Principles, Utility and Limitations of Pulse Oximetry in Management of COVID-19
Pulse oximetry is an essential component of the standard care of COVID-19 patients. In the context of the spreading COVID-19 pandemic for which no targeted therapy or vaccines are yet available, early identification of the severe cases or cases with high risk of severe disease and appropriate supportive treatment are of paramount importance to save lives. Pulse oximetry is a cheap, fast, easy to use, noninvasive, painless and accurate tool that allows real-time monitoring of hypoxemia. As the primary target of the disease is the respiratory system pulse oximetry provides an unparalleled way to assess the severity of the disease, guide supportive therapies and monitor the clinical status and response to treatment with greater benefits in the low-resource settings. All settings from the quarantine facilities at the ground level to the ICUs in the highest level hospitals can utilize it to achieve their goals. To get the best of this tool, it needs to be used properly and the findings interpreted carefully. Role of basic understanding of the physiological principles and technology behind its use and awareness of its limitations cannot be overemphasized. The pulse oximetry readings are interpreted in the context of blood hemoglobin concentration, tissue perfusion, arterial blood carbon dioxide concentration and oxygen supplementation status.
OpenWHO. Geneva: World Health Organisation; c2016-2020. WHO Clinical Care Severe Acute Respiratory Infection Training. OpenWHO. Available from: https://openwho.org/courses/severe-acute-respiratory-infection Accessed on 2020 May 14.
Hall JE. Guyton and Hall Textbook of Medical Physiology. 13th ed. New Delhi: Reed Elsiever India; 2015.
Collins J-A, Rudenski A, Gibson J, et al. Relating oxygen partial pressure, saturation and content: the haemoglobin-oxygen dissociation curve. Breathe Sheff Engl. 2015;11(3):194– 201. PMID: 26632351 DOI: https//doi.org/10.1183/20734735.001415
Pascarella G, Strumia A, Piliego C, et al. COVID-19 Diagnosis and Management: A Comprehensive Review. J Intern Med. 2020; [Epub ahead of print]. PMID: 32348588 DOI: https://doi.org/10.1111/joim.13091
Geng Y-J, Wei Z-Y, Qian H-Y, Huang J, Lodato R, Castriotta RJ. Pathophysiological characteristics and therapeutic approaches for pulmonary injury and cardiovascular complications of coronavirus disease 2019. Cardiovasc Pathol. 2020;47:107228. PMID: 32375085 PMCID: PMC7162778 DOI: https://doi.org/10.1111/joim.13091
Kowalik MM, Trzonkowski P, Łasińska- Kowara M, Mital A, Smiatacz T, Jaguszewski M. COVID-19 - toward a comprehensive understanding of the disease. Cardiol J. 2020;27(2):99-114. DOI: https://doi.org/10.5603/CJ.a2020.0065
Shi Y, Wang G, Cai XP, et al. An overview of COVID-19. J Zhejiang Univ Sci B. 2020;21(5):343‐360. PMID: 32425000 PMCID: PMC7205601 DOI: https://dx.doi.org/10.1631/jzus.B2000083
Wilcox SR. Management of respiratory failure due to covid-19. BMJ. 2020;369. DOI: https://doi.org/10.1136/bmj.m1786
Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D. COVID-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2020;201(10):1299–300. DOI: https//doi.org/10.1164/rccm.202003-0817LE
Dondorp AM, Hayat M, Aryal D, Beane A, Schultz MJ. Respiratory Support in Novel Coronavirus Disease (COVID-19) Patients, with a Focus on Resource-Limited Settings. Am J Trop Med Hyg. 2020; [Epub ahead of print]. PMID: 32319424 DOI: https://doi.org/10.4269/ajtmh.20-0283
World Health Organisation. Critical preparedness, readiness and response actions for COVID-19. Available from: https://www.who.int/publications-detail/critical-preparedness-readiness-and-response-actions-for-covid-19. Accessed 2020 May 31.
World Health Organisation. Clinical care for severe acute respiratory infection: toolkit. COVID-19 adaptation. Geneva: World Health Organization; 2020 (WHO/2019- nCoV/SARI_ toolkit/2020.1). Available from: https://apps.who.int/iris/handle/10665/331736 Accessed 2020 May 14.
Pretto JJ, Roebuck T, Beckert L, et al. Clinical use of pulse oximetry: official guidelines from the Thoracic Society of Australia and New Zealand. Respirology. 2014;19(1):38–46. PMID: 24251722 DOI: https//doi.org/10.1111/resp.12204
Nepal Medical Council, COVID-19 Treatment Guidance Committee. Interim clinical guidance for care of patients with COVID-19 in health care settings. Kathmandu: Nepal Medical Council; 2020 April 3. 30p. Available from: https://nmc.org.np/files/4/NMC%20COVID-19%20Interim%20Clinical%20Guideline%20for%20care%203%20April.pdf Accessed 2020 May 9.
Sinex JE. Pulse oximetry: principles and limitations. Am J Emerg Med. 1999;17(1):59– 67. DOI: https://doi.org/10.1016/S0735-6757(99)90019-0
Mannheimer PD. The light-tissue interaction of pulse oximetry. Anesth Analg. 2007;105(6 Suppl):S10-17. DOI: https//doi.org/10.1213/01.ane.0000269522.84942.54
Nitzan M, Romem A, Koppel R. Pulse oximetry: fundamentals and technology update. Med Devices Auckl NZ. 2014;7:231–9. DOI: http://dx.doi.org/10.2147/MDER.S47319
World Health Organisation. Pulse Oximetry Training Manual [Internet]. Geneva: World Health Organisation; 2011. Available from: https://www.who.int/patientsafety/safesurgery/pulse_oximetry/who_ps_pulse_oxymetry_ training_manual_en.pdf. Accessed on 12 May, 2020.
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