Early Discharge, Outpatient Evaluation, and Home Management of Acute Respiratory Failure from COVID-19 in Martinique

Abstract

A worldwide pandemic of viral infection due to SARS-CoV-2 (and its resultant disease, COVID-19) has been ongoing since 2019. Martinique was affected by a major wave in summer 2021, with saturation of the health system forcing the implementation of home care management. We conducted a retrospective, observational study that included patients treated in the KOVIDHOM 972 program. We included adult patients with SARS-CoV2 hypoxemic pneumonia and requiring 4 L per minute or less of oxygen. In total, 418 were discharged to home with oxygen therapy after hospitalization for SARS-CoV-2 hypoxemic acute pneumonia, and 416 were analyzed. Half (50.2%) were women. Mean age was 58.8 ± 13.0 years. Time from onset of symptoms to hospitalization was 9.1 ± 3.5 days, and average length of stay was 10.5 ± 7.4 days. Maximum oxygen flow during hospitalization was 6.9 ± 4.5 L/min in patients who did not require intensive care. Average oxygen flow at discharge was 1.8 ± 07 L/min. At 30 days after discharge, the readmission rate was 0.5% (95% CI: 0–1.18), and the death rate was 0.5% (95% CI 0–1.18). Our study shows a very low rate of readmission or death in COVID-19 patients discharged to home with oxygen therapy. These results highlight the possibility of safe home care in carefully selected patients. Such programs could be useful in pandemic or wide-scale emergency situations.

Effects of a Discourse Intervention on End-of-Life Knowledge and Attitudes of Bachelor of Science in Nursing Students

“…discourse, end of life, end-of-life education, nursing education, nursing student A pproximately 80% of all deaths in the United States occur in hospitals and nursing homes, 1 where patients and families receive end-of-life (EOL) care. Although health care is generally provided by an interdisciplinary team, nurses spend significantly more time at the patient's bedside 2,3 and have a primary role in supporting dying patients and their families at this difficult time. The role of nurses in EOL care focuses on patient-and family-centered care assisting in establishing realistic goals, decision making, optimizing comfort, and facilitating an understanding of the dying process for patients and families.…”