COVID, home pulse-ox and resp. symptoms

Q: Which of the following is a more reliable sign in COVID-19 patients to evaluate for possible inpatient admission? (select one)

A) Progressive dyspnea and respiratory symptoms

B) Low pulse-ox reading on mobile phone app

Answer: A

As expected, there is a little resurgence in COVID-19 cases with 'flu season' this year. Since the pandemic, the purchase/use of pulse-oximetry machines or measuring oxygen saturation via mobile phone applications has become immensely popular. Despite all such popularity, there is no substantial evidence that they help decrease mortality. Instead, they can be of more psychological distress, costly workups, and ER visits. 

In COVID-19 patients, dyspnea may not correlate with the degree of hypoxia in many patients. Low oximetry levels should be considered with the patient's clinical signs and symptoms. Significantly dyspneic patients may have normal saturation, and completely asymptomatic patients may have low pulse-ox saturation. Also, pulse-ox readings can be very misleading in patients with dark-colored skin, nail polish, or any underlying systemic or dermal disease.

Normal pulse-ox has no guarantee that respiratory status will not deteriorate!

#pulmonary

#COVID-19

References:

1. Lee KC, Morgan AU, Chaiyachati KH, et al. Pulse Oximetry for Monitoring Patients with Covid-19 at Home - A Pragmatic, Randomized Trial. N Engl J Med 2022; 386:1857.

2. Fawzy A, Wu TD, Wang K, et al. Racial and Ethnic Discrepancy in Pulse Oximetry and Delayed Identification of Treatment Eligibility Among Patients With COVID-19. JAMA Intern Med 2022; 182:730.

3. Modi A, Kiroukas R, Scott JB. Accuracy of smartphone pulse oximeters in patients visiting an outpatient pulmonary function lab for a 6-minute walk test. Respir Care 2019; 64.