If you need more support, you might receive oxygen therapy through a process called intubation. Haemoglobin is a protein in the blood that carries oxygen to cells of the body. 3. A new study, published in the journal Stem Cell Reports, has explained why many Covid-19 patients, even those not in the hospital, are suffering from hypoxia -- a potentially dangerous condition in which there is decreased oxygenation in the body's tissues. Tsolaki V, Siempos I, Magira E, et al. Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 201319: multicenter, retrospective cohort study. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Additionally, the RECOVERY-RS trial was stopped long before it reached its planned sample size for reasons not related to futility, efficacy, or harm; inferring benefit in this context is questionable. These events occurred infrequently during the study, and the incidences for these events were similar between the arms. Pulse oximeter not a substitute for talking to healthcare provider, watching for early COVID-19 symptoms. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lung recruitment maneuvers for adult patients with acute respiratory distress syndrome. While an at-home pulse oximeter can be helpful in certain situations, it has limitations and only shows one small aspect of your health. eCG normal, echo normal. SARS-CoV-2, the virus that causes COVID-19, infects immature red blood cells, reducing oxygen in the blood and hindering immune response, according to a new study published in Stem Cell Reports. In contrast to the RECOVERY-RS trial, the HiFlo-COVID trial randomized 220 patients with COVID-19 to receive HFNC oxygen or conventional oxygen therapy and found that a smaller proportion of patients in the HFNC oxygen arm required intubation (34.3% vs. 51.0%; P = 0.03). The Awake Prone Positioning Meta-Trial Group conducted the largest trial to date on awake prone positioning.20 This was a prospective, multinational meta-trial of 6 open-label, randomized, controlled, superiority trials that compared awake prone positioning to standard care in adults who required HFNC oxygen for acute hypoxemic respiratory failure due to COVID-19. 3. Grieco DL, Menga LS, Cesarano M, et al. An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. . Speaking to the media, study leads Shokrollah Elahi, Associate Professor in the Faculty of Medicine and Dentistry at University of Alberta, Canada, said, "Low. youre confused or are having trouble speaking, your lips, nail beds, and skin have turned pale, gray, or blue. A member of the medical staff treats a patient in the COVID-19 intensive care unit at the United Memorial Medical Center on July 2, 2020 in Houston, Texas. "These findings are exciting but also show two significant consequences," Elahi said. DOI: 10.1038/s41467-020-18672-6. During the first 14 days of the study, the median daily duration of awake prone positioning was 5.0 hours (IQR 1.68.8 hours).20 However, the median daily duration varied from 1.6 hours to 8.6 hours across the individual trials. Next, they looked at how blood clotting may affect blood flow in different regions of the lung. This is one of the most vital functioning of the human body. Patients who can adjust their position independently and tolerate lying prone can be considered for awake prone positioning. "New study may help explain low oxygen levels in COVID-19 patients: Researchers find SARS-CoV-2 infects immature red blood cells, reducing oxygen in the blood and impairing immune response." One study found that Black people were more than three times more likely than white people to have a pulse oximetry reading higher than the true value. With a massive second wave of Covid-19 sweeping through the city, it has been observed that the oxygen level drops faster in patients once the saturation falls below 94 per . The authors suggest that people who contract COVID-19 monitor their blood-oxygen saturation with a pulse oximeter. The patients included those who were critically ill and admitted to the ICU, those who had moderate symptoms and were admitted to hospital, and those who had a mild version of the disease and only spent a few hours in hospital. Some ways include: Open windows or get outside to breathe fresh air. Lack of oxygen in the body can also lead to neurological complications. Awake prone positioning, or having a nonintubated patient lie on their stomach, may improve oxygenation and prevent the patient from progressing to requiring intubation and mechanical ventilation. Pulse oximeters have often been applied because of concerns that patients might not notice their blood oxygen levels sliding dangerously. Covid-19 patients whose oxygen levels drop even slightly below 96% may face a greater risk of dying and current NHS guidelines aren't sensitive enough, study warns. The proportion of patients who met the primary endpoint was significantly lower in the NIV arm than in the conventional oxygen therapy arm (36.3% vs. 44.4%; P = 0.03). In this section, mechanical ventilation refers to the delivery of positive pressure ventilation through an endotracheal or tracheostomy tube. The smartwatches use reflectance oximetry while the oximeters use transmittance oximetry. COVID-19-related inflammation raises the risk of this type of heart attack by activating the body's clotting system and disrupting the blood vessel lining. Health & Wellness. As oxygen levels drop in patients with Covid-19, the brain does not respond until oxygen falls to very low levels -- at which point a patient typically becomes short of breath," he said. Without the nuclei, the virus has nowhere to replicate, the researchers said. Perkins GD, Ji C, Connolly BA, et al. In these patients, higher PEEP levels may cause harm by compromising hemodynamics and cardiovascular performance.23,24 Other studies have reported that patients with moderate to severe ARDS due to COVID-19 had low lung compliance, similar to the lung compliance seen in patients with conventional ARDS.25-28 These seemingly contradictory observations suggest that patients with COVID-19 and ARDS are a heterogeneous population, and assessments for responsiveness to higher levels of PEEP should be individualized based on oxygenation and lung compliance. Congenital heart disease in adults. Take accuracy rate into account. We aimed to determine the accuracy of post-exertional oxygen saturation for predicting adverse outcome in suspected COVID-19. As levels drop into the low 80s or below, the . Prone positioning improved oxygenation in all of the trials; patients in the prone positioning arms had higher PaO2/FiO2 on Day 4 than those in the supine positioning arms (mean difference 23.5 mm Hg; 95% CI, 12.434.5). But that just creates more targets for the virus. This scientific letter considers the rationale for the target oxygen saturation measured by pulse oximetry (SpO 2) range of 92-96% for oxygen therapy in adult patients without COPD or other conditions associated with chronic respiratory failure, recommended by the Thoracic Society of Australia and New Zealand, in contrast to the 94-98% target range recommended by the British Thoracic Society. Should people with COVID-19 use a pulse oximeter? For those individuals who are having an oxygen saturation of 92 or 94, there is no need to take high oxygen just to maintain your saturation. Any decline in its level can turn fatal. Hypoxia refers to a condition when the oxygen level in the blood drops below the average mark. The Food and Drug Administrations independent vaccine advisory committee voted unanimously in favor of having all COVID-19 vaccines in the United, You may wonder whether supplementing with vitamin D can help reduce your risk of contracting the new coronavirus that causes COVID-19. 9 Patients in the HFNC arm also had a shorter median time to recovery (11 . "We tried the anti-inflammatory drug dexamethasone, which we knew helped to reduce mortality and the duration of the disease in COVID-19 patients, and we found a significant reduction in the infection of immature red blood cells," said Elahi. Frat JP, Thille AW, Mercat A, et al. The drug also increases the rate at which the immature RBCs mature, helping the cells shed their nuclei faster. Healthy lungs keep the blood oxygenated at a level between 95 and 100%if it dips below 92%, its a cause for concern and a doctor might decide to intervene with supplemental oxygen. Pulse oximetry for monitoring patients with covid-19 at home a pragmatic, randomized trial. A pulse oximeter gives you your blood oxygen level as a simple percentage. Futurity is your source of research news from leading universities. Researchers have begun to solve one of COVID-19s biggest and most life-threatening mysteries: how the virus causes silent hypoxia, a condition where oxygen levels in the body are abnormally low. His kidneys were taking a hit. It can be easily measured using an oximeter, which is one of the highest-selling medical equipment today. Awake prone positioning is acceptable and feasible for pregnant patients and can be performed in the left lateral decubitus position or the fully prone position. (2021, June 2). High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. Can Vitamin D Lower Your Risk of COVID-19? A low level of oxygen in the blood, or . Feeling weak all the time and then being unable to breath is terrible. Your blood oxygen level is a measure of the amount of oxygen in your blood. Blood oxygen level is the amount of oxygen circulating in the blood. Happy hypoxia describes a situation in which a person's blood oxygen levels are low but they feel fine. Consume a Nutritious Diet. For mechanically ventilated adults with COVID-19 and ARDS: There is no evidence that ventilator management of patients with hypoxemic respiratory failure due to COVID-19 should differ from ventilator management of patients with hypoxemic respiratory failure due to other causes. The importance of properly performing recruitment maneuvers was illustrated by an analysis of 8 randomized controlled trials in patients without COVID-19 (n = 2,544) that found that recruitment maneuvers did not reduce hospital mortality (risk ratio 0.90; 95% CI, 0.781.04).22 However, a subgroup analysis found that traditional recruitment maneuvers significantly reduced hospital mortality (risk ratio 0.85; 95% CI, 0.750.97). The SARS-CoV-2 - virus that causes coronavirus, after entering the body infects the immature red blood cells (RBC) which eventually results in the reduction or declination of the oxygen level in the blood, causing serious effects on the immune system's response. A normal breathing rate is 12 to 20 breaths per minute. Oxygen levels at 95 to 96 percent is normal, do a online consultation with a pulmonologist in view of any persistent symptoms . Initially, a comparison between NIV and HFNC oxygen was not planned, but a post hoc analysis found that the proportion of patients who required endotracheal intubation or died was lower in the NIV arm than in the HFNC oxygen arm (34.6% vs. 44.3%; P = 0.02).