Home monitoring by pulse oximetry of primary care patients with COVID-19: a pilot randomised controlled trial.

BACKGROUND: Pulse oximetry as a home or remote monitoring tool accelerated during the pandemic for patients with COVID-19, but evidence on its use is lacking. AIM: To assess the feasibility of home monitoring by pulse oximetry of patients aged ≥40 years with cardiovascular comorbidity and moderate-to-severe COVID-19. DESIGN AND SETTING: A primary care-based, open, pilot randomised controlled trial, with nested process evaluation, was undertaken in the Netherlands. METHOD: From November 2020 to June 2021, eligible patients presenting to one of 14 participating Dutch general practices were randomly allocated to regular measurement of peripheral oxygen saturation (at least three SpO2 measurements per day for 14 days) with a validated pulse oximeter or usual care. RESULTS: All 41 participants (21 intervention, 20 usual care) completed the 45-day follow-up period. Overall, the intervention group performed 97.6% of protocolised measurements; the median daily measurement per participant was 2.7 (interquartile range 1-4). Hypoxemia (SpO2 <94%) was reported in 10 participants (in 52 measurements); of those, six consulted the GP as instructed. Participants reported a high feeling of safety (0-100 visual analogue scale): 71.8 for the intervention group versus 59.8 for the control (P = 0.09). Primary care consultations were similar across groups: 50 for the intervention versus 51 for the control. Eleven visits by 10 participants were made to the emergency department (eight from the intervention group versus three from usual care), of which six participants were hospitalised (five intervention versus one usual care). No participants were admitted to the intensive care unit or died during follow-up. CONCLUSION: Home monitoring of patients with moderate-to-severe COVID-19 by pulse oximetry appeared feasible; adherence was high, patients reported a high feeling of safety, while the number of primary care consultations remained similar to usual care.

COVID-19 and dysnatremia: A comparison between COVID-19 and non-COVID-19 respiratory illness.

OBJECTIVE: To investigate the occurrence of disorders of water and sodium balance in COVID-19 in our clinic. METHODS: In this retrospective chart review, patients were included if a polymerase chain test result for SARS-CoV-2 was obtained and if at least one plasma sodium concentration measurement was obtained during the period from March to June 2020. The occurrences of hyponatremia and hypernatremia were compared between 193 SARS-CoV-2-positive and 138 SARS-CoV-2-negative patients. A χ² test was used to determine statistical significance, and the corresponding p-values were calculated. RESULTS: Hypernatremia was significantly more frequently observed in COVID-19 patients, in 38% (74 of 193), versus only 8% in SARS-CoV-2-negative patients (11 of 138) (p < 0.01). Hyponatremia was observed in 34% of the included COVID-19 patients (65 of 193) versus 24% of SARS-CoV-2-negative patients (33 of 138). In 12% of all COVID-19 patients (23 of 193), both hyponatremia and hypernatremia were observed at some point during their admission. Among the non-COVID-19 patients, only 4% showed these plasma sodium concentration fluctuations (5 of 138). The mortality rate among the hospitalized COVID-19 patients was 23% (45 of 193). Correcting for double-counting, more than 71% (32 of 45) of the deceased COVID-19 patients developed dysnatremia (hyponatremia, hypernatremia or both) versus 57% (84 out of 148) of the surviving COVID-19 patients. CONCLUSION: Disorders of water and sodium balance-and especially hypernatremia-seem to be a common occurrence in COVID-19 patients. This has important implications for the treatment of COVID-19 patients.