Pulse Oximetry is Essential in Home Management of Elderly COVID-19 Patients

Abstract

<jats:p>Background: Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) is in Pandemic form and has affected people of 215 countries. It produces symptoms like fever, cough, shortness of breath, sore throat, headache, loss of taste, smell or appetite and many other rare symptoms. But the most important symptom is shortness of breath due to hypoxia. In a normal individual oxygen saturation (SpO2) is at least 95% and patient feels shortness of breath when SpO2 falls below 90% with some exception. SARS-CoV-2, a newly emergent coronavirus has the peculiarity to produce silent hypoxia, meaning SpO2&lt; 90% or less like 80%, 70%, 60% without shortness of breath. Silent hypoxia can be diagnosed by monitoring SpO2 with pulse oximeter. For management of COVID-19, early symptoms like fever &amp; cough, SpO2 should be monitored by pulse oximeter, followed by immediate correction of hypoxia by O2 supplementation and prophylactic oral or injectable anticoagulant to prevent thromboembolism and thus death rate can be reduced.&#x0D; Case summary: A 72-year-old man presented with the complaints of fever and headache followed by cough, fatigue, anorexia, loss of taste and appetite in next few days but no shortness of breath. The patient was clinically diagnosed as a case of COVID-19 &amp; positive result of Real time-Polymerase Chain Reaction (RT-PCR) test confirmed the diagnosis. From the first day, SpO2 was regularly monitored with pulse oximeter and SpO2 on day 1, it was 96-98%. On day 8, SpO2 fell to 89-93%, pulse 96/min, respiratory rate&gt;30/min, temperature 101o F, taste sensation was reduced. According to sign and symptoms, the patient was diagnosed as COVID-19 with severe pneumonia. Management was started at home with continuous monitoring, lying in prone position for 5-6 hours/day, supplemental oxygenation to maintain level of SpO2 between 94-96%, injectable anticoagulant enoxaparin to prevent venous thromboembolism (VTE) and disseminated intravascular coagulation (DIC) was given. Prophylactic antibiotics and symptomatic treatment were also given.&#x0D; Results: According to this case report, patient’s SpO2 was monitored by pulse oximeter on first day; on day 08, SpO2 fell to 89-93% &amp; on day 10, further dropped to 85-88% which indicated severe pneumonia but there was no complaint of breathlessness as it was silent hypoxia. Sometimes the patient spent 30 minutes or more in toilet and SpO2 used to fall to 82-83% without any subjective shortness of breath but with only mild heaviness of chest and cough. Therefore SpO2 monitoring by pulse oximeter is essential in early diagnosis of silent hypoxia. Correction of hypoxia by supplemental oxygenation and prevention of VTE and DIC by using anticoagulant was the mainstay of treatment and patient had significant improvement on day 14. The patient was managed completely at home except X-ray being done in a hospital.&#x0D; Conclusion: Fall of SpO2 in COVID-19 i.e. hypoxia (usually present as shortness of breath) or silent hypoxia can be diagnosed early by pulse oximeter or smart phone pulse oximetry apps. Early management by isolation, supplemental oxygenation and oral/injectable anticoagulation can prevent further events like Acute Respiratory Distress Syndrome (ARDS), respiratory failure followed by multiple organ failure (that may cause death). The authors advocate further clinical trial and research.&#x0D; Bangladesh J Otorhinolaryngol; April 2020; 26(1): 55-67</jats:p>

IoT-Based Smart Health Monitoring System for COVID-19 Patients

“…However, the pulse rate for COVID-19 patients is abnormal and requires aid from an emergency medical assistant. The internal heat level of an individual depends on various factors, such as surrounding temperature, gender, and dietary pattern, and the temperature ranges between 97.8 °F (36.5 °C) and 99 °F (37.2 °C) in healthy adults [9][10][11]. Various factors, such as influenza, low-temperature hypothermia, and other diseases, may prompt a fluctuation in body temperature.…”

Silent hypoxia in COVID-19: pathomechanism and possible management strategy

“…However, normal hypoxia-induced dyspnoea does not evoke a stronger and excessive volume like hypercapnia does [ 17 ]. This might be the reason for COVID-19 patients not showing any sign of distress even during the low oxygen saturation level [ 10 ]; (ii) the virus having an impact on the brain and nervous system; altering the mechanisms in our brain responsible for regulating respiration[ 10 ]; (iii) the virus having an effect on blood vessels and causing “lack of hypoxic vasoconstriction” [ 7 ]; (iv) undergoing hyper-fusion within a lung that has already gone through respiratory damage [ 11 ]; (v) fever caused by COVID-19 having a role in silent hypoxia [ 12 ], although there is not enough evidence to support this theory (Fig. 2 ).…”

“…(ii) the virus having an impact on the brain and nervous system; altering the mechanisms in our brain responsible for regulating respiration [10]; (iii) the virus having an effect on blood vessels and causing "lack of hypoxic vasoconstriction" [7]; (iv) undergoing hyper-fusion within a lung that has already gone through respiratory damage [11]; (v) fever caused by COVID-19 having a role in silent hypoxia [12], although there is not enough evidence to support this theory (Fig. 2).…”

“…Silent hypoxia is defined as a condition where an individual has alarmingly lower oxygen saturation level than anticipated (~ 50-80% saturation, while the anticipated saturation level is 95% or higher), however, the individual does not experience any breathing difficulty [8]. Normally, an increased respiratory rate (tachypnoea) is seen in normal hypoxic patients, but it is not typically found in patients with silent hypoxia [9][10][11][12][13][14][15]. Several reports revealed that the prevalence of silent hypoxia in COVID-19 patients ranges from 20 to 40% [10,[16][17][18].…”

Peripheral oxygen measurements in suspected elderly COVID-19 patients can be an effective tool for alerting physicians

“…This disease produces different symptoms including fever, cough, headache, loss of taste, smell or appetite, shortness of breath, amongst others. One of the most important symptoms is shortness of breath due to hypoxia 2 .…”