Studies have shown that abnormal blood oxygen levels and respiratory rates are powerful predictors of poor prognosis in hospital patients.
A study of 1,095 patients hospitalized with COVID-19 found that two easily measurable health signs, respiratory rate and blood oxygen saturation, clearly predict higher mortality. The author said it is worth noting that anyone who receives a positive COVID-19 screening test can easily monitor these two signs at home.
The Centers for Disease Control and Prevention currently lacks this background. The guidelines tell COVID-19 patients to seek medical help when they have obvious symptoms such as “dyspnea” and “continuous chest pain or pressure”-the authors of the indications group said that even if they breathe And blood oxygen reaches dangerous levels, it may not exist.
“These findings apply to the life experiences of most COVID-19 patients: being at home, feeling anxious, wondering how to know if their disease will progress, and wondering when it makes sense to go to the hospital,” said the doctor. Neil Chatterjee of the University of Washington School of Medicine.
Chatterjee and cardiologist Dr. Nona Sotoodehnia are the co-lead authors of the paper, which will be published today (May 24, 2021) in the journal Influenza and Other Respiratory Viruses.
They said the research results indicate that for some COVID-19 patients, when they come to the hospital feeling very bad, the window for early medical intervention may have passed.
“Initially, most COVID patients did not have difficulty breathing. Their oxygen saturation may be low, but they still have no symptoms,” Sotoodehnia said. “If patients follow current guidance because they may not be short of breath before blood oxygen is very low, then we miss the opportunity to intervene in life-saving treatment early.”
Researchers examined 1,095 patients 18 years and older who were admitted to the University of Washington School of Medicine in Seattle or Rush University Medical Center in Chicago for COVID-19. The research period is from March 1st to June 8th, 2020. The only exception is those who choose to “take comfort measures only” on admission.
Although patients often experience hypoxemia (low blood oxygen saturation; 91% or less in this study) or shortness of breath (rapid, shallow breathing; 23 breaths per minute in this study), few people report that regardless of blood Feel short of breath or cough regardless of oxygen.
The main measure of the study is all-cause hospital mortality. A total of 197 patients died in the hospital. Compared with patients with normoxia, the risk of death in patients with hypoxemia is 1.8 to 4.0 times higher, depending on the patient’s blood oxygen level. Similarly, patients with shortness of breath have a 1.9 to 3.2 times higher risk of death compared with patients with a normal respiratory rate. In contrast, other clinical signs at admission, including body temperature, heart rate, and blood pressure, are not related to mortality.
Almost all patients with hypoxemia and shortness of breath need supplemental oxygen. When used in conjunction with glucocorticoids that reduce inflammation, it can effectively treat acute cases of COVID-19.
“We supplement patients with oxygen to maintain blood oxygen saturation between 92% and 96%. It is important to note that only patients with supplemental oxygen can benefit from the life-saving effects of glucocorticoids,” Sotoodehnia said. “On average, our hypoxemia patients have an oxygen saturation of 91% when they are admitted to the hospital, so the blood oxygen saturation of a large number of patients is far below the level of life-saving measures we have taken. For them, this This kind of care has been postponed.”
These findings are relevant to family medicine practitioners and virtual care providers, who are usually first-line clinical contacts of people who have tested positive for COVID-19 and want to monitor for meaningful symptoms.
Chatterjee said: “We recommend that the CDC and [World Health Organization] consider reformulating their guidelines to take into account these asymptomatic people who are actually worthy of hospitalization and care.” “But people don’t move around and learn about WHO and Guidelines from the Centers for Disease Control and Prevention; we got this guidance from our doctors and news reports.”
Sotoodehnia recommends that people who test positive for COVID-19, especially those who are at higher risk of adverse consequences due to advanced age or obesity, buy or borrow a pulse oximeter and monitor blood oxygen levels below 92%. A clip-like device can be placed on your fingertips for less than $20.
“A simpler measure is the breathing rate-how many times do you breathe in a minute. If you are not paying attention to your breathing, let a friend or family member monitor you for one minute. If you breathe 23 times per minute, you should contact Your doctor,” she said.
Reference: Neal A. Chatterjee, Paul N. Jensen, Andrew W. Harris, Daniel D. Nguyen, Henry D. Huang, Richard K. Cheng, Jainy J. Savla, Timothy “Admission Respiratory Status Predicting COVID-19 Mortality “R. Larsen, Joanne Michelle D. Gomez, Jeanne M. Du-Fay-de-Lavallaz, Rozenn N. Lemaitre, Barbara McKnight, Sina A. Gharib and Nona Sotoodehnia, May 24, 2021, Influenza and other respiratory viruses . DOI: 110.11 /irv.12869
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