COVID-19: Pulse oximeters in the spotlight
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EDITORIAL
COVID‑19: Pulse oximeters in the spotlight Frederic Michard1 · Kirk Shelley2 · Erwan L’Her3 Received: 23 May 2020 / Accepted: 17 June 2020 © Springer Nature B.V. 2020
Abstract From home to intensive care units, innovations in pulse oximetry are susceptible to improve the monitoring and management of patients developing acute respiratory failure, and particularly those with the coronavirus disease 2019 (COVID-19). They include self-monitoring of oxygen saturation (SpO2) from home, continuous wireless SpO2 monitoring on hospital wards, and the integration of SpO2 as the input variable for closed-loop oxygen administration systems. The analysis of the pulse oximetry waveform may help to quantify respiratory efforts and prevent intubation delays. Tracking changes in the peripheral perfusion index during a preload-modifying maneuver may be useful to predict preload responsiveness and rationalize fluid therapy.
1 Introduction Pulse oximetry was developed in the 1970′s to monitor oxygen saturation (SpO2) during anesthesia, and, its inventor, Takuo Aoyagi, sadly passed away on April 18, 2020 at age 84. Although there is no strong evidence that monitoring SpO2 improves outcome in surgical patients [1], pulse oximetry is today a mainstay of perioperative monitoring. It is also widely used in intensive care units (ICU) and emergency departments. In the era of evidence-based medicine, no one is actually questioning its use and clinical value. After all, parachutes have not been scientifically proven to be lifesaving [2] and yet common sense prevails. In this article we describe recent innovations in pulse oximetry that could be useful in coronavirus disease 2019 (COVID-19) patients.
2 Self‑monitoring of oxygen saturation from home Although pulse oximeters have been miniaturized and have become wireless and affordable, they—unlike thermometers—are not yet found in our home medicine cabinet. However, during this pandemic, home pulse oximetry could be very useful in detecting patients requiring oxygen and hospitalization. An initiative led by Peter Pronovost from Cleveland University Hospitals is currently going on for COVID-19 outpatients. This program promotes the use of a finger disposable wireless sensor enabling continuous SpO2 monitoring at home. A dedicated command center receives measurements and alerts via the patient’s smartphone. Self-monitoring with miniaturized medical grade pulse oximeters—easily purchased on the web—may be a useful alternative.
3 Continuous monitoring of oxygen saturation on hospital wards
* Frederic Michard [email protected] 1
MiCo, Chemin de Chapallaz 4, Denens, Switzerland
2
Professor Emeritus, Department of Anesthesiology, Yale University, New Haven, CT, USA
3
Intensive Care Medicine, University Hospital of Brest, La Cavale Blanche, Brest, France
The recent surge of hospitalized COVID-19 patients created both material and healthcare worker shortages, raising concerns regarding patient safety. Wireless and wearable sensors are now available to m
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