# Outcomes and Functional Deterioration in Hospital Admissions with Acute Hypoxemia

## TL;DR

Most patients admitted to the hospital with acute low oxygen levels experience a significant decline in their ability to function after discharge.

## Contribution

The study highlights the high rate of functional deterioration in patients with acute hypoxemia and suggests guidelines for future clinical trials.

## Key findings

- Two-thirds of patients with acute hypoxemia experienced a decline in functional status by at least one grade after discharge.
- Good functional status and progressive cancer were significantly associated with functional decline.
- In-hospital mortality and the need for intubation were both 8% among the studied patients.

## Abstract

What are the main findings?
Significant functional deterioration occurs in the majority of patients after hospital admission due to acute hypoxemia;Patients with acute hypoxemia are usually elderly and the leading underlying diseases are infections, COPD exacerbation and congestive heart failure;

Significant functional deterioration occurs in the majority of patients after hospital admission due to acute hypoxemia;

Patients with acute hypoxemia are usually elderly and the leading underlying diseases are infections, COPD exacerbation and congestive heart failure;

What is the implication of the main finding?
In a planned randomized controlled trial to study permissive hypoxemia, there should be an upper age limit and patients with metastatic malignancy should be excluded.

In a planned randomized controlled trial to study permissive hypoxemia, there should be an upper age limit and patients with metastatic malignancy should be excluded.

Background: Many hospitalized patients decline in functional status after discharge, but functional decline in emergency admissions with hypoxemia is unknown. The primary aim of this study was to study functional outcomes as a clinical endpoint in a cohort of patients with acute hypoxemia. Methods: A multicenter prospective observational study was conducted in patients with new-onset hypoxemia emergently admitted to two respiratory departments at a university hospital and an academic teaching hospital. Using the WHO scale, the patients’ functional status 4 weeks before admission and at hospital discharge was assessed. The type and duration of oxygen therapy, hospital length of stay and survival and risk of hypercapnic failure were recorded. Results: A total of 151 patients with a median age of 74 were included. Two-thirds declined in functional status by at least one grade at discharge. A good functional status (OR 4.849 (95% CI 2.209–10.647)) and progressive cancer (OR 6.079 (1.197–30.881)) were more associated with functional decline. Most patients were treated with conventional oxygen therapy (n = 95, 62%). The rates of in-hospital mortality and need for intubation were both 8%. Conclusions: Patients with acute hypoxemia in the emergency room have a poorer functional status after hospital discharge. This decline may be of multifactorial origin.