Why it is important to have a pulse oximeter at home: the difference in some cases between life and death

Patients with COVID-19 who do not need immediate hospital care but are at high risk of developing severe symptoms should be given pulse oximeters for use at home to reduce the risk of severe impairment.

NHS England, the British National Health Service, has purchased around 200,000 pulse oximeters for the scheme, which will be available to clinical groups across England.

The initiative will roll out across the country over the next six weeks and is led by Matthew Inada-Kim, National Clinical Lead for Impairment at NHS England and Acute and General Medicine Consultant in Hampshire Hospitals NHS Foundation Trust.

Since the start of the pandemic, the entity has warned that medical intervention is necessary if oxygen saturation levels begin to drop. But during the first wave it became clear that some patients developed silent hypoxia, in which desaturation occurred, but did not show obvious symptoms, such as shortness of breath or feeling very ill. These patients tended to require invasive respiratory support and had poor outcomes.

Monitoring without hospitalization

Nigel Watson, chief executive of Wessex Local Medical Committees, which is expected to be one of the first areas to implement the home monitoring scheme, said: “the evidence now It was pretty strong that if oxygen saturation fell to 94% or 93% the risk of mortality rose to about 13%, and if it fell below that level, the risk rose to about 28%.”

The idea is to create “virtual COVID wards” for patients at risk, such as people over 65 or under 65 with a chronic condition, and to monitor the oxygen saturation through patients taking readings and relating them to their health teams. “If it starts to go down and particularly gets to 94%, then possibly some action will be taken, which may include the patient being admitted to the hospital,” Watson explained.

Pilot areas have used various arrangements to monitor patients. In North Hampshire, a group of general practices recruited two specialist nurses to run the service, while in Southampton the local GPs federation ran the service. On the Isle of Wight, the service was run by the local hospital. “They have different management models, but essentially the path is the same,” Watson said.

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Rob Barnett, chairman of Liverpool's Local Medical Committee, confirmed that in his area health officials were working on how "virtual COVID rooms" could be implemented to ensure patients are admitted to hospital "before their levels have dropped too low to make recovery nearly impossible, but he noted that this would put more strain on the hospital system.

“As we monitor more patients in the community, we'll know what the tipping point is for them to come into the hospital, which is probably sooner than we could if we weren't monitoring them at all,” he said. So the recovery will be better, but I actually think that inadvertently means we're going to have even more patients in the hospital.”

According to Infobae in this note, a pulse oximeter is a small device that looks like a kind of clothespin but larger. You can put it on your finger comfortably (most require the fingernail to be facing up) and in a few seconds lights with numbers indicate your oxygen level in the body and your heart rate. Most healthy people will have an oxygen reading between 95 and 98 percent. Some people with existing conditions may have a lower normal reading. You should contact your doctor if the number drops below 92 percent or below.

The device will also display your heart rate. The normal heart rate for an adult at rest is between 60 and 100 beats per minute, although athletes with more cardiovascular conditioning will have a lower pulse rate.

When you stick your finger into a pulse oximeter, it emits different wavelengths of light through your finger (you don't feel anything). It is looking for hemoglobin, a protein molecule in the blood that carries oxygen. Hemoglobin absorbs different amounts and wavelengths of light depending on the level of oxygen it is carrying. Your pulse oximeter will display a numerical reading: a percentage that indicates the oxygen saturation level in your blood. If you've seen a doctor in the last twenty years, you've used a pulse oximeter.

The device works better with warm hands than with cold hands. Also, since oxygen levels can fluctuate, consider taking measurements several times a day. Also try it in different positions: for example, lying down or walking.

Most healthcare technicians will place the device on the index fingers, but a study of 37 volunteers revealed that the highest readings came from the middle finger of the dominant hand. The closest second was the dominant thumb. Therefore, if you are right-handed, use the middle finger of your right hand. If you're left-handed, use the middle finger of your left hand. The difference between the fingers is small, so if you prefer the index finger, that's fine.

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