Short term home oxygen therapy COVID-19 patients: The COVID-HOT algorithm

Abstract

Innovative solutions are required to effectively address the unprecedented surge of demand on our healthcare systems created by the COVID-19 pandemic. Home treatment and monitoring of patients who are asymptomatic or mildly symptomatic can be readily implemented to ameliorate the health system burden while maintaining safety and effectiveness of care. Such endeavor requires careful triage and coordination, telemedicine and technology support, workforce and education, as well as robust infrastructure. In the understandable paucity of evidence-based, protocolized approaches toward HOT for COVID-19 patients, our group has created the current document based on the cumulative experience of members of the Joint ACAIM-WACEM COVID-19 Clinical Management Taskforce. Utilizing available evidence-based resources and extensive front-line experience, the authors have suggested a pragmatic pathway for providing safe and effective home oxygen therapy in the community setting.

Course of recovery in COVID-19 patients with pre-existing post Koch’s sequelae

“…He performed 14 repetitions of 1 Minute sit to stand test (1MSTS) which falls below normal range which is 25-37 reps/min for men above 24 years of age [13]. Roth score strongly correlates with severity as determined by hypoxia [14]. His total duration was 8 seconds and highest count was 25 indicating saturation above 95% on 8 th day after admission which it was.…”

Colchicine, aspirin, and montelukast – A case of successful combined pharmacotherapy for adult multisystem inflammatory syndrome in COVID-19

“…Hypoxia is another factor responsible for the development of CRS, and it needs to be proactively identified and aggressively treated in COVID-19 patients along the entire care continuum, including both prehospital/ambulatory and early hospitalization stages. [ 6 24 25 ]…”

Community distribution of oxygen: a unique COVID-19 intervention

“…In patients with mild fluctuations/instability in oxygen saturation (SpO 2 ), short-term oxygen therapy can be considered [9]. Using open wards (community centres or home-based settings), devices which can be readily moved for delivering oxygen (portable oxygen concentrators, compressed gas cylinders, portable continuous positive airway pressure (CPAP) machine, pulse oximeters) may prove beneficial [6] especially for patients that show normal compliance amidst hypoxemia (mild and moderate illness) as it ensures that these low priority patients have access to oxygen therapy.…”

“…Clinical information can as such be supplied by the patient or direct caregiver. Parameters that should be prioritized in facilitating the decision-making process for COVID-19 management will include: SpO 2 (< 93%); heart rate (<45 beats/min or >120 beats/min); temperature (<35°C or >38°C); respiratory rate (<12 breaths/min or >20 breaths/min) [9].…”

“…To ensure efficiency of this system, a group of physicians and health care professionals with various specialties in critical care and emergency medicine should be responsible for determining patient progression and need for escalation rather than a standalone healthcare practitioner [9]. These professionals will be aggregated at the central point.…”