CME INDIA Presentation by Dr. Rajeev Jayadevan, MD, DNB, MRCP, ABIM (Med) ABIM (Gastro), NY. Vice Chairman, Kerala state IMA Research Cell. Member, National IMA Task Force on Corona Epidemic, Cochin.

Pulse Oximeter – Covid-19 – Quick Take Away

• Pulse oximetry at home did not improve patient outcomes in a randomised trial.
• Telemedicine monitoring was good enough, finds this US study, NEJM April 6.
• The groups were age matched, <50% were >50 years.
• Death was the primary outcome.

What Dr. M. Kit Delgado, MD, MS narrates?

Courtesy: M. Kit Delgado, MD, MS@kit_delgadoMDER doc, epi prof @PennNudgeUnit

This is why randomised trials are important

• We often believe that some interventions are effective, when they are really not.
• The study was done during the first wave, which means people did not have the protection of vaccine and were relatively unlikely to have natural immunity from prior infection.
• They included over 600 people in each group, there were a total of 8 deaths. One can argue the sample size is not very large, but it is still a very good (and difficult) study to execute, and was adequately powered.
• The downside of having a Pulse Oximeter was that it prompted more phone calls – it must have caused needless anxiety for those being monitored at home.

This also ADDED to the workload of the telemedicine unit.

• This could be significant, especially in resource constrained settings, when more time is wasted to evaluate and counsel each of these instances.
• Think of it like repeated false fire alarms disrupting regular office work and that of the fire force (when there is no ‘real fire’ 🔥) .

One important message

• It was not a comparison between Pulse Oximeter and no monitoring.
• Both groups were diligently monitored by trained and qualified personnel by telemedicine.
• Therein lies the difference.
• The real message is that well-administered telemedicine is good enough, and such monitoring was sufficient to pick out those who needed to be at hospital, while keeping the rest at home.

Having a pulse Oximeter at home (in addition to telemedicine) did not change outcomes.

• In the post vaccination era, (and protection from natural immunity by prior infection), fewer people will likely be getting severe disease (unless new variants with unusual biological properties emerge).
• Thus, the role of pulse Oximeter will perhaps be even less.

Bottom line

• It might seem like a good thing, but it did not make a difference.

CME INDIA Learning Points

• Among patients with Covid-19, the addition of home pulse oximetry to remote monitoring may not result in a greater number of days alive and out of the hospital than subjective assessments of dyspnoea alone.
• Using a pulse oximeter to measure oxygen levels appears no better than just regularly asking patients with COVID-19 if they are short of breath, according to new research at the Perelman School of Medicine of the University of Pennsylvania.
• We are aware of the stories when patients were referred in panic due to false readings of pulse oximeters.
• Early in the pandemic, there was a prevalent theory that oxygen levels in the blood dropped before a COVID-19 patient became symptomatic and short of breath (Happy Hypoxia).
• So, detecting this earlier with a home pulse oximeter might provide an opportunity to get patients who are on the cusp of deteriorating to the hospital faster and initiate time-sensitive therapies to improve outcomes.
• More than 2,000 patients enrolled in COVID Watch between Nov. 29, 2020, and Feb. 5, 2021, were randomized to receive standard COVID Watch care or the same program with the addition of a pulse oximeter in this very important study.
• Clearly, we have got an answer that the pulse oximeter does not make the patients any better off.

CME INDIA Tail Piece

• A low-tech approach for remote monitoring systems based on symptoms is just as good as a more expensive one using additional devices.
• “Automated text messaging is a great way for health systems to enable a small team of on-call nurses to manage large populations of patients with COVID-19 and there are a lot of other medical conditions where the same kind of approach might really help.”  – Krisda Chaiyachati, MD, an assistant professor of Internal Medicine and now the physician lead for Value-based Care and Innovation at Verily.

References:

1. https://www.nejm.org/doi/full/10.1056/NEJMc2201541?query=featured_home

Discover CME INDIA

• Explore CME INDIA Repository
• Examine CME INDIA Case Study
• Read History Today in Medicine
• Register for Future CMEs

Get CME INDIA Highlights

Curated articles in your inbox.

SUBSCRIBE!

You have Successfully Subscribed!