Oxygen and mortality in COVID-19 pneumonia: a comparative analysis of supplemental oxygen policies and health outcomes across 26 countries

Goyal, Daniel

doi:10.1101/2020.07.03.20145763

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…Emerging international evidence has indicated that lower thresholds for oxygen saturation, are associated with worse patient outcomes 2 32 . In the case of our review, even though some authors argued that pulse oximetry identified the need for hospitalisation when using a cut-off of 92% 16 , we could not reach conclusions in relation to patient safety and the degree to which remote home monitoring models can conclusively identify cases of deterioration at an earlier stage in the disease trajectory.…”

Section: Discussionmentioning

confidence: 99%

“…Delays in the presentation of patients with COVID-19 has led to patients arriving as emergencies with very low oxygen saturations, often without accompanying breathlessness ('silent hypoxia') 1 . These delayed presentations of severe COVID-19 led to extended hospital admissions for patients, often requiring invasive treatment and potential admission to intensive care units (ICU) or death 2 . Remote home monitoring models (sometimes referred to as 'virtual wards') have been established to: 1) avoid unnecessary hospital admissions (appropriate care at the appropriate place), and 2) escalate cases of deterioration at an earlier stage to avoid invasive ventilation and ICU admission 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Remote home monitoring models (sometimes referred to as 'virtual wards') have been established to: 1) avoid unnecessary hospital admissions (appropriate care at the appropriate place), and 2) escalate cases of deterioration at an earlier stage to avoid invasive ventilation and ICU admission 3 . Some of these models have integrated the use of pulse oximetry to monitor oxygen levels and identify and treat cases of 'silent hypoxia' 2 .…”

Section: Introductionmentioning

confidence: 99%

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Remote home monitoring (virtual wards) during the COVID-19 pandemic: a systematic review

Vindrola‐Padros

et al. 2020

Preprint

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Objectives: The aim of this review was to analyse the implementation and impact of remote home monitoring models (virtual wards) during COVID-19, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. Design: The review was designed as a rapid systematic review to capture an evolving evidence base. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Setting: The review included models led by primary and secondary care across seven countries. Participants: 17 examples of models were included in the review. Main outcome measures: Impact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality. Results: The aim of the models was to maintain patients safe in the right setting. Most models were led by secondary care and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. Models based on phone calls were considered more inclusive. Patient/carer training was identified as a determining factor of success. We could not reach conclusions regarding patient safety and the identification of early deterioration due to lack of standardised reporting and missing data. Economic analysis was not reported beyond how the resources were used. Conclusions: Future research should focus on staff and patient experiences of care and inequalities in patients access to care. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators and the use of risk-stratification tools. Protocol registration: The review protocol was published on PROSPERO (CRD: 42020202888).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Remote home monitoring (virtual wards) during the COVID-19 pandemic: a systematic review

Vindrola‐Padros

et al. 2020

Preprint

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“…Delays in the presentation of patients with COVID-19 has led to patients arriving in acute care emergency departments with very low oxygen saturations, often without accompanying breathlessness ('silent hypoxia') [1]. As a result, many patients have been admitted with an advanced course of the disease, requiring extended hospital length of stays, invasive treatment, potential admission to Intensive Care Units (ICU) and death [2]. Remote home monitoring models (sometimes referred to as 'virtual wards'), using pulse oximetery and other measurements (i.e.…”

Section: Introductionmentioning

confidence: 99%

The implementation of remote home monitoring models during the COVID-19 pandemic in England

et al. 2021

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Background There is a paucity of evidence for the implementation of remote home monitoring for COVID-19 infection. The aims of this study were to identify the key characteristics of remote home monitoring models for COVID-19 infection, explore the experiences of staff implementing these models, understand the use of data for monitoring progress against outcomes, and document variability in staffing and resource allocation. Methods This was a multi-site mixed methods study conducted between July and August 2020 that combined qualitative and quantitative approaches to analyse the implementation and impact of remote home monitoring models developed during the first wave of the COVID-19 pandemic in England. The study combined interviews ( n = 22) with staff delivering these models across eight sites in England with the collection and analysis of data on staffing models and resource allocation. Findings The models varied in relation to the healthcare settings and mechanisms used for patient triage, monitoring and escalation. Implementation was embedded in existing staff workloads and budgets. Good communication within clinical teams, culturally-appropriate information for patients/carers and the combination of multiple approaches for patient monitoring (app and paper-based) were considered facilitators in implementation. The mean cost per monitored patient varied from £400 to £553, depending on the model. Interpretation It is necessary to provide the means for evaluating the effectiveness of these models, for example, by establishing comparator data. Future research should also focus on the sustainability of the models and patient experience (considering the extent to which some of the models exacerbate existing inequalities in access to care).

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“…Oxygen is an essential aspect of treatment for patients with COVID-19 pneumonia. Indeed, the major mechanism for injury and death in COVID-19 is related to hypoxia (14).…”

Section: General Characteristics and Clinical Presentationsmentioning

confidence: 99%

Evaluation of the renin-angiotensin-aldosterone system and neuroendocrine stress axis in COVID-19 suspicious outpatients tested for SARS-CoV2 RT-PCR referred to 16-hour comprehensive health centers in Abadan County: A cross-sectional case-control study

Naghashpour¹,

Adelipour

Mobarak³

et al. 2021

Preprint

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RAAS could play a substantial role in the pathophysiology of COVID-19. Also, the dynamics of the HPA axis may have changed in COVID-19. So, we aimed to assess RAAS and the HPA axis in COVID-19 suspicious outpatients referred to 16-hour comprehensive health centers in Abadan. Demographic and clinical data were collected. Serum cortisol and aldosterone measurements and blood grouping were done. Clinical symptoms of the positive PCR group were followed up on for four weeks. SPO2 was significantly lower in the positive PCR group, but the respiratory rate was significantly higher (P= 0.03 and P=0.001, respectively). Outpatients with the O blood group showed higher levels of cortisol in comparison to those with A and AB blood groups (P= 0.003 and P= 0.03 respectively) in the positive PCR group. Negative PCR individuals with the AB blood type had significantly higher levels of cortisol compared with those who had A (P= 0.02) and O (P=0.03) blood types. We saw significantly higher levels of aldosterone in males of the negative PCR group in comparison with females (P= 0.05). Cortisol (OR= 0.937, P= 0.033) and aldosterone (OR= 1.005, P= 0.020) levels had a decreasing and increasing effect on the chances of respiratory symptoms occurring over time, respectively. Also, over time, women were twice as likely as men to develop neurologic symptoms (OR= 0.530, P= 0.015). Cortisol and aldosterone are associated with the chance of respiratory symptoms occurring over time. However, the levels of these two markers do not seem to be related to the lower grades of COVID-19.

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Oxygen and mortality in COVID-19 pneumonia: a comparative analysis of supplemental oxygen policies and health outcomes across 26 countries

Cited by 6 publications

References 19 publications

Remote home monitoring (virtual wards) during the COVID-19 pandemic: a systematic review

Remote home monitoring (virtual wards) during the COVID-19 pandemic: a systematic review

The implementation of remote home monitoring models during the COVID-19 pandemic in England

Evaluation of the renin-angiotensin-aldosterone system and neuroendocrine stress axis in COVID-19 suspicious outpatients tested for SARS-CoV2 RT-PCR referred to 16-hour comprehensive health centers in Abadan County: A cross-sectional case-control study

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