A study of 1,095 patients hospitalized with COVID-19 found that two easily measurable health signs — respiration rate and blood-oxygen saturation — are clearly predictive of higher mortality. In particular, according to the authors, anyone who receives a positive screening test for COVID-19 can easily monitor these two signs at home.
This context is missing current orientation of the Centers for Disease Control and Prevention, which tells people with COVID-19 to search medical care when they experience obvious symptoms such as “breathing problems” and “persistent pain or pressure in the chest” —indications that may be absent even when breathing and blood oxygen they have reached dangerous levels, the authors say.
“These findings apply to the lived experience of most patients with COVID-19: being at home, feeling anxious, wondering how your illness will progress, and wondering when it makes sense to go to the hospital, ”said Dr. Neal Chatterjee of the University School of Medicine. of Washington.
Chatterjee and her cardiologist, Dra. Ninth Sotoodehnia, were co-authors of the paper, which would be published May 24 in the journal Influenza and other respiratory viruses.
They said the findings suggest that for some people with COVID-19, by the time they feel bad enough to come to the hospital, a window may have passed for early medical intervention.
“Initially, most patients with COVID have no difficulty breathing. They may have fairly low oxygen saturation and still be asymptomatic,” Sotoodehnia said. “If patients follow current guidelines, as they may not be short of breath until their blood oxygen is low enough, then we are missing out on the opportunity to intervene early with a life-saving treatment.”
The researchers examined the cases of 1,095 patients aged 18 and over who were admitted with COVID-19 to UW Medicine hospitals in Seattle or Rush University Medical Center in Chicago. The study period was from March 1 to June 8, 2020. Exclusive exclusions were people who chose “comfort measures only” at the time of admission.
Although patients frequently had hypoxemia (low blood oxygen saturation; 91% or less for this study) or tachypnea (rapid, shallow breathing; 23 breaths per minute for this study), few reported that they had shortness of breath or cough regardless of blood oxygen.
The main measure of the study was hospital mortality for all causes. Overall, 197 patients died at the hospital. Compared to normal blood oxygen intake, hypoxemic patients had a 1.8 to 4.0-fold higher risk of mortality, depending on the patient’s blood oxygen levels. Similarly, compared to patients admitted with normal respiratory rates, those with tachypnea had a 1.9 to 3.2-fold higher risk of mortality. On the contrary, others clinical signs on admission, including temperature, heart rate, and blood pressure, were not associated with mortality.
“We give supplemental oxygen to patients to maintain blood oxygen saturation of 92% to 96%. It is important to note that only patients with supplemental oxygen benefit from the life-saving effects of glucocorticoids,” Sotoodehnia said. . “On average, our hypoxemic patients had an oxygen saturation of 91% when they were admitted to the hospital, so a large number of them were already well below where we would have administered rescue measures. them, attention was delayed. “
The findings are relevant to family medicine professionals and virtual care providers, who are usually first-line clinical contacts for people who have received a positive COVID-19 test result and want to control for significant symptoms.
“It is recommended that CDC and [World Health Organization] “Think about recasting your guidelines to take into account this population of asymptomatic people who really deserve admission and hospital care,” Chatterjee said. “But people don’t walk away knowing the guidelines of the WHO and the CDC; we get that guidance from our doctors and news. “
Sotoodehnia recommended that people with positive COVID-19 test results, especially those with a higher risk of adverse effects due to old age or obesity, buy or borrow a pulse oximeter and monitor blood oxygen below 92%. Clip-shaped devices fit at your fingertips and can be purchased for less than $ 20.
“An even simpler measure is respiratory rate: how many breaths you breathe in a minute. Ask a friend or family member to watch you for a minute while you’re not paying attention to your breathing, and if you do 23 breaths per minute, you will need to contact your doctor, ”he said.
Influenza and other respiratory viruses, DOI: 10.1111 / irv.12869
University of Washington School of Medicine
Citation: Mortality from COVID-19 associated with 2 easily measurable signs at home (2021, May 24) recovered on May 24, 2021 at https://medicalxpress.com/news/2021-05-covid-mortality-easily-home .html
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