Home Pulse Oximetry Could Be Game Changer, Says ER Doc

The ALA’s Hill is more dubious about its utility. “Pulse oximetry in the outpatient setting may identify patients who are deteriorating sooner,” he commented. “Certainly in patients with comorbidities such as cardiac or cerebrovascular disease, it may be beneficial to have them come to medical attention sooner and receive supplemental oxygen.”

However, Hill added, “I would suspect that the majority of patients who deteriorate with COVID-19 are deteriorating due to progression of their viral disease and systemic inflammatory response rather than silent hypoxemia causing them to increase their respiration and induce lung injury.”

Much about COVID-19 is still unknown, he said, and “sudden deterioration in patients could be due to direct cardiac injury, increased clotting with cardiac, pulmonary, or CNS effects rather than progressive silent hypoxemia.”

Nevertheless, Hill concedes that “pulse oximeters are relatively inexpensive (if available),” and providing them to patients with suspected COVID-19 for monitoring “would likely have little downside.”

He noted, though, that detecting mild hypoxemia and tachycardia in patients who would otherwise do fine “could add to provider workload and potentially ER visits.”

Patients would also need to be trained on proper use, ie, “no nail polish or artificial nails, making sure their hands are warm when checking oximetry,” he added.

Another emergency physician, Jeremy Samuel Faust, MD, from Brigham and Women’s Hospital in Boston, who describes Levitan as “a great doc and a friend,” says he also has some concerns about the public’s reaction.

“While I think some pulse oximetry for patients with a known diagnosis of SARS-CoV-2 makes sense, I don’t support half the country buying these devices now on a ‘just in case’ basis,” he told Medscape Medical News. “My concern is that people who don’t have the virus are buying these in droves now. Like so many things, there will be shortages, and this will affect the people that actually have legitimate use for these devices.”

Sales of pulse oximeters spiked very early in the COVID-19 crisis, according to a report in Quartz, with a more than 500% increase already in mid-January.

In addition, Faust added that “as with any home medical equipment, there’s always the concern of over-triage. There is indeed such a thing as checking your numbers too often. Transient and spurious readings can lead to unnecessary fear, and this can send patients to clinics and emergency departments unnecessarily.”