From the Trenches to the Hospitals at Home: Physiologists, Clinicians and Oxygen Therapy, 1914–30

Oxygen therapy consists on administering oxygen at a higher concentration than that found in the air in order to treat problems due to respiratory failure. When the oxygen therapy treatment is not necessary to administer in the hospital, within a hospital admission, it can be prescribed for the patient to receive at home, referred to as continuous home oxygen therapy. This type of therapy has great advantages for patients and their families because it allows them to stay together longer. But there are also important difficulties to be taken into account that have to do with the handling of the devices that are used for the administration of oxygen, as well as the compliance or not of the time prescribed by the health professional.

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The unusual experience of managing a severe COVID-19 case at home: what can we do and where do we go?

BMC Infectious Diseases ◽

10.1186/s12879-020-05608-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ivan Chérrez-Ojeda ◽

Emanuel Vanegas ◽

Miguel Felix

Keyword(s):

Ct Scan ◽

Oxygen Therapy ◽

Clinical Decision Making ◽

Health Care Systems ◽

Severe Disease ◽

Clinical Decision ◽

Ambulatory Setting ◽

Medical Attention ◽

Treatment Standard ◽

At Home

Abstract Background The speed and reach of the COVID-19 pandemic has created special scenarios to be considered, such as those in where patients who meet criteria for hospitalization due to moderate/severe disease cannot be hospitalized due to economic constraints and saturation of national health systems. The aim of this report is to present an unusual case of a severe COVID-19 patient managed at home in a developing country, and to discuss some of the available guidelines and potential therapeutic options for this type of cases. Case presentation A 60-year-old female seeking medical attention through teleconsultation presents with profound dyspnea, oppressive chest pain, fatigue, episodic hallucinations, and difficulty sleeping, for what she originally sought medical attention at an ER but could not be admitted due to saturation of the health system. A positive PCR test for COVID-19, and a CT scan of the chest showing bilateral consolidations with ground-glass opacities confirmed the diagnosis. The patient was managed at home, with corticosteroids, nitazoxanide and a single dose of 40 mg of subcutaneous enoxaparin. Colchicine was added at the third day of treatment. Standard oxygen therapy through nasal cannula was also recommended. Daily follow-ups were established to monitor for signs of clinical improvement. Two weeks later from the initial consultation the patient presents marked improvement in her symptoms, as well as in her CT scan, which prompted in discontinuation of the medications and the oxygen therapy. Conclusions There are several limitations in this report regarding the clinical data and the management, but such limitations do also reflect the state of emergency and the chaos that resides in the health care systems of developing nations. For the ambulatory care of COVID-19 patients, several aspects of disease management may differ from current guidelines and basic requirements may represent a huge challenge to cover. Further research is needed to assist physicians in the daily clinical decision making, to optimize patient outcomes, and to reduce the probability of adverse scenarios of patients with COVID-19 managed in the ambulatory setting.

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The adequacy of oxygenation in COPD parients undergoing long-term oxygen therapy assessed by pulse oximetry at home

European Respiratory Journal ◽

10.1183/09031936.94.07020274 ◽

1994 ◽

Vol 7 (2) ◽

pp. 274-278 ◽

Cited By ~ 35

Author(s):

P. Śliwiński ◽

M. Łagosz ◽

D. Górecka ◽

J. Zieliński

Keyword(s):

Pulse Oximetry ◽

Oxygen Therapy ◽

Long Term Oxygen Therapy ◽

At Home

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Home Management of Patients with Moderate or Severe Respiratory Failure Secondary to COVID-19, Using Remote Monitoring and Oxygen with or without HFNC

Pathogens ◽

10.3390/pathogens10040413 ◽

2021 ◽

Vol 10 (4) ◽

pp. 413

Author(s):

Anna Annunziata ◽

Antonietta Coppola ◽

Novella Carannante ◽

Francesca Simioli ◽

Maurizia Lanza ◽

...

Keyword(s):

Respiratory Failure ◽

Clinical Experience ◽

Oxygen Therapy ◽

High Flow ◽

Nasal Cannula ◽

Home Treatment ◽

Severe Respiratory Failure ◽

High Flow Nasal Cannula ◽

Lung Failure ◽

At Home

Background: Home treatment of patients affected by COVID-19 is still a matter of daily debate. During the clinical evolution of the disease, there are high risks of lung failure, which requires oxygen therapy. Here, we report our clinical experience with at-home treatment using high-flow nasal cannula in non-hospitalised patients with confirmed COVID-19. Patients and methods: In this study, 18 patients with moderate-to-severe respiratory failure secondary to COVID-19 were monitored at home daily for temperature and SpO2 measurements. Other parameters such as saturation of peripheral oxygen (SpO2), SpO2/FiO2 (fraction of inspired oxygen), temperature, and lung performance were monitored periodically. Depending on oxygen requirements, the patients also received either standard oxygen via a face mask or, if higher FiO2 required, high-flow nasal cannula (HFNC). Results: All 18 patients had favourable outcomes and recovered from COVID-19. No death was recorded in this group. Conclusion: Our clinical experience proves that high-flow nasal cannula oxygen therapy may be considered for at-home treatment of COVID-19 patients with moderate lung failure. This could be useful for further treatment during the pandemic and may also be considered in future epidemics.

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