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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
You have diagnosed an 11 year old boy who has a PMH of mild intermittent asthma with COVID (he has been symptomatic with fever, vomiting, cough, and myalgias for 2 days). Currently, his RR is 20, SaO2 98% on room air, and his lungs are clear to auscultation. He has home albuterol MDI with spacer available. You discharge him with a portable pulse oximeter. For what persistent SaO2 would you tell the parent to bring him back to the ED?
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February 28, 2021 at 11:38 pm
There are no set guidelines for when a COVID patient should seek medical care based on home pulse oximetry. The American Thoracic Society did publish an article (https://pubmed.ncbi.nlm.nih.gov/32521167/) on potential pitfalls and practical guidance for home pulse oximetry monitoring in COVID patients. They recommend “pocket” oximeters that have information about pulse strength rather than those without, or smart phone applications. Measurements should be indoors, at rest, with quiet breathing, use the index or middle finger, observed 30-60 seconds to find the most common value, and associated with a strong pulse signal. Rather than a specific cutoff, they recommend trending values to look for a downward trend, although they also note that any cutoffs used should be adjusted for higher elevation geographical locations.